Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial.

The aim of the present study was to assess the impact of nasal continuous positive airway pressure (nCPAP) in ischaemic stroke patients followed for 2 yrs. Stroke patients with an apnoea-hypopnoea index ≥ 20 events·h⁻¹ were randomised to early nCPAP (n = 71; 3-6 days after stroke onset) or conventional treatment (n = 69). The Barthel Index, Canadian Scale, Rankin Scale and Short Form-36 were measured at baseline, and at 1, 3, 12 and 24 months. The percentage of patients with neurological improvement 1 month after stroke was significantly higher in the nCPAP group (Rankin scale 90.9 versus 56.3% (p < 0.01); Canadian scale 88.2 versus 72.7% (p < 0.05)). The mean time until the appearance of cardiovascular events was longer in the nCPAP group (14.9 versus 7.9 months; p = 0.044), although cardiovascular event-free survival after 24 months was similar in both groups. The cardiovascular mortality rate was 0% in the nCPAP group and 4.3% in the control group (p = 0.161). Early use of nCPAP seems to accelerate neurological recovery and to delay the appearance of cardiovascular events, although an improvement in patients' survival or quality of life was not shown.

Prevalencia de factores de riesgo cardiovascular en pacientes con síndrome de apneas-hipopneas obstructivas del sueño / Prevalence of cardiovascular risk factors in patients with obstructive sleep apnea/hypoapnea syndrome

OBJETIVO: Analizar la prevalencia de factores de riesgo cardiovascular(FRV) en pacientes con síndrome de apneas-hipopneasobstructivas del sueño (SAHOS).PACIENTES Y MÉTODO: Se incluyeron todos los pacientesdiagnosticados de SAHOS mediante estudio de sueño entre Enerode 1994 y Diciembre de 2000, analizándose los siguientes FRV:edad, sexo, hipertensión arterial (HTA), tabaquismo, obesidad,diabetes mellitus (DM), hipercolesterolemia (HCL) e hipertrigliceridemia(HTG).RESULTADOS: Se incluyeron 879 pacientes con edad media55,4±10.6 años, IAH 54,9±28,7, de los cuales 711 (80,9%) eranhombres. La prevalencia de los diferentes FRV fue la siguiente:obesidad 719 (81,8%) casos, tabaquismo 589 (67%), HTA 535(60,9%), HCL 581 (66%), HTG 191 (21,7%) y DM 312 (35,4%). Lamedia de FRV por paciente (excluyendo edad y sexo) fue de3,4±1,2, y 660 (75%) casos asociaron 3 ó más FRV. Los pacientescon IAH>30 presentaron más FRV que aquellos con IAH<30 (3,5 ±1,2 vs. 3,1 ± 1,2; p=0,02).CONCLUSIONES: Los pacientes con SAHOS presentaronuna elevada prevalencia de FRV y una tendencia acusada a la asociaciónde varios FRV en un mismo paciente. Los SAHOS gravestenían más FRV que los casos no graves

OBJECTIVE: To analyze the prevalence of cardiovascularrisk factors (CRF) in patients with obstructive sleepapnea/hypoapnea syndrome (OSHAS).PATIENTS AND METHOD: all patients diagnosed withOSHAS during a sleep study between January 1994 and December2000 were included, with the following CRF being analyzed: age,sex, arterial hypertension (AHT), smoking habits, obesity, diabetesmellitus (DM), hypercholesterolemia (HCL) and hypertriglyceridemia(HTG).RESULTS: 879 patients were included in the study, with anaverage age of 55.4±10.6 years, with an AHI (apnea/hypoapneaindex) of 54.9±28.7, of which 711 (80.9%) were men. The prevalenceof the various CRF was as follows: obesity 719 (81.8%) cases,smoking 589 (67%), AHT 535 (60.9%), HCL 581 (66%), HTG 191(21.7%) and DM 312 (35.4%). The average CRF per patient(excluding age and sex) was 3.4±1.2, and in 660 (75%) cases, therewere 3 or more associated CRF. The patients with AHI>30 presentedmore CRF than those with an AHI < 30 (3.5 ± 1.2 vs. 3.1 ±1.2; p=0.02).CONCLUSIONS: Patients with OSHAS presented anincreased prevalence of CRF and there was a marked tendency toassociate several CRF in one single patient. Serious OSHAS caseshad more CRF than the less serious cases

[Sarcoidosis following combined ribavirin and interferon therapy: a case report and review of the literature]. / Sarcoidosis tras tratamiento con interferón y ribavirina. Presentación de un caso y revisión de la bibliografía.

Treatment of active chronic viral hepatitis type C with interferon alpha has proved effective and therefore its use is being extended to a large number of patients. Common side effects include respiratory manifestations. One side effect attributable to the immunomodulatory effect of interferon is the possible triggering or exacerbation of systemic or cutaneous sarcoidosis. We report a new case and offer an exhaustive review of the literature. A 49-year-old man with type C chronic, active hepatitis developed new respiratory symptoms and pulmonary infiltrates with hilar and mediastinal adenopathy after 4 months of treatment with pegylated interferon and ribavirin. The transbronchial biopsy showed multiple sarcoid granulomas. When the patient was diagnosed, he had already taken the total dose of interferon and no specific treatment was started. His hepatitis did not respond to therapy and his viral load and transaminase levels remained high.

Sarcoidosis tras tratamiento con interferón y ribavirina. Presentación de un caso y revisión de la bibliografía / Sarcoidosis following combined ribavirin and interferon therapy: a case report and review of the literature

El tratamiento con interferón alfa en la hepatitis crónica activa por el virus C tiene una eficacia demostrada, por ello se está generalizando su uso a gran número de pacientes.Entre los efectos secundarios, las manifestaciones respiratorias banales son muy frecuentes. Un efecto secundario atribuible al efecto inmunomodulador del interferón es la posibilidad de agravar o desencadenar una sarcoidosis cutánea o sistémica. Presentamos un nuevo caso y hacemos una exhaustiva revisión de la bibliografía.Se comunica el caso de un varón de 49 años con hepatitis crónica activa por el virus C que a los 4 meses de tratamiento con interferón pegilado más ribavirina presentó sintomatología respiratoria que no tenía previamente e infiltrados pulmonares con adenopatías hiliares y mediastínicas. En la biopsia transbronquial se apreciaron abundantes granulomas sarcoideos. Cuando se diagnosticó, el paciente había finalizado toda la dosis de interferón y no se instauró ningún tratamiento específico. La hepatitis no respondió a la terapia, permaneciendo elevada la carga viral y las transaminasas (AU)

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