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Resumen Introduccion La escala modificada Rankin (mRS) es la principal herramienta para la valoracion funcional tras un evento cerebrovascular. Recientemente, fue validado en ingles, el cuestionario simplificado de la mRS (smRSq) telefonico, consiguiendo una escala basada en la mRS, mas sencilla, fiable y con buena reproductibilidad telefonica. Nuestro objetivo es validar en castellano el cuestionario smRSq telefonico. Metodo Se realizo un estudio de cohortes prospectivo, evaluando a 50 pacientes, a los 3 meses de haber sufrido un ictus isquemico. Se evaluo el cuestionario smRSq en castellano por telefono y posteriormente de forma presencial la mRS mediante entrevista estructurada, el cuestionario smRSq y la SIS-16 (Stroke Impact Scale-16). Se estudio la fiabilidad interobservador, test-retest y la validez de constructo y de criterio. Resultados La fiabilidad interobservador obtuvo una correlacion muy alta (k = 0,810); la fiabilidad test-retest y la validez de criterio respecto a la entrevista estructurada de la mRS de forma presencial, obtuvieron una correlacion alta (k = 0,639 y k = 0,759) y la validez de constructo respecto a la SIS-16, obtuvo una correlacion lineal alta (coeficiente de Spearman = -0,728). Conclusiones El cuestionario smRSq telefonico en castellano es una herramienta fiable, rapida y sencilla para la obtencion del estado funcional de los pacientes tras un evento cerebrovascular, basado en la mRS.

Introduction The modified Rankin Scale (mRS) is the main functional assessment tool used after stroke. The simplified mRS questionnaire (smRSq) has recently been validated in English, and represents a simpler, reliable scale with an excellent reproducibility via telephone. The present study aims to validate a Spanish-language version of the telephone smRSq. Methods We conducted a prospective cohort study, assessing 50 patients 3 months after they presented an ischaemic stroke. We assessed the Spanish-language smRSq by telephone and in person, the mRS with a structured interview, the Spanish-language smRSq, and the Stroke Impact Scale-16. Inter-rater reliability, test-retest reliability, construct validity, and criterion validity were assessed. Results Inter-rater reliability showed strong agreement (k = 0.810); test-retest reliability and criterion validity showed moderate agreement (k = 0.639 and k = 0.759, respectively), and construct validity showed moderate agreement (Spearman correlation coefficient = –0.728). Conclusions The Spanish-language telephone smRSq is reliable and simple, and saves time in the functional assessment after a stroke.

Asociacion entre miastenia grave y lupus eritematoso sistemico: es seguro el uso de hidroxicloroquina?

A cooperative study was conducted among six laboratories to compare the performance of the Cobas Amplicor (CA) polymerase chain reaction (PCR) system (Roche Molecular Systems, USA) for the detection of Mycobacterium tuberculosis with that of microscopy and culture in routine clinical laboratory diagnosis. A total of 5,221 decontaminated respiratory specimens were tested. The use of an internal control allowed detection of PCR inhibition in 144 (2.8%) specimens. Only two culture-positive samples were CA PCR inhibitory and therefore could not be detected by PCR testing. Of the 333 culture-positive specimens, 278 (83.5%) were positive by the CA PCR. Of the 4,744 culture-negative specimens, 52 (1.1%) were positive by the CA PCR. After analysis of discrepancies, 40 of the 52 culture-negative, CA PCR-positive specimens were classified as true positive. Thus, the overall sensitivities of culture, CA PCR and microscopy were 89.3%, 85.2% and 55.5%, respectively. The overall specificity of the CA PCR was 99.7%. Five of the six centers found similar performances for the CA PCR, with sensitivities ranging from 85.7 to 90.9%. The CA PCR was more sensitive for smear-positive samples, exhibiting overall sensitivities of 96.1% and 71.7% for smear-positive and smear-negative specimens, respectively. These results indicate that the Cobas Amplicor system enables microbiology laboratories with reasonable previous experience in molecular biology testing to perform PCR and to detect Mycobacterium tuberculosis in more than 70% of specimens obtained from infected patients.

Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) analysis is a recently developed method which could be suitable as a 'real-time' genotyping tool for Mycobacterium tuberculosis.One hundred and thirty-four M. tuberculosis isolates were analysed using the reference method, IS6110-restriction fragment length polymorphism (RFLP), and by MIRU, alone and together with spoligotyping.MIRU reduced the genotyping turnaround time by 21 days. The discriminatory power (HGDI) for MIRU and RFLP was 0.978 and 0.989, respectively. RFLP clustered 41.8% of the isolates (17 clusters; 2-9 representatives), whereas MIRU increased the number and size of the clusters (57.5% of the isolates in 20 clusters; 2-14 representatives). With respect to the RFLP clusters, MIRU data showed full correlation in only 7/ 17 (41%) clusters and low correlation in 8/17 (47%) clusters. When MIRU and spoligotyping were considered together, the analysis fitted better with RFLP data: 1) 42.5% of the isolates were grouped in 20 clusters of 2-6 representatives, and 2) the number of clusters with full correlation with RFLP data increased to 11/17 and those with low correlation decreased to 2/17.MIRU-VNTR analysis showed low correlation with RFLP. The addition of spoligotyping to MIRU analysis fitted much better with RFLP analysis, although full correlation was still not achieved.

Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients.

Pott's disease (PD) is an uncommon extra-pulmonary form of tuberculosis. Dissimilar data about location, diagnosis and treatment from various hospitals and different countries are reported.We present our experience with Pott's disease at our institution between January 1993 to December 1999, retrospectively, based on clinical bacteriological and pathological research. We found the medical records of 14 patients diagnosed as having PD at our hospital. The following information was obtained: age, sex, symptoms and sings at presentation, PPD tuberculin skin test, imaging techniques, mycobacterium cultures and smear, histopathologic study, treatment and clinical outcome.The number of microbiological diagnosed tuberculosis during the study period was of 1,400 (4 cases per 1,000 admissions). From them, 1,047 cases (74.8%) were pulmonary and 353 cases (25.2%) extra-pulmonary. We found the medical records of 14 patients diagnosed as having PD at our hospital. There was a diagnostic delay between 2 and 720 days. In 5 cases, cultures were positive (1.4% extra-pulmonary). The following information was obtained: age, sex, symptoms and signs at presentation, PPD tuberculin skin test, imaging techniques, mycobacterium cultures and smear, histopathologic study, treatment and clinical outcome. The mean age of the patients was 58 years. Pain and dorsal location were more frequent (8/14). In 6 cases, tuberculosis was diagnosed at other sites. Tuberculin skin test was positive in 7 ases (50%). The diagnosis was confirmed by positive cultures from biopsies in 5 from 8 cases performed and the histology was compatible in 8 from 11 cases performed. Diskitis was presented in 10 cases, soft tissue abscess in 9 cases (psoas abscess in 2); epidural compression in 9 cases and surgery was necessary in 9 cases (diagnostic in 3).Pott's disease is a rare entity even among HIV-patients in whom extrapulmonar disease has increased. Dorsal location, diskitis and advanced forms of the disease that deserve surgical treatment are frequent.