RESUMEN
Guillain-Barré syndrome (GBS) is the most common acute peripheral polyneuropathy in the world. The estimated incidence in Colombia is 1.2-1.7 cases per 100 000 inhabitants, although during 2016 an increase in the incidence of the disease was documented, apparently associated with an epidemiological peak of the Zika virus. We conducted to describe the clinical and neurophysiological characteristics of adult patients with GBS treated at Hospital Universitario San Ignacio, Bogota, Colombia, between 2009 and 2017. An observational, descriptive, cross-sectional study was designed.
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Síndrome de Guillain-Barré/diagnóstico , Conducción Nerviosa/fisiología , Neuralgia/etiología , Parestesia/etiología , Adulto , Anciano , Colombia , Estudios Transversales , Femenino , Síndrome de Guillain-Barré/epidemiología , Síndrome de Guillain-Barré/fisiopatología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neuralgia/epidemiología , Neuralgia/fisiopatología , Parestesia/epidemiología , Parestesia/fisiopatología , Evaluación de Síntomas , Adulto JovenRESUMEN
INTRODUCTION:: The incidence of dengue has increased throughout the 2000s with a consequent global increase in atypical clinical forms. METHODS:: This study reports a series of cases of neurological dengue out of 498 confirmed cases of laboratory dengue in Goiânia, Brazil. Cases were confirmed based on viral RNA detection via polymerase chain reaction or IgM antibody capture. RESULTS:: Neurological symptoms occurred in 5.6% of cases, including paresthesia (3.8%), encephalitis (2%), encephalopathy (1%), seizure (0.8%), meningoencephalitis (0.4%), and paresis (0.4%). DENV-3 was the predominant circulating serotype (93%). CONCLUSIONS:: We reported dengue cases with neurological manifestations in endemic area.
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Dengue/complicaciones , Encefalitis Viral/virología , Meningoencefalitis/virología , Parestesia/virología , Adolescente , Adulto , Anciano , Anticuerpos Antivirales/sangre , Brasil/epidemiología , Preescolar , Dengue/epidemiología , Virus del Dengue/genética , Virus del Dengue/inmunología , Encefalitis Viral/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Meningoencefalitis/epidemiología , Persona de Mediana Edad , Parestesia/epidemiología , Reacción en Cadena de la Polimerasa , ARN Viral/genética , Adulto JovenRESUMEN
Abstract INTRODUCTION: The incidence of dengue has increased throughout the 2000s with a consequent global increase in atypical clinical forms. METHODS: This study reports a series of cases of neurological dengue out of 498 confirmed cases of laboratory dengue in Goiânia, Brazil. Cases were confirmed based on viral RNA detection via polymerase chain reaction or IgM antibody capture. RESULTS: Neurological symptoms occurred in 5.6% of cases, including paresthesia (3.8%), encephalitis (2%), encephalopathy (1%), seizure (0.8%), meningoencephalitis (0.4%), and paresis (0.4%). DENV-3 was the predominant circulating serotype (93%). CONCLUSIONS: We reported dengue cases with neurological manifestations in endemic area.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Parestesia/virología , Ensayo de Inmunoadsorción Enzimática , Encefalitis Viral/virología , Dengue/complicaciones , Dengue/epidemiología , Meningoencefalitis/virología , Parestesia/epidemiología , Brasil/epidemiología , ARN Viral/genética , Reacción en Cadena de la Polimerasa , Encefalitis Viral/epidemiología , Virus del Dengue/genética , Virus del Dengue/inmunología , Meningoencefalitis/epidemiología , Persona de Mediana Edad , Anticuerpos Antivirales/sangreRESUMEN
BACKGROUND: Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of the patient lying down. Researchers have suggested many types of interventions to help prevent PDPH. It has been suggested that aspects such as needle tip and gauge can be modified to decrease the incidence of PDPH. OBJECTIVES: To assess the effects of needle tip design (traumatic versus atraumatic) and diameter (gauge) on the prevention of PDPH in participants who have undergone dural puncture for diagnostic or therapeutic causes. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and LILACS, as well as trial registries via the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal in September 2016. We adopted the MEDLINE strategy for searching the other databases. The search terms we used were a combination of thesaurus-based and free-text terms for both interventions (lumbar puncture in neurological, anaesthesia or myelography settings) and headache. SELECTION CRITERIA: We included randomized controlled trials (RCTs) conducted in any clinical/research setting where dural puncture had been used in participants of all ages and both genders, which compared different tip designs or diameters for prevention of PDPH DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 70 studies in the review; 66 studies with 17,067 participants were included in the quantitative analysis. An additional 18 studies are awaiting classification and 12 are ongoing. Fifteen of the 18 studies awaiting classification mainly correspond to congress summaries published before 2010, in which the available information does not allow the complete evaluation of all their risks of bias and characteristics. Our main outcome was prevention of PDPH, but we also assessed the onset of severe PDPH, headache in general and adverse events. The quality of evidence was moderate for most of the outcomes mainly due to risk of bias issues. For the analysis, we undertook three main comparisons: 1) traumatic needles versus atraumatic needles; 2) larger gauge traumatic needles versus smaller gauge traumatic needles; and 3) larger gauge atraumatic needles versus smaller gauge atraumatic needles. For each main comparison, if data were available, we performed a subgroup analysis evaluating lumbar puncture indication, age and posture.For the first comparison, the use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (36 studies, 9378 participants, risk ratio (RR) 2.14, 95% confidence interval (CI) 1.72 to 2.67, I2 = 9%).In the second comparison of traumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (one study, 658 participants, RR 6.47, 95% CI 2.55 to 16.43).In the third comparison of atraumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH.We observed no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles. Sensitivity analyses of PDPH results between traumatic and atraumatic needles omitting high risk of bias studies showed similar results regarding the benefit of atraumatic needles in the prevention of PDPH (three studies, RR 2.78, 95% CI 1.26 to 6.15; I2 = 51%). AUTHORS' CONCLUSIONS: There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.
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Agujas , Cefalea Pospunción de la Duramadre/prevención & control , Punción Espinal/efectos adversos , Dolor de Espalda/epidemiología , Dolor de Espalda/etiología , Diseño de Equipo , Cefalea/epidemiología , Cefalea/etiología , Humanos , Parestesia/epidemiología , Parestesia/etiología , Cefalea Pospunción de la Duramadre/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Sensibilidad y Especificidad , Punción Espinal/instrumentaciónRESUMEN
BACKGROUND: Outcome of lumbar disc herniation is often based on clinical scores and less frequently on the neurological examination. However, even when clinical outcome measures are favorable, patients may still experience motor or sensory impairment. OBJECTIVE: To evaluate the percentage of patients with persistent neurological deficits after lumbar disc surgery and whether these correlate with clinical outcome. METHODS: A total of 150 patients with sciatica and lumbar disc herniation with neurological impairment underwent microdiscectomy and were prospectively followed for 24 months. Patients were assessed pre- and postoperatively with neurological examination, the Oswestry Disability Index (ODI), and the visual analog scale (VAS) for pain. RESULTS: Twenty-four months after surgery, 25% of patients who presented with motor deficits, 40% of patients with sensory deficits, and 48% of patients with reflex abnormalities remained unchanged. The VAS and the ODI showed significant improvement in both patients with and without persistent neurological impairment immediately after surgical repair of the herniated disc with progressive improvement over the follow-up period. However, when calculating the area under the receiver operating characteristics curve, no statistically significant correlation could be established between the presence and persistence of neurological impairment and the 2 clinical scores. CONCLUSION: There seems to be no correlation between clinical results and neurological impairment when assessed by the VAS and ODI.
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Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Fuerza Muscular/fisiología , Parestesia/etiología , Reflejo/fisiología , Área Bajo la Curva , Evaluación de la Discapacidad , Discectomía , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Parestesia/epidemiología , Curva ROC , Resultado del TratamientoRESUMEN
OBJECTIVE: Determining the prevalence of prevention activities regarding diabetic foot recommended by doctors and carried out by out-patients attending general medicine self-care foot control and describing food habits. METHODS: This was a descriptive and cross-sectional studywhich was carried out in two health-care institutions in Bogotá, from March to October 2008, by weightedconveniencesampling of 307 diabetic patients, aged over 18 years. RESULTS: Some patients had a background of foot ulcers (13.0 %) and amputations of the lower limbs(1.6 %). Some patients referredto dysesthesia(65.5 %) and intermittent claudication (33.6 %)whilst many stated that they had received no education about foot care from their doctors(78.2 %). Many stated that the doctor had not checked their feet during the last year (76.2 %)and others that, despite presenting dysesthesia and intermittent claudication(89.0 % and 93.0 %, respectively), the patients had not been asked about these symptoms. Regarding patient activities,some did not checktheir feet each day (63.1 %), did not perform self-monitoring (93.4 %), consumed more than two sources of carbohydrateduring the main meals (38. %)and/or added sugar, "panela" or honey to preparations (38.8 %). CONCLUSIONS: The prevalence of diabetic foot prevention practices recommended by doctors and carried out by patients was poor. Interdisciplinary programmes must thus be created and strengthenedfor preventing diabetes mellitus and diabetic foot, at primary- attention out-patient level, besides providing pertinent trainingfor health teams.
Asunto(s)
Atención Ambulatoria/métodos , Pie Diabético/terapia , Cooperación del Paciente/estadística & datos numéricos , Atención Primaria de Salud/métodos , Adulto , Amputación Quirúrgica/estadística & datos numéricos , Automonitorización de la Glucosa Sanguínea/estadística & datos numéricos , Colombia/epidemiología , Estudios Transversales , Angiopatías Diabéticas/epidemiología , Pie Diabético/epidemiología , Pie Diabético/prevención & control , Pie Diabético/cirugía , Neuropatías Diabéticas/epidemiología , Conducta Alimentaria , Femenino , Humanos , Claudicación Intermitente/epidemiología , Masculino , Persona de Mediana Edad , Parestesia/epidemiología , Educación del Paciente como Asunto , Examen Físico/estadística & datos numéricos , Autoexamen/estadística & datos numéricos , Zapatos , Factores Socioeconómicos , Población UrbanaRESUMEN
Objetivo Determinar la frecuencia de actividades de prevención del pie diabético recomendadas por el médico y efectuadas por pacientes de consulta externa en medicina general, para autocuidado de los pies y describir los hábitos alimentarios. Metodología Estudio descriptivo de corte transversal, realizado en dos instituciones de salud de Bogotá, marzo-octubre 2008; muestra ponderada, por conveniencia, 307 pacientes diabéticos mayores de 18 años. Resultados Antecedente de úlceras en pies 13 por ciento, amputaciones en miembros inferiores 1,6 por ciento. Refirieron: disestesias 65,5 por ciento y claudicación intermitente 33,6 por ciento; no habían recibido educación sobre el cuidado del pie por parte del médico 78,2 por ciento. Su médico no le había examinado los pies en el último año al 76,2 por ciento; a pesar de presentar disestesias y claudicación intermitente no se indagó sobre estos síntomas al 89 por ciento y 93 por ciento de pacientes respectivamente. Actividades de pacientes: no revisaban diariamente los pies 63,1 por ciento, no realizaban automonitoreo 93,4 por ciento, consumían más de dos fuentes de carbohidratos en comidas principales 38,1 por ciento; adicionaban a las preparaciones azúcar, panela, miel de abejas 38,8 por ciento. Conclusiones La prevalencia de actividades de prevención del pie diabético recomendadas por médicos y efectuadas por pacientes fue deficiente. Es necesario crear y fortalecer programas interdisciplinarios para la prevención de la diabetes mellitus y del pie diabético a nivel primario de atención, además de formación del equipo de profesionales en salud.
Objective Determining the prevalence of prevention activities regarding diabetic foot recommended by doctors and carried out by out-patients attending general medicine self-care foot control and describing food habits. Methods This was a descriptive and cross-sectional studywhich was carried out in two health-care institutions in Bogotá, from March to October 2008, by weightedconveniencesampling of 307 diabetic patients, aged over 18 years. Results Some patients had a background of foot ulcers (13.0 percent) and amputations of the lower limbs(1.6 percent). Some patients referredto dysesthesia(65.5 percent) and intermittent claudication (33.6 percent)whilst many stated that they had received no education about foot care from their doctors(78.2 percent). Many stated that the doctor had not checked their feet during the last year (76.2 percent)and others that, despite presenting dysesthesia and intermittent claudication(89.0 percent and 93.0 percent, respectively), the patients had not been asked about these symptoms. Regarding patient activities,some did not checktheir feet each day (63.1 percent), did not perform self-monitoring (93.4 percent), consumed more than two sources of carbohydrateduring the main meals (38. percent)and/or added sugar, "panela" or honey to preparations (38.8 percent). Conclusions The prevalence of diabetic foot prevention practices recommended by doctors and carried out by patients was poor. Interdisciplinary programmes must thus be created and strengthenedfor preventing diabetes mellitus and diabetic foot, at primary- attention out-patient level, besides providing pertinent trainingfor health teams.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Ambulatoria/métodos , Pie Diabético/terapia , Cooperación del Paciente/estadística & datos numéricos , Atención Primaria de Salud/métodos , Amputación Quirúrgica/estadística & datos numéricos , Automonitorización de la Glucosa Sanguínea , Colombia/epidemiología , Estudios Transversales , Angiopatías Diabéticas/epidemiología , Pie Diabético/epidemiología , Pie Diabético/prevención & control , Pie Diabético/cirugía , Neuropatías Diabéticas/epidemiología , Conducta Alimentaria , Claudicación Intermitente/epidemiología , Parestesia/epidemiología , Educación del Paciente como Asunto , Examen Físico , Autoexamen , Zapatos , Factores Socioeconómicos , Población UrbanaRESUMEN
CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.
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Anestesia Epidural/métodos , Anestesia Raquidea/métodos , Bloqueo Nervioso/métodos , Procedimientos Ortopédicos , Anciano , Anestésicos Locales/administración & dosificación , Brasil/epidemiología , Bupivacaína/administración & dosificación , Distribución de Chi-Cuadrado , Relación Dosis-Respuesta a Droga , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Actividad Motora/efectos de los fármacos , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodos , Parestesia/epidemiología , Parestesia/etiología , Cefalea Pospunción de la Duramadre/epidemiología , Cefalea Pospunción de la Duramadre/etiología , Estudios ProspectivosRESUMEN
CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.
CONTEXTO E OBJETIVOS: Em cirurgias ortopédicas de grande porte, a raquianestesia contínua e o bloqueio combinado raqui-peridural são métodos seguros e confiáveis. Neste estudo prospectivo foram comparadas as propriedades e efeitos colaterais da raquianestesia contínua com o bloqueio combinado raqui-peridural de punção única em pacientes programados para cirurgia ortopédica de quadril, joelho e fraturas de fêmur. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, conduzido no Instituto de Anestesia Regional do Hospital de Base de São José do Rio Preto. MÉTODOS: 240 pacientes com cirurgias de quadril, artroplastia de joelho ou correção de fratura de fêmur programadas foram aleatoriamente arrolados para receberem raquianestesia contínua ou bloqueio combinado raqui-peridural (CSE). Os bloqueios foram realizados com o paciente na posição lateral no interespaço L3-L4. O sucesso das punções, dificuldades técnicas, parestesia, nível do bloqueio sensitivo e bloqueio motor, necessidade de doses complementares de anestésico local, grau de dificuldade técnica, alteração cardiociruculatória e cefaléia pós-punção foram registradas. Ao final da cirurgia, o cateter foi retirado e foi avaliado se havia refluxo de líquor. RESULTADOS: Sete pacientes foram excluídos (3 CSA e 4 CSE). Houve uma menor incidência significativa de parestesia no grupo CSA. O nível do bloqueio sensitivo foi significantemente mais alto no grupo CSE. Bloqueio motor completo ocorreu em 110 pacientes do grupo CSA e em 109 do grupo CSE. Hipotensão arterial foi observada significantemente mais freqüente no grupo CSE. Cefaléia pós-punção da dura-máter ocorreu em dois pacientes de cada grupo. CONCLUSÃO: Nossos resultados sugerem que ambas as técnicas provêm boa anestesia cirúrgica com baixa incidência de complicação. O nível do bloqueio sensitivo e as alterações hemodinâmicas foram menores com a raquianestesia contínua (CSA).
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Anestesia Epidural/métodos , Anestesia Raquidea/métodos , Bloqueo Nervioso/métodos , Procedimientos Ortopédicos , Anestésicos Locales/administración & dosificación , Brasil/epidemiología , Bupivacaína/administración & dosificación , Distribución de Chi-Cuadrado , Relación Dosis-Respuesta a Droga , Hemodinámica/efectos de los fármacos , Actividad Motora/efectos de los fármacos , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodos , Parestesia/epidemiología , Parestesia/etiología , Cefalea Pospunción de la Duramadre/epidemiología , Cefalea Pospunción de la Duramadre/etiología , Estudios ProspectivosRESUMEN
To study the reasons for referral to electrodiagnostic evaluation, 490 patients referred for electrodiagnostic evaluation to two laboratories (UNIFESP and UNEF) answered the following question: "What was the reason that brought you to look for a physician and that led him to ask this examination?" Paresthesia and/or pain were answered as the main reason by 175 of them (26% UNIFESP and 40% UNEF). The electromyographical examinations were normal in 30.8% and 35.3% and involvement of the median nerve at the wrist was detected in 5 9% and 51.5% of them. Nocturnal symptoms and paresthesia were commonly noted in both groups of patients; they, however, were not able to separate the patients with and without median nerve compression at the wrist. The question asked seems to be a useful selection instrument, to select two similar symptomatic samples of patients from two laboratories serving with very different target populations.