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Resumen El enfisema subcutáneo es el proceso por el cual el aire penetra en el espacio subcutáneo, produciendo distensión de las partes blandas. Puede ser de origen traumático, iatrogénico o producirse de forma espontánea. Es infrecuente su aparición tras procedimientos dentales y no ha sido descrito asociado a la ortopedia dentofacial. Presentamos el caso de una paciente con enfisema subcutáneo tras un traumatismo por un aparato de avance mandibular tipo Herbst.

Crohn's disease (CD) is a chronic, inflammatory disorder that can involve any part of the gastrointestinal tract, from the mouth to the anus. Although CD mainly affects the terminal ileum and colon, the involvement of the upper gastrointestinal tract rarely occurs. Diagnosis is based on clinical, endoscopic and histological features. Treatment for CD of the upper gastrointestinal tract is similar to distal CD therapy. Corticosteroids added to proton pump inhibitors are usually used. The case of a 42-year-old female patient with CD located in the oesophagus, stomach and duodenum is presented. Among the complementary tests, an endoscopic evaluation of the upper gastrointestinal tract with biopsies was essential to support CD diagnosis.

Resumen La enfermedad de Creutzfeldt-Jakob (ECJ) es la encefalopatia espongiforme transmisible mas frecuente en humanos. Se caracteriza clinicamente por una demencia rapidamente progresiva, mioclonias y ataxia. Las formas familiares son poco frecuentes (5-15% de los casos) y se presentan en ocasiones con sintomas atipicos y con un curso clinico mas prolongado que la forma esporadica. Las pruebas complementarias recomendadas ante la sospecha clinica de ECJ son la resonancia magnetica craneal, el electroencefalograma, la determinacion de la proteina 14-3-3 en liquido cefalorraquideo (LCR) y el estudio del gen de la proteina prionica (PRNP). Se expone el caso de una paciente de 54 anos que presento un trastorno depresivo prolongado asociado a un deterioro neurologico progresivo. Entre las pruebas complementarias, la elevacion de la proteina 14-3-3 en LCR y el hallazgo de la mutacion E200K en el estudio genetico fueron esenciales para llegar al diagnostico de una ECJ familiar.

Introduction and objectives To investigate the association between a patient's social network and hypertension risk in older adults in Spain and to determine whether the nature of the social network is related to a patient's awareness of hypertension, to disease treatment and control, or to adherence to hypertension drug therapy. Patients and method Cross-sectional study of 3483 subjects representative of the non-institutionalized Spanish population aged 60 years or more. Logistic regression analysis, adjusted for sex, age, educational level, lifestyle and frequency of medical consultation, was used to derive odds ratios (ORs) for associations between characteristics of the social network (e.g., marital status, cohabitation status, frequency of contact with family members, and frequency of contact with friends and neighbors) and aspects of hypertension. Results The hypertension risk in married individuals and those living with others was less than in those who were unmarried (OR=0.79; 95% confidence interval [CI] 0.67–0.94) or who lived alone (OR=0,75; 95% CI, 0.61–0.93). Men who saw their friends frequently were more likely to be aware of hypertension (OR=1.57; 95% CI, 1.19–2.07). Women who saw their friends or neighbors frequently were less likely to be aware (OR=0.70; 95% CI, 0.51–0.97). No clear relationship between social network characteristics and other hypertension-related variables was observed. Conclusions In older adults, hypertension was associated with aspects of social integration, such as marital and cohabitation status. Among hypertensives, awareness of hypertension was partly related to the frequency of contact with family and friends or neighbors.

Introduccion y objetivos. Examinar la asociacion de la red social con la hipertension arterial (HTA) y analizar si la red social esta relacionada con el conocimiento del estado hipertensivo, el tratamiento y el control de la presion arterial (PA), y el cumplimiento terapeutico en los ancianos espanoles. Pacientes y metodo. Estudio transversal realizado en 3.483 sujetos representativos de la poblacion espanola no institucionalizada = 60 anos. La asociacion de las variables de red social (estado marital, situacion de convivencia, frecuentacion de familiares y frecuentacion de amigos o vecinos) con los distintos aspectos de la HTA se resumio con las odds ratio (OR) obtenidas mediante regresion logistica, ajustadas por sexo, edad, nivel de estudios, estilos de vida y frecuencia de consulta medica. Resultados. Los individuos casados y los que vivian acompanados presentaron HTA con menos frecuencia que los no casados (OR = 0,79; intervalo de confianza (IC) del 95%, 0,67-0,94) y los que vivian solos (OR = 0,75; IC del 95%, 0,61-0,93). La probabilidad de conocer el estado hipertensivo fue mayor en los varones que veian a sus familiares con mayor frecuencia (OR = 1,57; IC del 95%, 1,19-2,07) y menor en las mujeres que veian a amigos o vecinos con mayor frecuencia (OR = 0,70; IC del 95%, 0,51-0,97). No se observo una asociacion clara entre la red social y el resto de variables relacionadas con la HTA. Conclusiones. En los ancianos, la HTA se asocia con algunas variables de integracion social, como el estado civil y la situacion de convivencia. Entre los hipertensos, el conocimiento del estado hipertensivo depende en parte de la frecuentacion de familiares y amigos o vecinos.

Resumen El penfigo vulgar es una enfermedad ampollosa caracterizada por la fragilidad de la piel y las mucosas, que afecta sobre todo a pacientes adultos y ancianos. El diagnostico precoz es muy importante porque puede comprometer la vida del paciente, debido a infecciones o complicaciones secundarias al tratamiento. Sobre piel normal aparecen ampollas flaccidas que se rompen con facilidad, dejando grandes erosiones. En ocasiones, las lesiones aparecen sobre piel alterada. Se expone el caso clinico de una mujer de 76 anos, que presento una quemadura por aceite caliente en region toracica anterior. La evolucion clinica atipica de la quemadura oriento el diagnostico de penfigo vulgar.

Crohn's disease (CD) is a chronic, inflammatory disorder that can involve any part of the gastrointestinal tract, from the mouth to the anus. Although CD mainly affects the terminal ileum and colon, the involvement of the upper gastrointestinal tract rarely occurs. Diagnosis is based on clinical, endoscopic and histological features. Treatment for CD of the upper gastrointestinal tract is similar to distal CD therapy. Corticosteroids added to proton pump inhibitors are usually used. The case of a 42-year-old female patient with CD located in the oesophagus, stomach and duodenum is presented. Among the complementary tests, an endoscopic evaluation of the upper gastrointestinal tract with biopsies was essential to support CD diagnosis.

The objective of the study was to examine the contribution of sociodemographic factors, lifestyle, social network, chronic morbidity and use of healthcare services to the poorer health-related quality of life (HRQL) of women, as compared to that of men, among the older population of Spain. Data were collected by home-based personal interview and physical examination of 3260 subjects representative of the Spanish non-institutionalized population aged 60 years and over. HRQL was assessed with the SF-36 health questionnaire. Relative differences in HRQL between women and men were summarized using odds ratios of suboptimal health (score < 100) on each scale of the SF-36, obtained from logistic regression. The contribution of the variables of interest to the relative differences in HRQL between the sexes was evaluated as the percentage change in the odds ratio before and after adjustment for such variables. The odds ratio of suboptimal health among women versus men was higher than 2 (p < 0.0001) on all SF-36 scales. Adjustment for sociodemographic variables led to a reduction of 23% (95% confidence limits (CL): -38 to -5%) in the odds ratio on the social functioning scale, while adjustment for lifestyle reduced the odds ratio on the general health and social functioning scales by 45% (95%CL: -64 to -15%) and 29% (95%CL: -42 to -13%), respectively. Adjustment for the social network, chronic morbidity and use of healthcare services variables did not lead to significant changes in the odds ratios on any of the SF-36 scales. In general, the contribution of the study variables to differences in HRQL between the sexes was smaller in the oldest age groups. We conclude that sociodemographic and lifestyle factors may explain a substantial part of the differences between women and men in certain HRQL dimensions. Some of these factors, such as the lower educational level and the higher frequency of sedentary lifestyles and obesity among women, are potentially modifiable.

La inmunodeficiencia comun variable (ICV) es un trastorno inmunologico primario, caracterizado por niveles disminuidos de inmunoglobulinas y una mayor susceptibilidad a las infecciones. Su diagnostico suele ser tardio, y la primera manifestacion clinica habitualmente es una infeccion bacteriana recurrente. Aunque la mayoria de los pacientes con ICV presentan infecciones del tracto respiratorio, tambien pueden tener otras infecciones, como meningitis recurrentes, que pueden ser graves y presentar complicaciones. Se expone el caso clinico de una paciente de 34 anos que, tras presentar una meningitis neumococica recurrente, fue diagnosticada de ICV. La ICV es una alteracion inmunologica infrecuente que, ademas, no suele sospecharse en la practica habitual. Es recomendable tener en cuenta esta entidad y otros trastornos del sistema inmune ante la aparicion de infecciones bacterianas de repeticion no explicadas. Mediante la realizacion de una prueba sencilla y de facil acceso, como el proteinograma, se puede descartar la presencia de una ICV que, sin tratamiento sustitutivo, podria tener graves complicaciones y un pronostico desfavorable.

Background Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. Methods Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status), need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL)) and enabling factors (educational level, marital status, head-of-family employment status and social network). Relative differences in the use of each service between women and men were summarized using odds ratios (OR), obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. Results As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL): 1.07–1.44), received home medical visits (OR: 1.67; 95% CL: 1.34–2.10) and took ≥3 medications (OR: 1.54; 95% CL: 1.34–1.79), but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL) of women versus men for ingestion of ≥3 medications was 1.24 (1.06–1.45). After adjustment for HRQL, the OR was 1.03 (0.89–1.21) for visits to medical practitioners, 1.24 (0.98–1.58) for home medical visits, 0.71 (0.58–0.87) for hospitalization, and 1.14 (0.97–1.33) for intake of ≥3 medications. After adjustment for the number of chronic diseases and HRQL, the OR of hospitalization among women versus men was 0.68 (0.56–0.84). Conclusion The factors that best explain the greater utilization of health-care services by elderly women versus men are the number of chronic diseases and HRQL. For equal need, certain inequality was observed in hospital admission, in that it proved less frequent among women.