Cryptogenic stroke and PAF: ¿Causality or casuality?

49 p.El término ESUS– embolic stroke of undertermined source – fue introducido en 2014 para incluir a todos aquellos pacientes con ictus no lacunares de etiología desconocida. Respecto a los criterios TOAST representaba un avance hacia una selección más “positiva” de pacientes, al proponer un algoritmo diagnóstico mínimo para poder clasificar un ictus criptogénico como ESUS. En España, según datos de la SEN cada año se producen 71.780 nuevos casos de ictus con 27.000 defunciones situándose como la segunda causa de muerte en España. De todos los ictus el 85% de éstos son isquémicos y dentro de este grupo, ESUS representa un 17% del total. Eso supondría unaincidencia anual de más de 10.000 casos. Tras la información aportada por los ensayos clínicos EMBRACE y CRYSTAL AF la FAPS – fibrilación auricular paroxística silente – cobró un papel relevante como mecanismo patogénico de los ictus criptogénicos. Esta afirmación abre la posibilidad a un manejo terapéutico diferente, al que se veía preconizando: la anticoagulación. Sin embargo, la publicación reciente de los resultados “negativos” de los ensayos clínicos con ACOD, mantiene abierta la controversia sobre la aproximación terapéutica de estos pacientes, abriendo nuevos paradigmas. Este trabajo pretende revisar el impacto que ha creado el término ESUS en la comunidad científica: su acogida, su fisiopatología, el despistaje de FAPS como mecanismo principal, el manejo terapéutico basado en la evidencia, las críticas más actuales y las perspectivas de futuro.The term ESUS- embolic stroke of undertermined source - was introduced in 2014 to include all patients with nonlacunar stroke of unknown etiology. With regard to the TOAST criteria, it represented a step towards a more "positive" selection of patients, proposing a minimum diagnostic algorithm to be able to classify a cryptogenic stroke as ESUS. According to SEN data, 71,780 new cases of stroke with 27,000 deaths occur each year in Spain, making it the second leading cause of death. Of all strokes, 85% are ischemic and within this group, ESUS accounts for 17% of the total. This would mean an annual incidence of more than 10,000 cases. After the information provided by the clinical trials EMBRACE and CRYSTAL AF the SPAF – silent paroxysmal atrial fibrillation – played a significant role as a pathogenic mechanism of cryptogenic stroke. This statement opens up the possibility of a different therapeutic treatment, to that which was advocated: anticoagulation. However, the recent publication of the "negative" results of the clinical tests with ACOD, keeps open the controversy about the therapeutic approach of these patients, opening new paradigms. This paper aims to review the impact that the term ESUS has created on the scientific community: its reception, its pathophysiology, the screening of FAPS as the main mechanism, the therapeutic management based on evidence, the most current criticisms and the future prospects.Grado en Medicin

A facility and community-based assessment of scabies in rural Malawi.

Background Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. Methodology/principal findings From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions/significance Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control

A facility and community-based assessment of scabies in rural malawi

Altres ajuts: CantabriaLabs; Martiderm; Italfarmaco; Fundación CSAI; Ayuntamiento de Villanueva de la Cañada; Spanish Academy of Dermatology (CG); Colegio Oficial de Médicos de Madrid (CG); Fundación Mutua Madrileña (CG); Celia Delgado Matías Association; Universidad de Salamanca.Background Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. Methodology/Principal findings From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatologi-cal care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions/Significance Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control

Patients attended: Scabies, Impetigo and demographic data

A dataset that contains information on patients who received a facility or community-based assessment of Scabies . It contains six variables – age, gender, scabies assessment status, impetigo assessment status, site location, and treatment round number. Data was collected by the DerMalawi project through integrated skin diseases clinics and Tele-dermatology care that they established in 2015 in the Nkhotakota and Salima health districts in Malawi