Introduction: Parkinson's disease (PD) affects nearly 1 % of the population over 50 years worldwide. The diagnosis of this disease is based on clinical characteristics wich include: tremor, rigidity, bradikinesia and postural instability. Pharmacological treatment sometimes is insufficient to alleviate this symptoms, and some patients will requiere surgery to treat them. Deep brain stimulation (DBS) of the bilateral subthalamic nucleus (STN) has been considered the gold standar for the surgical treatment of PD. Nonetheless pallidotomy, prelemniscal radiations (RAPRL) ablation and thalamotomy, are surgical techniques that had been proved their efficacy for the treatment of PD. The Functional and Stereotactic Neurosurgery and Radiosurgery (FNSR) Unit of the General Hospital Mexico (GHM) was the first medical center in our country to operate on patients with PD in the 70's decade. So far the outcome of the surgery in general, has not been published yet. The main purpose of this paper is to describe the surgical results of the patients with PD operated on at the FNSR during the period 1992-2009. Materials and methods: 33 medical files were reviewed and considered for this paper, at the FNSR. For the statistical analysis we use de median, media, standar deviation and Wilcoxon test to evaluate the results. We also made statistical correlations to define a positive one based on clinimetrics and type of surgery used for each patient. Results: The age of the patients was in the range between 38 and 83 years old. The median test of the presurgical Hoen and Yahr (HY) scale was 3, compared to 2 postoperative (P < 0.0001). The surgical target internal globus pallidus was the most frequently used, but we cannot find a significant correlation between this and the UPDRS and HY scales. Discussion: Currently there is no the optimal surgical treatment for PD, however the surgical techniques used, ablation or DBS, has proven to be very effective in the treatment of some of the symptoms of PD. Our unit is a main medical center in the country to perform this kind of surgeries, but we do not have the whole clinical information through this decades of the patients that had been treated at the FNSR. This is because most clinical records are eliminated of the hospital archive. We report on 33 patients that were operated on at our unit, in different surgical targets, and our clinical results are very similar to other's autors series. The most frequent surgical type of procedure was ablation, instead of DBS; this was because of economic reasons. Conclusion: An alectronic database is needed to preserve the clinical and surgical records of our patients.
The Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder characterized by rapid deterioration and the selective death of motor neurons in the cerebral cortex, brainstem and spinal cord. In this paper we performed a literature review of the Mexican contributions during the last 15 years in relation to ALS. We have performed a systematic review through PubMed about publications of Mexican Researcher about ALS in English. There are 19 publications about ALS performed by Mexican researchers including case reports, series, experimental models, diagnostic methods and cellular therapy. One of them described epidemiological data in Mexican ALS patients that fulfilled El Escorial criteria to definite ALS. The age of onset was 47.5 years predominantly in men (1.8:1) with an interval of 12 months from onset to diagnosis. The survival was longer than described in other countries. In Mexico an estimated prevalence is between 5,000 to 7,000 ALS patients. In conclusion, the ALS diagnosis is challenging and death occurs in short term after onset. Few epidemiological are described in México; there is no effective treatment for this disorder. In México is imperative to create a national ALS registry and an association dedicated to support ALS patient, obtain economical funds from private sources and government to increase research in ALS.
Introduction: Due to the fact that the multiple sclerosis is an autoimmune disease characterized by the presence of multifocal areas of demyelinization in the nervous central system, the Interferon Beta 1a has been outlined as the viable treatment for this suffering, especially of the relapsing-remitting type. Objective: To compare two INF b 1a of different brands measuring their effect on the induction of them sVCAM-1. Material and methods: The effect of two different sources of Interferon Beta 1a (INF β 1a) on the soluble Vascular Cell Adhesion Molecules (sVCAM-1) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) was compared. Patients were randomized to receive either, INF β 1a (12 MUI, sc) from a standard international source, or INF β 1a from a Mexican source (same dose), three times weekly during 12 weeks. Serum sVCAM-1 levels were measured before and several weeks after treatment. Quality of life was also assesses before and three months after treatment. Results: sVCAM-1 levels were increased after treatment more than 60% in both groups. Adverse events were similar for both INF β 1a brands. Conclusion: Safety profiles and effect on serum sVCAM-1 were similar for both groups; no differences were found regarding gender, age, baseline or final disease status. This is the first worldwide study to compare the cellular immunologic effect of the international INF β 1a versus a biogeneric.
Introduction: Cerebrovascular disease (CVD) is a growing health problem in countries living the epidemiological transition. In Mexico, population data on this issue is scarce. Objective: To describe the changing pattern on CVD mortality in Mexico, during the period 2000 to 2008. Methods: We consulted the Mexican Health Ministry database provided by the National System on Health Information. Data on the period 2000 to 2008 (the only available) was extracted. Crude CVD deaths, annualized population mortality rates and proportions attributed to CVD among other mortality causes are here presented. Results: By the year 2000 a total of 435,486 deaths were registered in Mexico (general mortality rate: 4.42/100,000; total population: 98,438,557 inhabitants), increasing to 538,288 in 2008 (general mortality rate: 5.05/100,000; total population: 106,682,518 inhabitants), which coincided with an increment in the population aged ≥ 65 years specifically (year 2000: 4,591,319; year 2008: 5,983,927). Specific CVD mortality also showed a growing pattern from 2000 (annualized mortality rate: 25.21/100,000) to 2008 (annualized mortality rate: 28.30/ 100,000). By 2008, the Mexican state with the highest CVD mortality rate was Veracruz (annualized mortality rate: 36.3/100,000), followed by Oaxaca (annualized mortality rate: 36.2/100,000) and the Federal District (annualized mortality rate: 34.9/100,000). Of note, a decreasing annualized mortality rate was observed in the population aged ≥ 65 years, at expense of a higher frequency at younger ages. Conclusions: CVD mortality has increased in Mexico, particularly in persons aged < 65 years. Comprehensive population studies on fatal and non-fatal CVD incidence by specific clinical types are urgently needed.
Introduction: Cerebrovascular disease (CVD) mortality in Mexico has shown a growing pattern in recent years. It is not known whether data obtained in the important multicenter CVD Mexican registries adequately represent all the hospital units of the health system. Objective: To describe the frequency of acute CVD subtypes and shortterm outcome in discharge registries from public institutions of the Mexican health system, during the year 2010. Methods: We consulted the Mexican public health system database of hospital discharges corresponding to the year 2010 (Secretaría de Salud, IMSS, IMSS Oportunidades, ISSSTE, PEMEX, SEMAR y SEDENA). CVD registries were identified with the International Classification of Diseases 10th revision codes (ICD-10). Specified CVD was defined as the existence of ICD-10 codes describing precise CVD subtypes. Results: In 2010, a total of 5,314,132 hospital discharges were registered in the Mexican public health system. Of them, 46,247 (0.9%) were acute CVD including: acute ischemic stroke (AIS) 20,298 (43.9%), intracerebral hemorrhage (ICH) 6,005 (13.0%), subarachnoid hemorrhage 2,655 (5.7%), cerebral venous thrombosis (CVT) 194 (0.4%) and non-specified CVD 17,095 (37.0%). Among specified CVD discharges (n=29,152), 69.6% corresponded to AIS, 20.6% to ICH, 9.1% to SAH and 0.7% to CVT. The global 30-day case fatality rate was 17.1% (18.8% among specified subtypes); higher for ICH (33.6%), followed by SAH (29.3%) and AIS (13.9%) (p < 0.001). Conclusions: The relative frequency of acute CVD subtypes by the year 2010 was similar to that of the previous Mexican multicenter registries. Short-term mortality is higher in hemorrhagic forms of CVD, as compared with ischemic stroke.
Introduction: Dementia refers to a group of neurodegenerative disorders characterized by progressive deterioration of
cognitive skills and is one of the main pathologies associated with disability and dependency among older adults.
Objective: The objective of the study was to analyze the relationship between the demographic factors and mortality from
dementia in the Mexican population. Methods: This was a population-based, retrospective, and cross-sectional study. We
employed an open-access national dementia-related mortality dataset. Results: The overall mortality rate in Mexico was
0.16/1000 inhabitants. The mean age of mortality was 84.37 ± 0.10 years. In the statistical analysis, sociodemographic varia-
bles that were associated with greater mortality due to dementia were age > 80 (OR 2.91, p < 0.001), single (OR 1.66, p < 0.001),
female (OR 1.53, p < 0.001), an urban area (OR 1.42, p < 0.001), to have higher education (OR 1.23, p = 0.001), and residen-
cy in large cities (OR 1.33, p < 0.001). Conclusions: Mortality from dementia arises as a cosmopolitan phenomenon asso-
ciated with socioeconomic factors.
Key words: Dementia. Epidemiology. Mortality. Aged.
Objective: To analyzed whether risk factor profile, baseline features and prognosis of cervical artery dissection (CAD) differ according to the type and dissection site. Material and methods: We analyzed 215 consecutive patients diagnosed from January 1990 to January 2011 with confirmed diagnosis of ischemic stroke secondary to CAD. Results: Vertebral artery dissection (VAD) was present in 133 cases (62%). Two thirds of patients with VAD were men (65%). No differences were found between major vascular risk factors or history of trauma. Carotid artery dissection (CAD) was mainly extracranial (p= 0.0001) with occlusive dissection pattern (p = 0.0001) and worse functional outcome (modified Rankin scale 3-5; 56%). While in the cases of VAD, we most frequently found; multiple concomitant disease (p = 0.009), intracranial affection (p = 0.001), pattern of stenosis (p = 0.05) and very good functional outcome (modified Rankin scale 0-1; 45 vs. 17%). At follow-up, 14 patients died (6 carotid, 7 vertebrals) and 4 had a recurrence (3 carotid and 1 vertebral). Conclusion: In our series, vertebral dissectionretrospredominates, especially in men, and with better longterm functional prognosis. We observe significant differences between VAD and CAD in terms of location and type of dissection. There is poor long-term recurrence.
INTRODUCTION: Chordoma is an uncommon, slow-growing tumor, locally invasive and destructive, arising from notochordal remnants. It originates from skull base central portion, demonstrating different patterns of invasiveness, including duramater penetration and its spread through vascular structures, compromising its completely resection. OBJECTIVE: To analyze the different options of treatment, results, and complications. METHODS: Between 2002 and 2012, 31 patients presenting skull base chordomas were treated surgically at the Evangelico University Hospital of Curitiba, Curitiba-Brazil. The follow-up period was 1-72 months. All patients were evaluated by means of head CT and MRI. Surgical approaches were chosen for each specific case, aiming to obtain a tumor radical resection. Some patients were submitted to radiotherapy after surgical resection. RESULTS: Radical resection was performed in 81% of the patients. A five-year survival rate was 75%. Radical resection had a positive impact on the survival rate. The possibility to perform a radical resection depended on the tumor volume pre-operation and number of anatomic regions invaded. The sixth cranial nerve palsy and CSF fistula were the most common surgical complications. CONCLUSION: The purpose of the surgical management treating skull base chordomas consists in performing radical resection using different types of surgical approaches, which implies an acceptable risk.
OBJECTIVE: To evaluate the efficacy and safety of Probioglat® by the occurrence of multiple sclerosis (MS) relapses, changes in disability, the emergence and evolution of demyelinating lesions viewed on magnetic resonance imaging (MRI), and the occurrence of adverse events in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: A multicenter, open, non-comparative, longitudinal and prospective study in patients from a previous study (Study PRO-3209) and new patients. Patients received Probioglat ® 20 mg subcutaneously daily for a period of 24 months; this report presents the results of the first year of treatment of Study PRO-4109. RESULTS: A total of 54 patients were included and 8 patients discontinued the study; 39 patients were from the previous study (PRO-3209) and 15 were new patients. The mean age was 34 years and 30 of the patients were women. Twelve patients (22%, 95% CI: 14.5 to 38.2) had MS relapses; the annualized relapse rate was 0.29 (IC 95%: 0.14 a 0.44). The Expanded Disability Status Scale (EDSS) scores had no notable changes from baseline to 12 months. The mean change was -0,046 (standard deviation: 0.92). The demyelinating active lesions identified by gadolinium-contrasted MRI scans (Gad+) tended to decrease in size and intensity. The number of Gad+ lesions decreased significantly from baseline to 12 months (p = 0.0011, paired t-test). Thirty-seven patients (68.5%) presented at least one adverse event during the study. Injection site reaction was the most frequent adverse event, which was reported in 16 patients (29.6%), followed by depression in 11 patients (20.4%) and fatigue in other 9 patients (16.6%). CONCLUSIONS: The interim analysis of the study found that the administration of Probioglat ® in a daily subcutaneous dose of 20 mg in Mexican patients with RRMS for 12 months showed beneficial effect: reduced EM relapses, decreased the progression of disability and the number of new demyelinating lesions. The treatment was also safe and well-tolerated. However, it's recommended completing 24 months of treatment to obtain final results.
Introduction: In newborns the Apgar score not only can predict a short-term outcome, but it also has the potential to estimate the risk of several disabilities in the long term. Objective: To describe the association of the Apgar score with the motor neuron syndrome in high-risk newborns. Methods: This is a longitudinal analytic study on the Apgar score and its association with the risk of the motor neuron syndrome in 400 high-risk newborns in a 10-year followup, in the Hospital General de Zona/Unidad de Medicina Familiar #8 «Dr. Gilberto Flores Izquierdo». Results: A total of 400 high-risk newborns were studied: 182 (45.5%) of the female sex and 218 (54.5%) of the male sex. The motor neuron syndrome (either inferior or superior) occurred in 156 (39%) neonates: in the first year of life in 24.4% of neonates with Apgar score 8-9, 40.4% with Apgar 5-7 and 35.3% with Apgar 0-4 (p = 0.02). In the second year of life the motor neuron syndrome occurred in 23.4% of newborns with Apgar 8-9, 40.6% with Apgar 5-7 and 35.9% with Apgar 0-4 (p = 0.03). In the fourth year of life this differences were 12.5%, 50% and 37.5%, respectively (p = 0.09). In the sixth year of life, however, there was no motor neuron syndrome in any of the children. All neonates with the motor neuron syndrome received early neurorehabilitation. Conclusion: The Apgar score is associated with the risk of motor neuron syndrome in the long run. Early neurorehabilitation seems to have a determinant effect in the resolution of the motor deficit.
INTRODUCTION: In the treatment of epilepsy it is necessary to select drugs with high efficacy and minimum side effects. Levetiracetam seems to have an ideal pharmacological profile. Although the oral route is the usual form of administration, sometimes it is required the intravenous administration. OBJECTIVE: To describe the clinical profile, indications in intravenous administration and seizures control of 48 pediatric epileptic patients managed with intravenous levetiracetam in monotherapy or add-on therapy. METHODS: This is a retrospective and observational study performed at the National Institute of Pediatrics between February 2011 to April 2013, in patients receiving intravenous levetiracetam, for whom the enteral route was contraindicated. RESULTS: A total of 48 records were included, 60% of the population < 2 years. Symptomatic focal epilepsy was present in 39 patients (81%). The most common etiologies were: hypoxic-ischemic encephalopathy (HIE) (n = 14), cerebral dysgenesis (n = 10) and acquired metabolic disorders (n = 7). Indications for intravenous administration: uncontrolled seizures (n = 23) and fasting due to medical illness (n = 11). A total of 43 patients (89.5%) were seizure-free during the first 24 h. Intravenous administration was performed with dose 20 mg/kg b.i.d. and the patients received 2 to 6 IV doses, without any adverse effects. Once the enteral route was restored, the change from intravenous to oral route was made in equivalent doses. In all, 35 patients (73%) maintained levetiracetam treatment in mono/politherapy for up to 36 months (average 18.5 months, SD ± 10.5). A total of 13 patients (27%) discontinued levetiracetam, none for therapeutic failure, 1 patient developed aggression during the first week as adverse event and suspended levetiracetam, followed by economic hardship. CONCLUSIONS: This series shows that levetiracetam is an antiepileptic drug that enabled adequate control in acute seizures and chronic management of epilepsy. Adherence was obtained in 80% of patients. The levetiracetam is a safe, broad-spectrum antiepileptic with few adverse effects and is a good option for intravenous use in children.
Introduction: The Raven Progressive Matrices test ismost commonly used in children to assess fluid intelligence. Investigations require large test populations with less application time. Methods: The study sought to determine the psychometric properties of the Raven test and its abbreviated form in the school population. The sample was selected in various schools in the provinces of Cienfuegos and Matanzas, Cuba, being made up of 249 children aged 6-11 years with learning difficulties by school. The validity was determined with a linear regression on both instruments with the aim of knowing how to separate out the results of a line. We also used other experimental indicators (sensitivity, specificity, positive and negative predictive value). The reliability measure was obtained with Cronbach's alpha. Results: Cronbach's alpha was 0.96. Linear regression indicated that 93% of the population assessed by the Raven and its abbreviated form can be diagnosed with similar results. The sensitivity of the proposed instrument showed that 75% of the population can be identified with the specific disorders, and the specificity shows that 95% of the population can be identified as negative to the disorder. There is a 91% probability that the proposed instrument can identify population with a disorder; however, there is 84% probability of identifying a child who does not have the disorder. Conclusions: The short form of the Raven test is an alternative simple, rapid and valid to group populations with intellectual difficulties in school settings.
Polyglutamine diseases comprise a group of neurodegenerative diseases caused by expansion of citosine-adenine-guanine (CAG) repeats in coding regions of specific genes. Among its phenotypical features, the saccadic abnormalities are very common. Saccades allow us to shift, rapidly and accurately, the attention from a target to other in the visual scene. Saccadic eye movements are generated by an extensive cortical-subcortical circuitry and they are usually used as important tools in basic and clinical researches of nervous central system. This paper presents an updated review of saccadic abnormalities in polyglutamine diseases, emphasizing in the usefulness of these features for diagnosis and disease biomarkers identifications. Saccadic abnormalities in polyglutamine diseases point out the marked vulnerability of saccadic system to CAG expansions. Its study allows us to identify useful parameters for early diagnosis and disease biomarkers for therapies evaluation. Nevertheless, other studies are mandatory to get deep into the pathophysiology of these oculomotor abnormalities.
INTRODUCTION: Intrathecal baclofen (ITB) treatment is increasingly used in cases of severe spasticity. It is very important to know the eventual complications that can appear during the therapy. OBJECTIVE: To emphasize the importance of an early identification of symptoms and differential diagnosis of the intrathecal baclofen withdrawal syndrome (ITBWS), in order to be able to establish opportunely the correct treatment, essential to achieve an optimal outcome. CASE REPORT : We report our experience with the clinical case of a patient with multiple sclerosis and severe spasticity treated with ITB who presented a fatal ITBWS. CONCLUSIONS: The abrupt baclofen intrathecal withdrawal can cause a syndrome with deadly consequences, which justifies the importance of its early identification and distinction from other syndromes with similar symptoms, but with very different treatments.
The cerebral abscess defines how the purulent infection of the focal type on cerebral parenchyma, is secondary to the dissemination of a distant infectious source, the formation of the abscess is a complex process that will depend on the immune response of the host, which will limit or spread the infection within the central nervous system. The variants in the clinical presentation of the cerebral abscess determine a delay in the diagnosis since the classic triad of migraine, fever and focal shortage only appears in less than 50% of the cases. The studies of conventional imaging have revolutionized the timely diagnosis of the injury, nevertheless these techniques have failed to distinguish the abscess from other intracranial injuries rising the number of false positives. The advent of imaging techniques such as the spectroscopy and the diffusion magnetic resonance have increased the diagnostic specificity. The advances in the surgical and medical procedures have diminished the mortality and after effects of this illness. There are no current international guides for the prognosis and treatment of the cerebral abscess. There have not been documented in contemporary literature one meta-analysis or prospective studies, with enough statistical power, to be able to establish a global consensus in the management of this patients.
Anxiety disorders, characterized by behavioral and physiological changes similar to those caused by fear, show symptomatic similarity unclear for the patient, making difficult its diagnosis and treatment. Its various clinical conditions are associated to addiction in its dual nature: of psychiatric and addictive co-morbidity (derived from psychotropic consumption or other abuse/ dependence substances). Its etiology has available for its study, several theoretical points of view (psychodynamic, behavioral, and cognitive). Beyond the terminological confusion between anxiety, anguish, and panic attack, anxiety is distinguished between exogenous (phobias) and endogenous anxiety (panic and generalized anxiety). Its clinical variations: generalized anxiety disorder, panic attack; fobic disorders (specific phobias, social phobia and agoraphobia without panic disorder) PTSD; obsessive-compulsive disorder; anxiety disorder, due to medical condition induced by drugs require for their diagnosis the analysis of the deployment and evolution of symptoms and family history. Primary care personnel in the various countries take care of 90% of the cases. However, they only derive to a specialist (psychiatrist, neurologist, etc.) those cases with psychotic signs, suicidal attempts, episodes associated with bipolar disorder, or because of lack of response to treatment. This should promote reconsideration of their professional performance, not only at their basic training but also at the continuous one, in main psychiatric issues such as anxiety and co-morbidity, key ones for early detection, improved diagnosis and proper treatment.
Introduction: Although the risks associated with radiation exposure during imagenological studies are considered low in modern times, their use is justified only when it is expected to obtain useful information for decision-making. Objective: To describe the most frequent indications for head computed tomography (CT) in pediatric patients. Methods: Head CT studies and their indications performed from January 2008 and March 2010 in the Department of Radiology of the Unit of Medical Specialties of the Ministry of National Defense were reviewed. Results: A total of 668 head CT studies performed to pediatric patients (age range: 1 month to 18 years) were reviewed: 403 (60.3%) boys and 265 (39.7%) girls. The most frequent indications for head CT were study of headache (39.1%), seizures/ epilepsy (32.2%), investigation of structural abnormalities (13.9%), neurodevelopmental retardation (10%) and attention deficit hyperactivity disorder (4.9%). Only 5% of the head CT studies were abnormal. Conclusion: A minority of the patients of this study had an abnormal head CT study with findings potentially changing the decision-making process.
We review the major obstacles that limit access to treatment programmes (TP), Substance Abuse Disorders (SAD), in patients with abuse/dependence on psychotropic substances, based on the data produced by contemporary literature. This brief description illustrates a group of institutional activities inherent to services, plannification-action and personnel from diagnosis to a longterm rehabilitation, which traditionally have been identified as a recommendation for achieving the operational improvement of the health personnel (HP), for the sake of building a more effective tool for professional work based on the doctor-patient relationship. There are recommendations on amendments to the institutional framework and operational HP, working in these units, focusing on obtaining a positive and respectful; shows confidence; minimizing the power structure that allows a relationship productive during and after the TP, to help redefine a new positive Ego, in order to model a healthy lifestyle; spontaneity, objectivity, projecting confidence, sense of humor show, without confrontation and encourage openness to develop a warm relationship and support to patients in their care. It stresses the importance of preventing relapses and family participation in the management, to encourage therapeutic adherence, and some patterns suitable for the amendment of TP emphasizing the principles, values and treatment guidelines.
Introduction: In a previous study, prolongation of P300 wave latencies was observed in women with low education. Objective: To prove that there are not differences in amplitude and latency of mismatch negativity (MMN) and P300 between two groups of elderly adults (aged ≥ 60 years) of both genders with continued intellectual activity and high level of education. Methods: Two groups of elderly adults were allocated into 2 groups with years of education >15 years. Continued intellectual activity, Wechsler IQ test, mini-mental state examination, clock test and Yesavage scale were evaluated, all with normal results. Normal auditory brainstem responses (ABR). Without risk factors for central auditory processing disorders. ABR, MMN and P300 were measured for both groups: 6-lead (3 central, 3 frontal) latency and amplitude records (p < 0.05). Results: A total of 37 elderly adults were studied: group I (GI, n = 28) with 60-69 years of age (mean 64 ± 2.7 years); group II (GII, n = 9) 3 70 years (mean 77 ± 3.7 years). Years of formal education in GI:21 ± 4 years; GII: 20 ± 5 years. In MMN and P300 significant differences were observed between both groups for P300 FZ latency. Conclusion: The results of this study suggest that a high level of education and continued intellectual activity in elderly adults influence performance favorably, a finding evidenced by the absence of electrophysiological changes previously described in other elderly adults.
Glatiramer acetate is a treatment approved in relapsing remitting multiple sclerosis (RRMS). OBJECTIVE: To evaluate the effect of study glatiramer acetate on CD4 + T lymphocytes levels with Th1 and Th2 phenotype with the reference glatiramer acetate in patients with RRMS for 4 months. METHODS: Multicenter, comparative, longitudinal and prospective blinded investigator. Patients were randomized to one of two glatiramer acetate in a 1:1 ratio. Patients were invited to continue treatment for 24 additional months. RESULTS: A total of 51 patients were included: 28 (55%) were female, mean age of 35 years, 26 to group test glatiramer acetate and 25 to the reference group. There were no significant differences in age, gender and baseline clinical characteristics between groups. Comparing baseline against the end of treatment, it was observed in both groups decreased serum levels of IFNγ (Th1 response) and an increase in levels of IL-10 (Th2 response). Probioglat® generated a Th2 response (anti-inflammatory) comparable to Copaxone®. The results over sVCAM levels showed few change after drug treatment of both test and for the reference. Antibodies anti-glatiramer acetate was observed in one patient treated with reference glatiramer acetate. Adverse events associated with the use of both drugs are also comparable in frequency and severity. CONCLUSION: The immune response generated by both molecules is similar, suggesting bioequivalence, at least in these parameters, for both compounds.
Introduction: Primary central nervous system lymphoma (PCNSL) is considered infrequent, even in cases of human immunodefficiency virus (HIV) infection. However, little is known about the frequency of this association in Mexico. Objective: To determine the prevalence and neurological manifestations of patients with PCNSL and the HIV/AIDS complex, in a 10-year period in a reference hospital of the Mexico City. Methods: In this retrospective study, clinical records of PCNSL cases in patients with HIV infection were reviewed from the clinical database of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, from January 2001 to January 2011. Results: In this 10-year period, the pravalence of PCNSL in patients with HIV infection was 0.2% (5 cases, age range: 30-39 years): 3 (60%) man and 2 (40%) women. Histopathological analysis was achieved in 3 cases (all diffuse large B-cell non-Hodgkin lymphoma); in the rest, diagnosis was based on the clinical presentation, suggestive neuroimaging and negative serology for toxoplasmosis. Main sign and symptoms wereheadache (100%), seizures (80%), papilledema (60%), multiple cranial neuropathies (60%) and hemiparesis (60%). During the first 6 months after diagnosis, 60% of the patients died due to disease activity. Conclusions: Diagnosis of PCNSL is challenging. The low prevalence here reported, as compared with relatively old series, could be a consequence of the use of highly active antiretroviral therapy, as it has been recognized in other parts of the world.
In recent years it has been increasingly recognized the presence of acquired neuromuscular disease in the critically ill patient, either as a form of acute myopathy, polyneuropathy or persistent blockade by neuromuscular relaxing agents. Critical illness polyneuropathy (CIP) and myopathy (CIM) are characterized for the presence of weakness, manifested as a quadriparesia, usually flaccid and symmetrical with reduction and/or absence of deep tendon reflexes. Involvement of phrenic nerve, intercostal and accessory respiratory muscles, atrophy and contractile dysfunction of the diaphragm have been described as a cause of delayed mechanical ventilation weaning. Although routine electrophysiological examination sometimes cannot discriminate between patients with CIM and CIP, mainly because they usually coexist, it is useful to rule out other causes of neuromuscular weakness, being able to be practiced before sedation withdrawal. Despite some clinical trials propose as treatment options nutritional interventions with diverse supplements and antioxidants, intravenous immunoglobulin administration or activated protein C, none of them has demonstrated clinical utility. The only management so far is preventive, with emphasis on reducing or discontinuing glucocorticoids and neuromuscular blockers as soon as possible, reaching strict control on blood glucose with insulin, aggressive management of sepsis, early use of spontaneous breathing tests in patients with mechanical ventilation, anticipation of further medical complications and early rehabilitation.
Orexins A and B are two neuropeptides synthesized in the lateral hypothalamus, perifornical area and dorsomedial hypothalamus. Bothare derived from the proteolytic cleavage of a protein called pre-pro-orexin; they together exert their biological effects through two G protein-coupled receptors named OX1R and OX2R. The axons of theorexinergic neurons are distributed almost throughout the central nervous system and they can be found in some organs including the reproductive tract of both sexes. The wide distribution of orexins and their receptors includes the entire hypothalamic-pituitary-gonadal axis and brain nuclei related to reward processing such as the ventral tegmental area and the nucleus accumbens. Although the reproductive process has been extensively investigated, recent evidence suggests that in addition to the hypothalamic-pituitary-gonadal neuroendocrine axis, there are other systems such as orexinergic system that are heavily involved in the regulation of reproductive process and sexual behavior in vertebrates, mainly in mammals.
Neurofibrillary tangles (NFT) composed of tau protein abnormally assembled are the hallamarks of Alzheimer'diseased brains. NFTs represent dense accumulation of paired helical filaments (PHF). Hyperphosphorylation and endogenous proteolysis (truncation) are the two major pathological changes found in tau-PHF. Despite the fact that the majority of studies focus on the hyperphosphorylation as a key event in Alzheimer's disease (AD) pathogenesis, some reports are contradictory in the sense that they have not found any evidence of toxicity of the hyperphosphorylated NFT. Moreover, these same studies suggest that hyperphosphorylated tau has, in fact, a protective role in AD against to the progressive cytoplasmic accumulation of a truncated tau fragment at Glu391. This fragment of 90-92 aminoacid length is so-called the PHF «core». This fragment is highly toxic and the cause of neuronal death in AD. In this review, we analyzed the role the hyperhosphorylated and truncated tau species focusing in toxicity and protection in AD pathogenesis.
INTRODUCTION: The physical disability and the level of dependence for daily activities that follow a stroke requires validated and standardized instruments to measure objectively the functional status and the impact of interventions on prognosis. The Motor Activity Log (MAL-30) and Action Research Arm (ARA) scales possess these characteristics, currently being the most used in evaluation of the upper extremity. OBJECTIVE: To analyze the psychometric properties and utility of MAL-30 and ARA as tools to assess the function of the paretic upper limb after stroke for the clinical practice and research. METHODS: We performed an observational, longitudinal design with clinimetric performance analysis, with a sample of 80 patients. Two measurements were made, at baseline (time 1) clinical and socio-demographic profile, MAL-30 and ARA was applied. One month later (time 2), MAL-30, ARA and Stroke Impact Scale (SIS 3.0) were applied. RESULTS: MAL-30 and ARA have adequate internal consistency and temporal stability. In addition, an appropriate construct validity by correlating significantly and in the expected direction between the two instruments and items of SIS 3.0, spasticity, pain, age, educational level and employment status. CONCLUSIONS: The evidence indicates that both MAL-30 and ARA have psychometric properties that make them ideal tools for assessing functional recovery in the paretic arm. However, it is necessary to consider some characteristics of each instrument before defining its clinical use and research properties.
The organization of the endothelial cells within the central nervous system shows special anatomical features, comprising the ultimate protective barrier for the brain. Since circulatory and nervous systems interact, a malfunction on the close relation between blood dynamic and neural activity could lead to cerebralvascular diseases and potentially, certain neurodegenerative diseases. Nowadays, the interest to detect changes in blood flow and visualize active areas within the brain has evolved into anatomical and functional research lines of the circulatory system. Changes in the cerebral vasculature (loss of vessels, angiogenesis) have been associated with disorders such as brain tumors, Alzheimer's disease and epilepsy. Therefore, it is important to direct efforts to describe anatomical structure and function of brain capillaries in order to better understand its relationship with cellular activity, together with the techniques used for monitoring blood supply in the brain regions. In conclusion, knowledge on the endothelial cell functions as the main homeostatic vascular unit, could shed light and assist new interpretations of the exchange mechanisms between blood and brain tissue, improve our understanding of cerebral diseases, and the development of new preventive or therapeutic treatments as anti-angiogenic drugs formulation.
Introduction: Despite the growth of the elderly population in Mexico, little information exists on the risk factors and prognosis of patients older than 80 years suffering acute ischemic stroke (AIS). Objective: To identify differences in the frequency of risk factors for AIS and outcome in patients aged ≥ 80 years and their younger counterparts in a reference hospital from Mexico. Methods: A cross-sectional analysis was performed on 238 adult patients with AIS: 56 (23.5%) aged ≥ 80 years and 182 (76.4%) patients aged < 80 years, as comparators. Data were collected from the clinical records and risk factors and short-term outcome were analyzed. Results: There were no differences in gender proportion between both groups. Diabetes (55%) and hypertension (53%) were the main risk factors, but in patients aged ≥ 80 years diabetes had a significantly lower frequency than that of their younger counterparts (32 vs. 62%, respectively; p <0.001). In contrast, the frequency of atrial fibrillation was significantly higher in octogenarians than in comparators (37 vs. 12%, respectively; p < 0.001). In a Cox proportional hazards model adjusted for relevant covariables, age ≥ 80 years (RR: 3.67, 95% CI: 1.82- 7.37) and the occurrence of septic shock (RR: 6.73,95% CI: 3.19-14.20) were the factors associated with inhospital mortality. Conclusion: Octogenarians hospitalized with AIS have a lower frequency of some vascular risk factors, but a higher risk for in-hospital mortality, when compare with younger individuals.
Introduction: Acute disseminated encephalomyelitis is a demyelinating disease of central nervous system with an immunoallergic pathophysiology, usually occurring in young patients, with monophasic course and good prognosis, following an infection or immunization; which occurs with an incidence of 0.4 to 3/100,000 inhabitants per year in those those under 20 years of age. Case Reports: Case 1: a 13-year-old male who starts with acute pharyngitis and fever, nausea and vomiting, with a latter addition of convulsive crises and subsequent quadriparesis, who had discarded neuroinfection, but MRI showed images compatible with typical demyelination. Case 2: a 7-year-old female who after application of triple viral vaccine and influenza develops nausea and vomiting, left hemiparesis and central facial ipsilateral paralysis. Other differential diagnoses were also ruled-out. Brain MRI showed multiple hyperintense lesions compatible with demyelination. Both cases were consistent with the diagnosis of acute disseminated encephalomyelitis and both were treated with corticosteroids, showing a good clinical evolution. Discussion: Although acute disseminated encephalomyelitis is rare, is particularly important due to neurological sequels secondary to inadequate diagnosis and treatment. It should be suspected in the young population with encephalitis and a history of infection or recent vaccination.
A case of a woman with a history of resected sellar prolactinoma for over 15 years and major dental and gum disease, with no other medical history, which is hospitalized due to acute meningitis caused by Enterococcus faecium sensitive to vancomycin, with an excellent response to medical management. E. faecium, is a gram positive cocci, commensal, often found in nature and in the gastrointestinal tract.1 It is an unusual pathogen of meningitis in immunocompetent individuals and no prior history of hospitalizations, although this case we think it nevertheless must be considered as a differential diagnosis of purulent meningitis in such patients to provide an appropriate empirical treatment.
INTRODUCTION: Guillain-Barré syndrome (GBS) has been associated with various conditions, infectious agents, lymphoproliferative disorders, trauma, recent surgery, acute myocardial infarction and application of immunological drugs. Its association with the use of tissue plasminogen activator (rtPA) is extremely rare. CASE REPORT: A 53-year-old man was admitted to the emergency room for a stroke in the territory of the right middle cerebral artery, with 2 hours of evolution and NIHSS of 7 points. After discarding intraparenchymal hemorrhage by head CT, the pattient received thrombolysis with rtPA. At 24 hours a control head CT showed an infarct with hemorrhagic transformation, without neurological repercussion. The patient was discharged after 96 hours with NIHSS of 5 points. On the ninth day after discharge the patient returned to the emergency room with generalized weakness, dysphagia, and progressive respiratory distress of 24 hours of evolution, requiring invasive mechanical ventilation upon arrival. At 48 hours it was documenteda right VI nerve paresis, bilateral VII nerve palsy, quadriplegia and areflexia. An MRI showed a right temporo-parietal subacute ischemic stroke with hemorrhagic transformation without evidence of brain stem infarction. Nerve conduction studies were abnormal, showing motor axonal and demyelinating polyneuropathy. The patient underwent 5 sessions of plasmapheresis without improvement. CONCLUSION: This case could point to an association between thrombolytic use and GBS. However, it is necessary to wait for many other reports before this association is considered epidemiologically sound. The rare risk of GBS after thrombolysis should not be an impediment to timely reperfusion of a patient with a stroke through the use of rtPA.
An acute case of Wernicke's encephalopathy (AWE ) is here reported in a 24 year old woman who vomited all ingested food. Onset of AWE was insidious with muscular weakness and a progressive motor disturbance evolving to total paralysis until the patient was unable to stand up or even keep her head up. Associated language disturbance and confusional state developed, followed by oculomotor paresis and nystagmus in all directions. A magnetic resonance study on day 56th showed hyperintensities in periventricular regions, including ventromedial thalamic area and mammillary bodies, mesencephalic tegmenta at quadrigeminal and periaqueductal regions. Though the pontine tegmentum also showed periventricular hyperintensity, the latter tapered down to the upper third of the medulla oblongata near the vestibular nuclei. Patient died on day 60th. The brain displayed severe hemorrhage associated to capillary endothelial swelling, total necrosis of the neuropil and myelin loss in all the affected areas. The lesions in this case are characteristic of the acute phase of Wernicke's encephalopathy due to thiamine deficiency. The lesional intensity seems to be the most relevant among the extense series of cases of AWE described in the scientific literature. Moreover, it is the only case in which the clinical features, the magnetic resonance and the neuropathological findings permit a strict and precise comparison.
Introduction: Epilepsy management is still a problem in spite of recent therapeutic advances. Levetiracetam is a new antiepileptic that has been successfully used in refractory epilepsies. The aim of this study was to evaluate the efficacy of levetiracetam as an add-on therapy in Mexican patients with refractory partial epilepsy. Methods: In an open-label multicenter trial, 70 patients from both genders, aged 12 to 60 years, were included, with a seizures frequency of 5 to 30 per month and who received at baseline 2 to 3 antiepileptics during at least 6 months prior to inclusion, at maximal therapeutic doses. Eight centers participated in the study, 4 included pediatric patients and the resting 4 centers in adult ages. Patients received doses ranging from 1,000 mg to 3,000 mg per day. The inventory QOLIE-10 was applied at baseline and at the end of the study to evaluate the impact on quality of life. Results: We included 30 patients aged 12 to 16 years, 17 aged 17 to 30 and 23 aged 31 to 60 years. In 50% was achieved a reduction in the frequency of seizures. In 17.5% of the adult patients and 76.1% of pediatric subjects (p = 0.001) it was possible to reduce difeat least one antiepileptic during follow-up. Ninety-five percent of patients showed a significant increment in quality of life scoring (p > 0.001), being the youngest patients those who observed the greatest benefit: 97%, 94% and 69.6% of the age groups 12 to 16, 17 to 30 and 31 to 60 years, respectively, reported an increment in the category of quality of life scores (homogeneity, p < 0.001). In only one case suspension of levetiracetam was required due to intolerance. Conclusions: Levetiracetam as an add-on therapy in refractory partial epilepsy is useful, is associated with an improvement in quality of life, diminishes the frequency of crisis, reduces the number of antiepileptics and with this, it potentially lowers the frequency of adverse reactions associated with polytherapy.
We describe the documented link between substance use disorders and severe mental disorders; population that suffers and the characteristics of its heterogeneity (type and severity of the disorder; skills for coping; psychosocial support available and other factors involved). We review the recommendations of the National Project of Evidence Based Practice to encourage its use in organizations that provide management against addictions in Mexico, as unstructured groups, whose schemes approach reduced not assume yet the therapeutic strategies combined psychotherapeutic interventions, social and pharmacological, which aggravates co-morbid disorders, representing a serious challenge to any health care system. Such conditions in most of the services related, not even contemplate the management of this interaction, limiting most of the patients access to simultaneous handling of their disorders. It describes the goals of rehabilitation based interventions to promote to improve personal skills and appropriate use of support systems. It is intended to facilitate the affected its confrontation with the pathology to overcome his disability, the goal of achieving individual process of generating hope and autonomy. It concludes by noting some actions which together represent the management of comorbidity in favour of a custom process, at the hands of qualified personnel prepared ad hoc, and guided by programs that use sites and systems to promote abstinence, with support from psychoeducation programs and family system.
Misinformation and misrepresentation of facts frequently overlaps in Psychiatry, in addition to the erratic vision of the complex issues it handles. In large part, this occurs with the help and participation of the technical process, which is often not considered as an educational matter for patients and their families, permitting the persistence of doubts, reflections and inadequate conclusions regarding professional procedures. The professional activity must consider, health education for patients with as a benchmark that would guide to the handling of some of their health problems, the healthy functioning of their body in order to help to reach a good care of the social health of the community. The word vice and its moral connotations, having already permeated social education on health, is threatening and requires prompt and forced solution to avoid that the patient mentally ill and/or abuser addicted be considered as a bad person and no longer a patient: it is then a vicious person, not worthy of respect and attention, but worthy of punishment. In parallel, the underlying resistance becomes now the best condition, justifying the fears and apprehensions on behalf of a rational defense.
We describe the documented link between substance use disorders and severe mental disorders; population that suffers and the characteristics of its heterogeneity (type and severity of the disorder, skills for coping, psychosocial support available and other factors involved). We review the recommendations of the National Project of Evidence Based Practice to encourage its use in organizations that provide management against addictions in Mexico, as unstructured groups, whose schemes approach reduced not assume yet the therapeutic strategies combined psychotherapeutic interventions, social and pharmacological, which aggravates co-morbid disorders, representing a serious challenge to any health care system. Such conditions in most of the services related, not even contemplate the management of this interaction, limiting most of the patients access to simultaneous handling of their disorders. It describes the goals of rehabilitation based interventions to promote to improve personal skills and appropriate use of support systems. It is intended to facilitate the affected its confrontation with the pathology to overcome his disability, the goal of achieving individual process of generating hope and autonomy. It concludes by noting some actions which together represent the management of comorbidity in favour of a custom process, at the hands of qualified personnel prepared ad hoc, and guided by programs that use sites and systems to promote abstinence, with support from psychoeducation programs and family system.
We review the recommendations of a professional modality published in the literature relating to the therapeutic approach of addictions, issued by international experts (UNODC, CICAD /OEA, Health Canada, NIH, NIDA, SAHMSA, CSAT, ASAM and SSA: National Health Program 2007-2012). Its purpose, attached to the national legislation, based guidelines for treating professional in the National Network for Treatment of Addictions. Its elements collected clinical and academic considerations that result in the best possible practice in order to support specific Program of Action 2007-2012 for the Prevention and Treatment of addictions, issued by the National Council against Addictions, SSA, in favor of therapy for abusers/addict's psychotropic substances and their families. It presents an overview of epidemiological addictive current problem, which includes a brief description of the clinical conditions of acute cases (syndromes of intoxication and abstinence), aiming to achieve the organizations and institutions of addiction treatment in the country, in order to consolidate his eventual certification and indispensable in the field. To achieve that goal, is expected to improve its procedures for boarding, relieve and rehabilitation, enriching the comprehensive network working for the benefit of all involved and the wellbeing of society.
International data found that the severity of the problem epidemiological, clinical comprehensive assessments recommend to patients abusers/addicts and use of psychotropic diagnostic tools, whose efficiency makes them useful elements in certain brain pathologies. We describe the neuroanatomy-physiology of the areas involved in the production of addictive disease as a centre of management and long-term rehabilitation. It indicates the role of frontal cortical structures in human behaviour which disables alteration to the individual to assess the potential reward associated with self-medication. Emphasis is placed in the imagenological participation in the diagnosis and management of these disorders, techniques that make it over him without invading and where the identification of underlying neuro-biochemical mechanisms is crucial. It highlights the resources for better long term psychotherapeutic rehabilitation that joins the utility-educational information to patients and their families. Synergy pharmacological, psychological counseling and vocational favors the highest rate of abstinence and relapse prevention in disorders such as addiction to nicotine, which along with psychosocial support reach the goal of early referral of consumption and maintenance of sustained abstinence. The involvement of health personnel in educating patients and families gives the professional work force and contributes to the dissemination of health recommendations made to that effect, as strengthening management of individual cases, whose quality and warmth contributes to the decline in social stigma due to ignorance and misunderstanding of these disorders.
The therapeutic alliance, the basis of the concept of adherence to treatment of any curative-rehabilitative activity, faces various impediments that influence to the health personnel responsible for promoting a successful treatment of patients with addictive disease and its comorbidities. Herein it is presented a concise review of psychodynamic elements that evidence the importance of technical and methodological factors recommended in the literature for a successful approach to the mechanisms that restrict therapeutic practice in these patients and their families. All of them, given the psychopathological characteristics, behave in a special way and require more comprehensive and combined approaches on management schemes, constant monitoring and evaluation to encourage a better long-term evolution. Limited by their complex health condition, the sufferers and their therapists will consolidate the changes that enable engagement and a effective involvement. Attachment styles affect the therapist-patient dynamics; therefore, it is a specific task of the health professional to promote the development of a better participation and to invigorate the patient's desire for improvement. Besides, this professional behavior sets pragmatic guide or the beginner in psychotherapeutics. This self-monitoring-based learning promotes improvement and facilitates the complex management processes.
INTRODUCTION: Non-adherence to drug therapy is one of the main problems in providing medical management for patients with Parkinson's disease. The factors involved are many and include clinical and socio-demographic aspects. These factors have not been described in Mexican patients. OBJECTIVE: To determine the level of adherence and perceptions about treatment of Mexican patients with Parkinson's disease. MATERIAL AND METHODS : A cross-sectional study was conducted in patients with Parkinson's disease. Clinical and demographic data including antiparkinsonic treatment were recorded. The following clinical instruments were applied: Movement Disorders Society Unified Parkinson's Disease Rating Scale, Morisky-Green Questionnaire, Brief Medication Questionnaire and the Beliefs about Medicines Questionnaire. RESULTS: A total of 64 patients (33 men) were included, the mean age was 59.2 ± 14.5 years. Low adherence was found in 32.8% of the patients; intermediate adherence on 31.3%and high adherence on 35.9%. The 18.8% of the patients reported suspending their antiparkinsonic drugsby choice in the last six months; 56.2% say they worry about side effects, although 90.7% recognized the benefit of treatment. A younger age (p = 0.005), early age of onset (p = 0.001) and having employment (p = 0.043) were the factors associated with a high adherence. CONCLUSIONS: Adherence in the studied sample is less than that reported in other countries. Age and employment have a very important role in treatment adherence.
The rehabilitation addiction is the highest management provided to the patient because of their disorders and comorbidity, effort would fall apart without which the achievement. This is particularly true in the pathology resulting in consumption of psychotropic substances, which often multiple-unit, makes it imperative the goal of achieving and maintaining abstinence productive, as part of a program to prevent relapses. The rehabilitation goal is to help people develop emotional skills, social and intellectual necessary in order to live, learn and work in the community with the least possible amount of support from professionals in different areas. A real and successful rehabilitation requires that individual and community processes are integrated into an active program, phased regarding the needs and potentials of each person. The problems of people not only are individual or internal and solutions lie in interpersonal systems that involve one another. Social networks are a description of certain interactions that set a certain number of people. The congruence between any living being and their environment is adaptation. While an ecosystem retains its consistency, maintains its adaptation, organization and existence. The rehabilitation in this area can help even the addicts, some of whom are infected with HIV/AIDS, to understand and manage their disease, providing simultaneously, the possibility of transforming the person-object-subject in person, through the improvement of self-esteem achieved by them.
Introduction: Epilepsy is a disease that affects all age groups, with a prevalence of 6-18/1,000. The incidence is higher in early infancy and after 65. Development of epilepsy in adolescence is less frequent and there are very few studies about it; in this age group predominates the idiopathic epilepsies. Material and methods: We have studied prospectively a group of 17 patients that initiated with non idiopathic epilepsy (symptomatic/cryptogenic) in adolescence. All of them were studied with CT-Scan and magnetic resonance imaging (MRI), and we compare the results of both studies. Results: The MRI showed brain lesions in six of 17 patients (35%). The most frequent pathology was hipocampal atrophy and sclerosis. Conclusions: Initiation of symptomatic or cryptogenic epilepsy in adolescence is frequent. Partial seizures predominate and MRI is a very important diagnostic tool, which must be done in all the patients in whom CT-scan fails to show the etiology.