Learners' acceptance of a webinar for continuing medical education.

The aim of this study was to evaluate learners' acceptance of a webinar for continuing medical education that was instigated by the International Association of Oral and Maxillofacial Surgeons (IAOMS). A live, interactive webinar on orthognathic surgery was broadcast via the Internet. The learners' acceptance of the webinar was evaluated using a standardized, validated questionnaire (Student Evaluation of Educational Quality, SEEQ). One hundred and fifty-three participants attended the webinar; 55 participants (46 male, nine female) completed the questionnaire. The mean age of the respondents was 41.6±10.0years. The age of male and female respondents did not differ significantly. The respondents were spread over five continents, with the highest number from Brazil. The SEEQ showed a high level of acceptance for almost all subscales. There was no statistically significant difference between male and female respondents concerning acceptance of the webinar (P=0.614). The wide distribution of participants shows the potential for webinars as facilitators of barrier-free distribution of knowledge. The webinar was well accepted by the attendees independent of sex, specialty, and work experience. However, the sex ratio reflects the underrepresentation of women in oral and maxillofacial surgery.

Inspiratory fraction as a marker of skeletal muscle dysfunction in patients with COPD.

BACKGROUND: An inspiratory capacity to total lung capacity (IC/TLC) ratio of ≤25% has emerged as a better marker of mortality in chronic obstructive pulmonary disease (COPD) patients. The relationship among the IC/TLC ratio to lower extremity skeletal muscle function remains unknown. METHODS: Thirty-five men with moderate to severe COPD were divided into those with IC/TLC≤25% (n=16) and >25% (n=19). The subjects were tested for thigh muscle mass volume (MMT), maximal strength, power output of the lower extremities, and physical activity. RESULTS: Total MMT in the IC/TLC<25% group was significantly lower (413.91±89.42cm3) (p<0.001) than in the IC/TLC>25% group (575.20±11.76cm3). In the IC/TLC≤25% group, maximal strength of the lower extremities and muscle peak power output of the lower extremities were 36-56% lower (p<0.01) than among the patients in the IC/TLC>25% group. CONCLUSION: IC/TLC≤25% is associated with reduced maximal strength and peak power output of the lower extremities. IC/TLC≤25% may have an important clinical relevance as an index to determine peripheral muscle dysfunction.

Usefulness of rhinomanometry in the identification and treatment of patients with obstructive sleep apnoea: an algorithm for predicting the relationship between nasal resistance and continuous positive airway pressure. a retrospective study.

OBJECTIVES: We tried to assess the relationship between nasal resistance measured by rhinomanometry and the pressure used in CPAP. DESIGN: Retrospective medical case series review, January 2004 to December 2014. SETTING: Tertiary care academic medical centre. PARTICIPANTS: Thirty-eight patients (m = 56.55 years; male = 90.5%) with CPAP settings ≤8 and 39 patients (m = 57.49 years; male = 74.9%) with pressure settings ≥12. MAIN OUTCOME MEASURES: Study variables were BMI, neck circumference, Epworth Sleepiness Scale score, nasopharyngeal examination and computerised anterior active rhinomanometry, sitting and supine, in basal conditions and after intranasal administration of oxymetazoline (0.05%). Nocturnal polysomnography was performed to calculate the apnoea-hypopnoea index without and with CPAP to analyse the effectiveness of the treatment. RESULTS: BMI and resistance in supine position after vasoconstriction at 150 Pa were useful variables to predict the pressure setting that should be used. We obtained an equation to calculate the probability that a patient requires a pressure >12 cm H2 O as a function of their BMI and total nasal airflow at 150 pascal in supine position after vasoconstriction. CONCLUSIONS: Rhinomanometry is useful to predict the impact of structural nasal modifications on the positive pressure to support decision-making in relation to surgery.

[Diagnosis of tuberculosis infection]. / Diagnóstico de la infección tuberculosa.

The prevalence of tuberculosis infection varies between countries, with an estimate in adults in Spain of 25%. The technique for its diagnosis, in spite of its antiquity, is tuberculin. Even today, this test continues to be in use in the majority of countries. In recent years two methods of immunodiagnosis based on detection of IFN-g released by T cells in response to M. tuberculosis-specific antigens, enables us to diagnose the infection in a laboratory without all of the problems deriving from the administration of tuberculin. From the contact studies made it has been shown that these techniques correlate better with the degree and duration of exposure to Mycobacterium tuberculosis and that prior vaccination with BCG does not interfere with their results, which without doubt will result in a reduction in the number of unnecessary chemoprofilaxis.

[Dealing with tuberculosis in primary care. Contact tracing procedures]. / Abordaje de la tuberculosis en Atención Primaria. Estudio de contactos.

Although the number of cases of tuberculosis in Navarre has fallen in recent years, it is necessary to adapt the control programs to the new situation. The keys to advancing in its prevention and control are: obtaining an early diagnosis and an effective treatment of patients and detecting and treating people with a latent infection. Primary care plays an important role in both activities. Half of the cases of active tuberculosis that are diagnosed have been contacts by bacilliferous TB patients or else have had a high personal predisposition to developing the disease. That is why detection and treatment of the latent infection in our setting must be carried out: 1) through screening persons at high risk of becoming infected and developing the disease, and 2) trough a systematic study of contacts of persons with the disease. In the treatment of both active tuberculosis and latent infection it is essential to obtain good patient adherence.

Diagnóstico de la infección tuberculosa / Diagnosis of tuberculosis infection

La prevalencia de infección tuberculosa varía de unos países a otros, siendo la estimada en adultos en España del 25%. La técnica habitual para su diagnóstico, pese a su antigüedad, es la tuberculina. Todavía hoy, esta prueba continúa estando vigente en la mayoría de los países. En los últimos años se han desarrollado dos métodos de inmunodiagnóstico que, a través de la cuantificación in vitro del interferón-γ liberado por los linfocitos T sensibilizados, nos permiten diagnosticar en un laboratorio la infección obviando todos los problemas derivados de la administración de la tuberculina. En los estudios de contactos realizados se ha visto que estas técnicas se correlacionan mejor con el grado y duración de la exposición a Mycobacterium tuberculosis y que la vacunación previa con BCG no interfiere en sus resultados lo que sin duda alguna redundará en una reducción del número de quimioprofilaxis innecesarias

The prevalence of tuberculosis infection varies between countries, with an estimate in adults in Spain of 25%. The technique for its diagnosis, in spite of its antiquity, is tuberculin. Even today, this test continues to be in use in the majority of countries. In recent years two methods of immunodiagnosis based on detection of IFN-γ released by T cells in response to M. tuberculosis–specific antigens, enables us to diagnose the infection in a laboratory without all of the problems deriving from the administration of tuberculin. From the contact studies made it has been shown that these techniques correlate better with the degree and duration of exposure to Mycobacterium tuberculosis and that prior vaccination with BCG does not interfere with their results, which without doubt will result in a reduction in the number of unnecessary chemoprofilaxis

Abordaje de la tuberculosis en Atención Primaria. Estudio de contactos / Dealing with tuberculosis in primary care. Contact tracing procedures

Aunque el número de casos de tuberculosis en Navarra ha descendido en los últimos años, resulta necesario adaptar los programas de control a la nueva situación. Las claves para avanzar en su prevención y control son: conseguir un diagnóstico precoz y un tratamiento efectivo de los enfermos y detectar y tratar a las personas con infección latente. En ambas actividades la atención primaria juega un importante papel. La mitad de los casos de tuberculosis activa que se diagnostican han sido contactos de enfermos bacilíferos o bien tenían una elevada predisposición personal de desarrollar la enfermedad. Por ello la detección y tratamiento de la infección latente en nuestro medio se debe realizar: 1. Mediante cribado en personas con alto riesgo de infectarse y desarrollar enfermedad, y 2. Fundamentalmente en el estudio sistemático de contactos de los casos con enfermedad. En el tratamiento, tanto de la tuberculosis activa como de la infección latente, es imprescindible conseguir un buen cumplimiento del paciente

Although the number of cases of tuberculosis in Navarre has fallen in recent years, it is necessary to adapt the control programs to the new situation. The keys to advancing in its prevention and control are: obtaining an early diagnosis and an effective treatment of patients and detecting and treating people with a latent infection. Primary care plays an important role in both activities. Half of the cases of active tuberculosis that are diagnosed have been contacts by bacilliferous TB patients or else have had a high personal predisposition to developing the disease. That is why detection and treatment of the latent infection in our setting must be carried out: 1) through screening persons at high risk of becoming infected and developing the disease, and 2) trough a systematic study of contacts of persons with the disease. In the treatment of both active tuberculosis and latent infection it is essential to obtain good patient adherence

[Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)]. / Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003).

AIM: To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. METHODS: The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. RESULTS: The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. CONCLUSION: There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population.

Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003) / Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)

Objetivo. Describir los cambios en la incidencia y en el perfil epidemiológico de la tuberculosis en Navarra. Métodos. Se analizaron los casos de tuberculosis del período 1994-2003 según el sistema de enfermedades de declaración obligatoria, completado con los diagnósticos microbiológicos y con los casos captados por otros registros sanitarios.Resultados. La incidencia de tuberculosis disminuyó desde 21 por 100.000 habitantes en el quinquenio 1994-1998 hasta 16 por 100.000 en 1999-2003. En ambos períodos los casos en hombres duplicaron a los de mujeres, y la máxima incidencia se produjo en los grupos de 25 a 44 y mayores de 65 años. Los diagnósticos de tuberculosis en personas con infección por el VIH disminuyeron del 15,1 al 6,6% y los realizados en personas inmigrantes aumentaron del 2,2 al 21,3%. Algo más del 3% de los casos había recibido tratamiento antituberculoso previo y en torno al 6% presentaban resistencia a algún fármaco, sin diferencias significativas entre periodos. La proporción de tuberculosis potencialmente transmisibles (73%) no experimentó cambios significativos, ni la de aquellas con baciloscopia de esputo positiva (53%). El número de brotes (agrupaciones de dos o más casos) pasó de 18 a 26 y el porcentaje de casos secundarios a otro reciente aumentó desde 3,6 a 10,1% (p<0,001). En el período 1999-2003, la localización pulmonar se presentó de forma aislada en el 67,7% y combinada con otras localizaciones en otro 5,1%. La forma pleural aislada apareció en el 9,9% y la meníngea en el 1,5% de los pacientes.Conclusión. Se ha avanzado en el control de la tuberculosis aunque todavía la incidencia es alta respecto a otros países europeos. El control de los casos importados es uno de los retos para los próximos años, sin descuidar las medidas de control en la población autóctona

Aim. To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. Methods. The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. Results. The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. Conclusion. There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population

[Analysis and detection of fibres in the pulmonary tissue]. / Análisis y detección de fibras en tejido pulmonar.

Microscopic techniques for the analysis of fibres in pulmonary tissue and bronchovesicular washing have provided information of great interest for a better understanding of diseases related to the inhalation of asbestos. These tests serve to help in establishing an individual estimation of previous exposure to asbestos. A mineralogical analysis of the concentration of intra-pulmonary fibres can be needed on some special occasions, for example when the data obtained from the occupational history are of scarce relevance or inconclusive. For these reasons, this type of study is increasingly used in clinical work and in resolving medico-legal problems, but the complexity of some of them makes the creation of reference laboratories useful as they make methodological homogenisation possible and facilitate the comparison of results. Plueropulmonary diseases related to inhaling asbestos are considered to be of occupational type and are therefore subject to a series of legal requisites for their recognition and possible compensation. A history of exposure with a suitable latency period, together with a compatible clinical-radiological picture, can be sufficient for the diagnosis but, in certain situations, such as when the exposure data are not precise, the analysis and detection of asbestos fibres in respiratory samples or from the pulmonary tissue can be clarifying.

[Tuberculosis as an occupational disease]. / Tuberculosis como enfermedad ocupacional.

Health workers are exposed to numerous infectious diseases from which the patients they attend are suffering and that have been recognised as occupational infectious diseases. Those most frequently reported are acquired by the haematogenous path, especially hepatitis due to virus B. Numerous infectious diseases are transmitted through airways and until the coming of acute severe respiratory syndrome caused by a coronavirus, tuberculosis was one of the most dreaded. In this paper we analyse the reasons why tuberculosis is considered to be an occupational disease in health personnel; which activities entail most risk and the measures that should be adopted to reduce nosocomial transmission.

Análisis y detección de fibras en tejido pulmonar / Analysis and detection of fibres in the pulmonary tissue

Las técnicas microscópicas para el análisis defibras en tejido pulmonar y lavado broncoalveolar hanaportado información de gran interés para un mejorentendimiento de las enfermedades relacionadas conla inhalación de asbesto. Estas pruebas sirven deayuda para establecer una estimación individual de laexposición previa al amianto.Un análisis mineralógico de la concentración defibras intrapulmonares puede ser necesario en algunasocasiones especiales, como por ejemplo cuando losdatos obtenidos en la historia ocupacional sean pocorelevantes o inconclusos.Por todo ello, este tipo de estudios se utiliza cadavez más en trabajos clínicos y en la resolución de problemasmedicolegales, pero la complejidad de algunode ellos hace conveniente la creación de laboratoriosde referencia que permitan la homogeneización metodológicay faciliten la comparación de resultados.Las enfermedades pleuropulmonares relacionadascon la inhalación al asbesto son consideradas como detipo profesional y, por tanto, están sujetas a una seriede requisitos legales para su reconocimiento y posiblecompensación. Una historia de exposición con períodode latencia adecuado, junto con un cuadro clínicoradiológicocompatible, puede ser suficiente para eldiagnóstico pero, en determinadas situaciones, comopor ejemplo cuando los datos de exposición no sonprecisos, el análisis y detección de fibras de asbesto enmuestras respiratorias o de tejido pulmonar puede seraclaratorio

Microscopic techniques for the analysis of fibresin pulmonary tissue and bronchovesicular washinghave provided information of great interest for abetter understanding of diseases related to theinhalation of asbestos. These tests serve to help inestablishing an individual estimation of previousexposure to asbestos.A mineralogical analysis of the concentration ofintra-pulmonary fibres can be needed on some specialoccasions, for example when the data obtained fromthe occupational history are of scarce relevance orinconclusive.For these reasons, this type of study isincreasingly used in clinical work and in resolvingmedico-legal problems, but the complexity of some ofthem makes the creation of reference laboratoriesuseful as they make methodological homogenisationpossible and facilitate the comparison of results.Plueropulmonary diseases related to inhalingasbestos are considered to be of occupational type andare therefore subject to a series of legal requisites fortheir recognition and possible compensation. A historyof exposure with a suitable latency period, togetherwith a compatible clinical-radiological picture, can besufficient for the diagnosis but, in certain situations,such as when the exposure data are not precise, theanalysis and detection of asbestos fibres in respiratorysamples or from the pulmonary tissue can beclarifying

Tuberculosis como enfermedad ocupacional / Tuberculosis as an occupational disease

Los trabajadores sanitarios están expuestos a múltiplesenfermedades infecciosas que padecen lospacientes a los que atienden y que han sido reconocidascomo enfermedades infecciosas ocupacionales.Las declaradas con más frecuencia son las adquiridaspor vía hematógena, en especial la hepatitis por virusB. Existen múltiples enfermedades infecciosas trasmitidaspor vía aérea y hasta el advenimiento del síndromerespiratorio agudo severo ocasionado por un coronavirus,la tuberculosis era una de las más temidas. En elpresente trabajo analizaremos las causas por las que latuberculosis se considera una enfermedad ocupacionalen el personal sanitario, cuáles son las actividades conmás riesgo y las medidas que deben adoptarse paradisminuir la transmisión nosocomial

Health workers are exposed to numerousinfectious diseases from which the patients they attendare suffering and that have been recognised asoccupational infectious diseases. Those mostfrequently reported are acquired by thehaematogenous path, especially hepatitis due to virusB. Numerous infectious diseases are transmittedthrough airways and until the coming of acute severerespiratory syndrome caused by a coronavirus,tuberculosis was one of the most dreaded. In thispaper we analyse the reasons why tuberculosis isconsidered to be an occupational disease in healthpersonnel; which activities entail most risk and themeasures that should be adopted to reducenosocomial transmission

[Marking pulmonary nodules with a spiral harpoon using computerised tomography, for resection by minimally invasive surgery]. / Marcaje de nódulos pulmonares con arpón espiral mediante tomografía computarizada para su resección por cirugía mínimamente invasiva.

BACKGROUND: To show the efficacy of placing a spiral harpoon in pulmonary nodules under the control of computerised tomography for their subsequent resection by minimally invasive surgery. MATERIALS AND METHODS: Fifteen nodules of between 0.5-1.5 cm were localised in fifteen patients, of whom ten had antecedents of neoplasia, with the placement of spiral harpoon model Somatex, of 120 mm length and 18 G of Laboratorios Léleman, S.L., by means of computerised tomography, resecting them by minimally invasive surgery. RESULTS: Following the resection of the nodule it was confirmed that in the fifteen cases the harpoon was next to the nodule or encompassing it -- just as it had been placed on the scanner, in two cases objectifying a small intraparenchymatose haemorrhage and in one case a small pneumothorax. The time taken to place the harpoon oscillated between fifteen and thirty minutes. CONCLUSION: Marking a pulmonary nodule with a spiral type harpoon is a simple method that makes it possible to securely anchor the nodule for its subsequent resection by minimally invasive surgery.

Marcaje de nódulos pulmonares con arpón espiral mediante tomografía computarizada para su resección por cirugía mínimamente invasiva / Marking pulmonary nodules with a spiral harpoon using computerised tomography, for resection by minimally invasive surgery

Fundamento. Mostrar la eficacia que supone colocar un arpón espiral en nódulos pulmonares bajo control de tomografía computarizada para su posterior resección por cirugía mínimamente invasiva. Material y métodos. Se localizaron quince nódulos de 0,5-1,5 cm en quince pacientes de los cuales diez tenían antecedentes de neoplasia, con la colocación de arpón espiral modelo Somatex, de 120 mm de longitud y 18 G de Laboratorios Léleman, S.L., a través de tomografía computarizada, resecándose por cirugía mínimamente invasiva. Resultados. Tras la resección del nódulo se comprobó que en los quince casos el arpón estaba junto al nódulo o englobando al mismo -tal como se había colocado en el escáner-, objetivándose en dos casos una pequeña hemorragia intraparenquimatosa y en uno de ellos un pequeño neumotórax. El tiempo de la colocación del arpón osciló entre quince y treinta minutos. Conclusión. Marcar un nódulo pulmonar con arpón tipo espiral es un método sencillo que permite anclar con seguridad el nódulo para su posterior resección por cirugía mínimamente invasiva (AU)

Situación en Navarra del diagnóstico y tratamiento en el síndrome de apneas-hipopneas obstructivas durante el sueño / Diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome: the situation in Navarra (Spain)

OBJETIVO: Evaluar la situación del diagnóstico y tratamiento en el síndrome de apneas-hipopneas obstructivas durante el sueño (SAHS) y conocer algunas características de los pacientes tratados con presión nasal positiva continua en la vía aérea (n-CPAP) en nuestra comunidad. METODOLOGÍA: Se incluyó en el estudio a todos los pacientes que en julio de 2000 recibían tratamiento con n-CPAP a cargo del Servicio Navarro de Salud. Una enfermera realizó una visita a cada paciente en la que rellenaba un formulario con datos epidemiológicos, antropométricos y clínicos; posteriormente llevaba a cabo las siguientes exploraciones: medición del CO en el aire espirado, determinación de la presión de n-CPAP utilizada y lectura del contador horario de la n-CPAP.Entre uno y 2 meses después, y sin previo aviso, se ponía de nuevo en contacto con el usuario y se procedía a una segunda visita en la que realizaba una segunda determinación de CO en el aire espirado y nueva lectura del contador. RESULTADOS: La tasa de prevalencia de tratamientos con n-CPAP en nuestra comunidad fue de 125 por 100.000 habitantes, y se comprobó un progresivo incremento de las prescripciones anuales. Se visitó en el domicilio a 535 pacientes (el 80,7 per cent del total). El 83,5 per cent de las indicaciones fueron realizadas por neumólogos; la media de horas/día reales de utilización de n-CPAP fue de 6,1 y existió una correlación estadísticamente significativa entre las horas de uso de n-CPAP declaradas y las reales; el índice de apneas-hipopneas (IAH) medio fue de 51,5 y este índice no se determinó en el 4,2 per cent de los casos. Un 83,7 per cent de los pacientes declaraban tener una tolerancia del tratamiento muy buena o buena y el 24,8 per cent llevaba más de 4 años con esta terapia. La enfermedad asociada con el SAHS más frecuente fue la obesidad, presente en el 73,4 per cent de las personas, seguida de la hipertensión arterial en el 40 per cent; 299 enfermos (55,8 per cent) padecían dos o más enfermedades asociadas y 54 (9,7 per cent) no tenían ninguna. El 45,9 per cent de los casos disponía de polisomnografía convencional como método diagnóstico y un 49,7 per cent de poligrafía respiratoria; en el 19,4 per cent la nivelación de la presión se realizó con polisomnografía y el 32,1 per cent no disponía de ningún estudio para este fin. Un 50,8 per cent de las personas referían presentar algún efecto secundario al tratamiento. CONCLUSIONES: Elevada tasa de prevalencia de tratamientos con n-CPAP en Navarra y progresivo incremento de prescripciones. Buena tolerancia y cumplimiento de la terapia por parte de los pacientes. Disponibilidad en la mayoría de los casos de polisomnografía o poligrafía respiratoria como métodos diagnósticos de SAHS y alto porcentaje de titulaciones de n-CPAP sin haberse realizado los estudios recomendados (AU)

[Diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome: the situation in Navarra (Spain)]. / Situación en Navarra del diagnóstico y tratamiento en el síndrome de apneas-hipopneas obstructivas durante el sueño.

OBJECTIVE: To assess the diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in Navarra (Spain) and to know the characteristics of patients treated with nasal continuous positive airway pressure (n-CPAP) in our community. METHOD: All patients receiving nasal n-CPAP from the public health service of Navarra in July 2000 were enrolled. A nurse visited each patient and filled in a form with epidemiological data, and patient and clinical characteristics. The nurse then measured CO in expired air and the n-CPAP pressure used and recorded the hour counter reading on the n-CPAP device. Between one and two months later and without prior warning, the patient was once again contacted and a second visit was made. The counter was read again and expired CO was measured. RESULTS: The prevalence of treatment with n-CPAP in Navarra was 125/100,000 inhabitants, and a gradual increase in annual prescriptions was observed. Home visits were made to 535 patients (80.7% of the total). Pneumologists wrote 83.5% of the prescriptions. n-CPAP was used a mean 6.1 hours/day, and the numbers of declared and real hours of use were statistically correlated. The mean apnea-hypopnea index was 51.5, although results were not available for 4.2% of the patients. The treatment was well tolerated according to 83.7% of the patients and 24.8% had been following it for over four years. The pathology most often associated with OSAHS was obesity (73.4% of the patients), followed by high blood pressure (40%); 299 patients (55.8%) had two or more associated diseases and 54 (9.7%) had none. Conventional polysomnography was the diagnostic method used in 45.9% of the cases, and respiratory polygraphs were available for 49.7%. Pressure was adjusted with the aid of polysomnography for 19.4% patients, whereas 32.1% had undergone no testing. Side effects of treatment were reported by 50.8%. CONCLUSIONS: a) The prevalence of n-CPAP treatment in Navarra is high and prescriptions are increasing; b) patient tolerance of and compliance with therapy are good, c) polysomnographs or respiratory polygraphs are available for diagnosis of OSAHS in most cases but the n-CPAP pressure level is adjusted without the recommended studies for many patients.

Angiolymphoid hyperplasia with eosinophilia affecting the oral mucosa: report of a case and a review of the literature.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon disorder of unknown aetiology. Clinically, it is characterized by cutaneous papules or nodules on the head and neck, and extracutaneous involvement is rare. We report a 30-year-old woman who had an asymptomatic submucosal nodule on the upper lip, which histopathologically showed features of ALHE, and review the previously described 15 cases of oral ALHE.