[Acute polyneuropathies in a hospital in the south of Spain: ten years' experience]. / Polineuropatias agudas en un hospital del sur de España: diez años de experiencia.

INTRODUCTION: Guillain-Barre syndrome is the most frequent cause of acute flaccid paralysis in children. AIM: To describe the characteristics of patients diagnosed with acute polyneuropathies and their long-term progress. PATIENTS AND METHODS: We conducted a retrospective descriptive analysis of children under 14 years of age admitted to our hospital between January 2004 and December 2014. Clinical, demographic and neurophysiological variables were collected together with other imaging tests. RESULTS: Twenty-six patients, with a mean age of 3.83 years, were diagnosed with acute polyneuropathies, four of them of Moroccan origin. Twenty of them (76%) had a history of previous infection. The mean time elapsed since the onset of the symptoms until admission to hospital was 9.2 days, and from admission until beginning with gamma globulins it was 1.6 days. The clinical signs and symptoms prior to diagnosis were of a very heterogeneous nature. They all presented muscular weakness; 90% displayed areflexia; and 30% showed involvement of the cranial nerves. All of them (100%) received intravenous gamma globulins, and 38.4% were given systemic corticosteroids. Two patients presented chronification of the pathology. There was no mortality in the series. CONCLUSIONS: The patients included in our study presented very unspecific symptoms in the early phases, which initially led to alternative diagnoses. To avoid this delay in the diagnosis, it is essential to perform an exhaustive physical examination that includes the myotatic reflexes and to maintain a high level of suspicion of the disease even with normal results in the complementary tests if they are performed at an early stage. We detected a greater number of cases of axonal polyneuropathy, which can possibly be explained by the high number of patients of Moroccan origin who were treated.

TITLE: Polineuropatias agudas en un hospital del sur de España: diez años de experiencia.Introduccion. El sindrome de Guillain-Barre es la causa mas frecuente de paralisis flacida aguda en niños. Objetivo. Describir caracteristicas de los pacientes diagnosticados de polineuropatias agudas y su evolucion a largo plazo. Pacientes y metodos. Analisis descriptivo retrospectivo de los menores de 14 años ingresados en nuestro hospital entre enero de 2004 y diciembre de 2014. Se recogieron variables clinicas, demograficas, neurofisiologicas y otras pruebas de imagen. Resultados. Veintiseis pacientes, con una mediana de edad de 3,83 años, fueron diagnosticados de polineuropatias agudas, cuatro de ellos de origen marroqui. Veinte (76%) tenian antecedentes de infeccion previa. El tiempo medio desde el inicio de los sintomas hasta su ingreso fue de 9,2 dias y, desde este hasta el inicio de gammaglobulinas, de 1,6 dias. La sintomatologia que precedio al diagnostico fue de caracter muy heterogeneo. Todos presentaron debilidad muscular; el 90%, arreflexia; y el 30%, afectacion de los pares craneales. El 100% recibio gammaglobulinas intravenosas, y el 38,4%, corticoides sistemicos. Presentaron cronificacion de la patologia dos pacientes. No hubo mortalidad en la serie. Conclusiones. Los pacientes incluidos en nuestro estudio presentaron en fases tempranas sintomas muy inespecificos que llevaron a diagnosticos alternativos iniciales; para evitar este retraso diagnostico, resulta fundamental realizar una exhaustiva exploracion fisica que incluya los reflejos osteotendinosos y mantener un alto indice de sospecha de la enfermedad aun con normalidad en las pruebas complementarias si estas son precoces. Detectamos un mayor numero de polineuropatia axonal, posiblemente explicado por el elevado numero de pacientes atendidos de origen marroqui.

[Epileptic spasms without hypsarrhythmia. A new case report and review of the literature]. / Espasmos epilepticos sin hipsarritmia. Aportacion de un nuevo caso y revision de la bibliografia.

INTRODUCTION: The term 'epileptic spasm' must be used to refer to a type of seizure that is typically found in childhood. Clinically, it is expressed as brief axial contractions, in flexion, extension or mixed, which can be symmetrical or asymmetrical and usually appear in clusters. The best-known epileptic syndrome associated with the appearance of grouped spasms is West's syndrome. They may also appear in other generalised epilepsies, epilepsies with periodic spasms or even seizures that are similar to grouped spasms in certain partial epilepsies. CASE REPORT: A 6-month-old girl with paroxysmal episodes of cluster spasms, for whom no pattern of hypsarrhythmia was observed in the electroencephalogram. The physical examination, neuroimaging and metabolic studies did not offer any pathological findings of interest. The psychomotor development of the patient prior to the onset of the seizures was normal. Following treatment with several different antiepileptic drug regimes, finally control over the seizures was accomplished with a combination of valproic acid and vigabatrine. CONCLUSIONS: There are cases like this, with cluster spasms, which fall within the age bracket at which West's syndrome typically occurs and which, nevertheless, do not present the electroencephalographic characteristics of hypsarrhythmia (neither typical nor atypical) or neuropsychological impairment. In these patients it is not clear whether we are dealing with a variant related with West's syndrome or not, since two of the three criteria required for its diagnosis are not fulfilled.

Características clinicoepidemiológicas de los enfermos con tuberculosis en un área sanitaria de Málaga / Epidemiological and clinical characteristics of tuberculosis a population area of Malaga

OBJETIVOS: Estudiar las características clínico epidemiológicas mediante la búsqueda de los casos diagnosticados de tuberculosis en un Área Sanitaria perteneciente a un Hospital de Tercer Nivel del sur de España. MÉTODOS: Se realizó un estudio descriptivo y retrospectivo de los casos de enfermedad tuberculosa (TBC) diagnosticados entre el 1 de Enero de 2005 y el 31 de Diciembre de 2005 en el Área de Salud dependiente del Hospital Regional Universitario Carlos Haya de Málaga. Para ello se aplicó un protocolo de recogida de datos poblacionales, clínicos y microbiológicos. RESULTADOS: Se diagnosticaron 104 casos de enfermedad tuberculosa, de los cuales, 85 pertenecían al área estudiada, siendo la incidencia de 30,04 casos por 100.000 habitantes. La edad media fue de 39,6 años. El 20,4% eran inmigrantes. La forma más frecuente de diagnóstico fue bacteriológico (64,4%). La muestra microbiológica más usada fue el esputo (78,8%). Sólo en el 57,4% de los pacientes transcurrió un período menor de treinta días para el diagnóstico desde el inicio de los síntomas. La localización predominante fue la pulmonar (85,6%). Las comorbilidades más frecuentes fueron el tabaquismo (59%) y la positividad a VIH (22%). Se realizó estudio de resistencias al 65,3% de los pacientes detectándose éstas en un5,9%. Sólo el 68,4% de los casos habían sido declarados en el Registro de Enfermedades de Declaración Obligatoria. La presentación radiológica más frecuente fue el infiltrado alveolar en lóbulos superiores. La población inmigrante tenía una edad de presentación menor (30,1 vs 42 años), así como, un menor grado de tabaquismo, EPOC y afectación pulmonar en relación a la población autóctona. CONCLUSIONES: La incidencia de TBC (..) (AU)

OBJECTIVES: To study epidemiologic and clinical characteristics of tuberculosis in a tertiary hospital from the south of Spain. METHODS: A descriptive and retrospective study was made of cases of tuberculosis diagnosed between January 1st and December 31st 2005, in a population area assigned to the University Hospital Carlos Haya, in Malaga. We collected demographic, clinical and microbiological data. RESULTS: From 104 cases of tuberculosis diagnosed, 85belonged to the studied area with an incidence of 30,04 per 100.000population. The mean age was 39,66 years. 20,4% were immigrants. The most frequent diagnosis was made on bacteriological grounds (64,4%). Only 57,5% of the patients were diagnosed within 30 days from the beginning of symptoms. The most frequent localization was pulmonary (85,6%). The most frequent comorbidities were smoking habit (59%) and HIV + (22%). Resistances were found in 5,95% out of 63,5% of patients in whom the analysis of resistances was made. Only 68,4% of cases were declared in the Obligatory Disease´s Registry. Immigrant population were younger (30,1 vs 42 years), with less smoking habit, less COPD, and less severity of pulmonary disease than the autochthonous population. CONCLUSION: The tuberculosis incidence in our population is still high with an inadmissible under-declaration and long delay in diagnosis. In our area, immigrant population present high rates of tuberculosis. HIV infection remains an important comorbidity factor (AU)

Radiografía simple de tórax (I). El patrón alveolar, intersticial y alveolointersticial. Signos radiológicos de atelectasia / No disponible

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