La adherencia a los tratamientos de rehabilitación pulmonar: revisión exploratoria / Adherence to pulmonary rehabilitation: An exploratory review

En la actualidad diversos estudios han identificado una baja adherencia al tratamiento de rehabilitación pulmonar en pacientes con EPOC, a pesar de los efectos positivos que se obtienen con el tratamiento; factores como la ausencia de soporte familiar, las múltiples comorbilidades, la dificultad respiratoria, la ansiedad y la depresión afectan la adherencia de los pacientes a la rehabilitación pulmonar. Dado que no existe evidencia concluyente acerca de cuáles de estos factores son más determinantes en la adherencia a la rehabilitación pulmonar de los pacientes con EPOC, se decidió realizar esta revisión exploratoria (scoping review) con el objetivo de revisar y analizar la evidencia disponible sobre los factores que influyen en la adherencia de los pacientes con EPOC a los programas de rehabilitación pulmonar. Se realizó una búsqueda de literatura en las bases de datos Medline, Ovid, Science Direct, EMBASE, EBSCO, ISI-web of science y se definieron previamente criterios de selección que consideraran los factores que se relacionan con la asistencia y la adherencia en pacientes con EPOC en PRP. Como marco conceptual para el análisis de los resultados se utilizó el modelo de adherencia propuesto por la OMS. Como resultado significativo se encontró que los factores en la dimensión enfermedad (40%) y paciente (30%) son los que se mencionan con mayor frecuencia en los estudios, permitiendo identificar que el diseño de un programa de rehabilitación pulmonar debe tener en cuenta las necesidades específicas del paciente y su condición clínica. Se requiere un estudio que permita establecer las barreras y facilitadores de la adherencia en el medio colombiano (AU)

Currently, several studies have identified low adherence to pulmonary rehabilitation in patients with COPD, despite the positive effects of the treatment. Patient adherence to pulmonary rehabilitation is affected by factors such as the absence of family support, and the presence of multiple comorbidities, respiratory distress, anxiety and depression. Given that there is no conclusive evidence about which of these factors are most influential in determining adherence to pulmonary rehabilitation in patients with COPD, we conducted this scoping review to analyse the available evidence on the factors influencing the adherence of patients with COPD to pulmonary rehabilitation programs (PRP). A wide literature search was carried out in Medline, Ovid, Science Direct, EMBASE, EBSCO and ISI-web of science, with prior definition of the selection criteria that included the factors associated with healthcare and adherence in patients with COPD in PRP. We used the adherence model proposed by the WHO as a conceptual framework. As a significant result, we found that factors in the dimension of illness (40%) and patient (30%) were the most frequently found dimensions in the studies, revealing that the design of pulmonary rehabilitation programs must take into account the specific needs of the patient. Further studies are needed to establish barriers and facilitators of adherence among COPD patients to PRP in the Colombian setting (AU)

[Adherence to pulmonary rehabilitation: An exploratory review]. / La adherencia a los tratamientos de rehabilitación pulmonar: revisión exploratoria.

Currently, several studies have identified low adherence to pulmonary rehabilitation in patients with COPD, despite the positive effects of the treatment. Patient adherence to pulmonary rehabilitation is affected by factors such as the absence of family support, and the presence of multiple comorbidities, respiratory distress, anxiety and depression. Given that there is no conclusive evidence about which of these factors are most influential in determining adherence to pulmonary rehabilitation in patients with COPD, we conducted this scoping review to analyse the available evidence on the factors influencing the adherence of patients with COPD to pulmonary rehabilitation programs (PRP). A wide literature search was carried out in Medline, Ovid, Science Direct, EMBASE, EBSCO and ISI-web of science, with prior definition of the selection criteria that included the factors associated with healthcare and adherence in patients with COPD in PRP. We used the adherence model proposed by the WHO as a conceptual framework. As a significant result, we found that factors in the dimension of illness (40%) and patient (30%) were the most frequently found dimensions in the studies, revealing that the design of pulmonary rehabilitation programs must take into account the specific needs of the patient. Further studies are needed to establish barriers and facilitators of adherence among COPD patients to PRP in the Colombian setting.

[Mondini dysplasia: recurrent bacterial meningitis in adolescence]. / Displasia de Mondini: meningitis bacteriana recurrente en la adolescencia.

INTRODUCTION: Episodes of recurrent bacterial meningitis can occur in patients due to either congenital or acquired disorders. Congenital deformity of the bony labyrinth can be linked to a fistulous tract communicating it with the intracranial subarachnoid space. Mondini deformity is a frequent malformation in congenitally deaf patients. CASE REPORT: We report the case of an adolescent with a history of being unable to hear in one ear who, from the age of 10 years, began to suffer repeated bacterial meningoencephalitis with microbiological recovery of Streptococcus pneumoniae on three occasions. The type of germ recovered in the cerebrospinal fluid (CSF) and the history of congenital deafness that was detected when the patient was 3 years old were the diagnostic clues to the possible anomaly of the inner ear with a CSF fistula. The clinically proven CSF rhinorrhea contributed to the diagnosis of an ear anomaly with a fistula. Computerised axial tomography and magnetic resonance studies of the petrous portion of the temporal bone revealed the malformation that was later found and closed during the surgical intervention on the affected ear. The clinical absence of rhinorrhea, a year's progression without new infections after operating on the patient and post-surgery imaging studies were all proof that the fistula had closed. CONCLUSIONS: Mondini dysplasia with CSF fistula must be included as a possible diagnosis when faced with a patient with recurrent bacterial meningoencephalitis. Imaging studies, especially magnetic resonance, enable the clinician to check the diagnosis and the CSF fistula can be closed with ear surgery.

Displasia de Mondini: meningitis bacteriana recurrente en la adolescencia / Mondini dysplasia: recurrent bacterial meningitis in adolescence

Introducción. Los episodios recurrentes de meningitis bacteriana pueden presentarse en pacientes por alteraciones congénitas o adquiridas. La deformidad congénita del laberinto óseo puede asociarse con un trayecto fistuloso entre éste y el espacio subaracnoideo intracraneal. La deformidad de Mondini es una malformación frecuente en pacientes con sordera congénita. Caso clínico. Adolescente con antecedente de no oír por un oído, que a partir de los 10 años de edad comenzó a presentar meningoencefalitis bacterianas de repetición, con aislamiento microbiológico en tres ocasiones de Streptococcus pneumoniae. El tipo de germen aislado en el líquido cefalorraquídeo (LCR) y el antecedente de sordera congénita que se detectó a los 3 años de edad fueron las pistas diagnósticas de la posible anomalía del oído interno con fístula de LCR. La rinorrea de LCR que se demostró clínicamente contribuyó al diagnóstico de anomalía del oído con fístula. Los estudios de tomografía axial computarizada y resonancia magnética del peñasco evidenciaron la malformación, que luego, en el acto operatorio del oído afectado, fue posible comprobar y cerrar. La ausencia clínica de rinorrea, la evolución sin nuevas infecciones un año después de operar a la paciente y los estudios posquirúrgicos con imágenes aportaron evidencias del cierre de la fístula. Conclusión. La displasia de Mondini con fístula de LCR debe ser una posibilidad diagnóstica ante un paciente con meningoencefalitis bacteriana de repetición. Los estudios de imágenes, sobre todo la resonancia magnética, permiten comprobar el diagnóstico, y la cirugía del oído permite el cierre de la fístula de LCR (AU)

[Myasthenia gravis in infancy. A report of 12 cases]. / Miastenia grave en la infancia. Presentación de 12 casos.

INTRODUCTION: Myasthenia gravis (MG) shows specific clinical features in children. It is essential to know this and also the use of diagnostic techniques used in infancy and childhood for correct diagnosis. OBJECTIVES: To analyze the clinical behaviour of this disorder and the use of complementary tests in the diagnosis of paediatric patients. PATIENTS AND METHODS: We studied a group of 12 children diagnosed as having MG, who were admitted to the Instituto de Neurolog a y Neurocirug a de Ciudad de La Habana (Cuba) between March 1997 and June 2001. Data were obtained from the clinical histories regarding the clinical picture, anticholinesterase test, repetitive stimulation test (RST), simple fibre test (SFT), computerized axial tomography (CAT) of the mediastinum and the treatment given in each case. RESULTS: Juvenile myasthenia gravis (JMG) presented in 91% of the patients studied. The average age of onset of JMG was 7.45 years, with no difference in presentation in the two sexes. The extrinsic muscles of the eye were most affected and the form with generalized clinical involvement predominated at the time of admission. The RST was positive in four of the nine patients in whom it was done (44%) and the SFT was positive in the six cases in which it was done. No changes were found in the mediastinum on CAT scanning. Mestinon and prednisone were the most commonly used drugs. CONCLUSION: In our group JMG was the most frequent form seen. Neurophysiological studies were very useful diagnostic tools.