Embarazo ectópico abdominal con feto vivo en el Hospital Provincial de Bié, Angola / Abdominal ectopic pregnancy with a live fetus in Bié Provincial Hospital, Angola

El embrión, en condiciones normales, es concebido en la trompa y migra al útero. Un pequeño porcentaje que no llega a completar esta migración, se convierte en embarazo ectópico. Se presentó el caso de un embarazo ectópico abdominal con feto vivo; paciente femenina de 32 años de edad, multigesta con 4 partos eutócicos a término. A las 37 semanas de edad gestacional se remitió al Hospital Provincial de Bié por presentar dolor abdominal difuso, de moderada intensidad, que se exacerbaba con los movimientos fetales. Se realizó la cesárea, se encontró un embarazo ectópico abdominal con feto vivo y placenta implantada en fondo uterino, epiplón y colon transverso. Se dejó placenta in situ para un posterior seguimiento.

The embryo, under normal conditions, is conceived into the fallopian tube and migrates to the uterus. A small percentage of the embryos that do not complete this migration become an ectopic pregnancy. We present a 32-year-old female patient with multiple gestation pregnancies and 4 normal term deliveries who had an abdominal ectopic pregnancy with a live fetus. She was referred to Bié Provincial Hospital at 37 weeks' gestation due to diffuse abdominal pain of moderate intensity, which was exacerbated by fetal movements. A cesarean section was performed; an abdominal ectopic pregnancy with a live fetus and the placenta implanted in the uterine fundus, omentum, and transverse colon was found. The placenta was left in situ for further follow-up.

Estrategia de superación profesional sobre fibrilación auricular contextualizada en la Atención Primaria de Salud / A strategy for the professional training related to atrial fibrillation contextualized to the Primary Health Care settings

RESUMEN Introducción: la solución de los problemas de salud que afectan a la población constituye punto de partida para el diseño de la superación profesional, proceso que posibilita la actualización, ampliación y perfeccionamiento continuo de los conocimientos, habilidades básicas y especializadas de los profesionales que laboran en el nivel de atención primaria de salud. Objetivo: diseñar una estrategia de superación profesional sobre fibrilación auricular contextualizada en la atención primaria de salud en el Policlínico Universitario "Luis Augusto Turcios Lima" de Pinar del Río. Métodos: la investigación se sustentó en el enfoque Dialéctico Materialista que permitió profundizar en el conocimiento del proceso y sus interrelaciones en las condiciones históricas sociales de la educación de postgrado en el especialista en MGI. Se utilizaron métodos teóricos como el análisis documental, histórico lógico, de modelación y criterio de expertos. Resultados: se presenta la estrategia de superación profesional sobre fibrilación auricular contextualizada en la atención primaria de salud con base en las derivaciones teóricas y empíricas del proceso investigativo y a partir de fundamentos sustentados en diferentes áreas del conocimiento, se proponen la estructura, características, componentes y relaciones para el proceso en estudio y su validación teórica. Conclusiones: en la estrategia de superación profesional sobre fibrilación auricular contextualizada en la atención primaria de salud se concretaron los propósitos para lograr un desempeño eficiente del mismo en la transformación de la realidad en el área de salud del Policlínico Universitario "Luis Augusto Turcios Lima" de Pinar del Río.

ABSTRACT Introduction: solving the problems of health that influence on the population constitutes the starting point for the design of professional training, a process that makes possible the update, widening and continuous improvement of knowledge, including the basic and specialized skills of healthcare professionals working in Primary Health Care level. Objective: to design a strategy for the professional training related to atrial fibrillation contextualized to the Primary Health Care settings at Luis Augusto Turcios Lima University Polyclinic, Pinar del Rio. Methods: the research was supported on the Dialectic-Materialistic approach which allowed deepening on the knowledge of the process and its interrelation in the historical and social conditions of postgraduate education for the Comprehensive Medicine Specialists. Theoretical methods were mainly used, such as the documentary analysis, historical-logical, modeling and the criteria of experts. Results: the strategy for professional training related to atrial fibrillation contextualized to the Primary Health Care settings was presented and based on theoretical and empirical derivations of the research process and from the foundations supported on the different areas of knowledge, the structure, characteristics, components and relations toward the process in study and its theoretical validation. Conclusions: the strategy for the professional training related to atrial fibrillation contextualized to the Primary Health Care setting, defined the purposes for the achievement of an efficient performance along with the transformation of the reality in the healthcare area of Luis Augusto Turcios Lima University Polyclinic, Pinar del Rio.

Síntomas depresivos en pacientes diagnosticados con COVID-19 en Pinar del Río / Depressive symptoms in patients diagnosed with COVID-19 in Pinar del Rio province

RESUMEN Introducción: la pandemia por la COVID-19 trae como consecuencia un aumento en el número de casos confirmados y muertes en el mundo. Esta situación provoca el desarrollo de emociones y pensamientos negativos que interfieren en el bienestar y en la salud mental. Objetivo: evaluar síntomas depresivos en pacientes diagnosticados con COVID-19, ingresados en el Hospital Provincial Clínico Quirúrgico Docente Dr. León Cuervo Rubio de Pinar del Río, en los meses de abril a junio en el año 2020. Métodos: se realizó un estudio observacional, descriptivo de corte transversal, en pacientes institucionalizados con diagnóstico de COVID-19 para evaluar síntomas depresivos en el periodo de actividad de la enfermedad durante el año 2020, en un universo de 37 pacientes, en enfermos con edades de 20 años y más. Resultados: en la población estudiada existió un predominio del 50 % del sexo femenino en edades entre 40-59 años, de ellos 34 pacientes presentaron humor depresivo para un 91,89 %, seguido de disminución de su vitalidad 86,48 % y pérdida de la atención y concentración. Dentro de las enfermedades crónicas no transmisibles que presentaron mayor presencia de síntomas depresivos se encontraron la hipertensión arterial y el asma bronquial. Conclusiones: la investigación ha demostrado que la percepción de enfermedades infecciosas referida por la población objeto de estudio, se expresa en una mayor prevalencia de síntomas depresivos. Se destacan el humor depresivo, disminución de su vitalidad, esto repercute en el estado físico y emocional del paciente.

ABSTRACT Introduction: COVID-19 pandemic is resulting in an increase in the number of confirmed positive cases and deaths worldwide. This situation causes the development of negative emotions and thoughts that interfere with well-being and mental health. Objective: to evaluate depressive symptoms in patients diagnosed with COVID-19 admitted to Dr. León Cuervo Rubio Provincial Clinical-Surgical-Teaching Hospital in Pinar del Río province, from April to June 2020. Methods: an observational, descriptive and cross-sectional study was conducted with institutionalized patients diagnosed with COVID-19 to evaluate the depressive symptoms in the period of activity of COVID-19 during the year 2020, with a target group comprising 37 patients who were 20 years and older. Results: the population studied presented a predominance of 50 % of female patients (40-59 years old), where 34 of them showed depressive mood (91,89 %), followed by a decrease in vitality 86,48 % and loss of attention and concentration. Among the chronic non-communicable diseases they suffered from, there was a greater presence of depressive symptoms in patients with hypertension and bronchial asthma. Conclusions: the research has shown that the perception of infectious diseases referred by the population under study evidenced a higher prevalence of depressive symptoms. Depressive mood and decreased vitality stand out, having repercussions on the physical and emotional status of the patients.

Único paciente grave reportado con COVID-19 en Pinar del Río / The only severely-ill COVID-19 patient reported in Pinar del Río

RESUMEN Introducción: la COVID-19 causada por el SARS-CoV-2 constituye una amenaza para la salud pública mundial; con mayor efecto negativo en pacientes con comorbilidades y deterioro del estado de salud. Caso clínico: paciente femenina, de color de piel blanca, de 59 años de edad con antecedentes patológicos personales de hipertensión arterial, diabetes mellitus tipo II, enfermedad pulmonar obstructiva crónica y exfumadora con confirmación de COVID-19 por PCR-RT, presentó neumopatía aguda inflamatoria como complicación y evolución satisfactoria. Sin fuente de infección precisada, se aislaron todos los contactos, se estudiaron y fueron negativos a la COVID-19. Conclusiones: se concluye con la presentación de este caso que la pandemia actual significa un desafío para la comunidad científica porque no existe un tratamiento específico contra el SARSCoV-2. No obstante, Cuba utiliza en su protocolo diversos medicamentos que han demostrado efectividad en el control de la enfermedad al lograr la evolución clínica satisfactoria de varios casos críticos.

ABSTRACT Introduction: SARS-CoV-2 (COVID-19) is a threat to global public health; with the most negative effect on patients with comorbidities and weak health status. Clinical case: a 59-year-old, white skinned, female patient with personal pathological history of high blood pressure, diabetes mellitus type II, chronic obstructive pulmonary disease and ex-smoker with confirmed positive PCR-RT (COVID-19 carrier), presented acute inflammatory pneumopathy as a complication and satisfactory evolution. Without a precise source of infection, all contacts were isolated, they underwent to studies and resulted negative to COVID-19. Conclusions: with this case report it is concluded that this pandemic is a challenge for the scientific community because there is not a specific treatment against SARSCoV-2. Nevertheless, Cuba makes use of its protocols of treatment where diverse medicines are included; which have demonstrated effectiveness in the control of the disease, achieving a satisfactory clinical evolution of several critical patients.

Mieloma múltiple en pacientes hospitalizados en hospital provincial pinareño / Multiple myeloma in patients admitted the provincial hospital of Pinar del Río

RESUMEN Introducción: el mieloma múltiple es un tumor derivado de las células plasmáticas, un tipo de células sanguíneas situadas en la médula ósea que se encargan de producir anticuerpos que sirven para combatir los gérmenes. Objetivo: describir el comportamiento clínico epidemiológico del mieloma múltiple, en pacientes hospitalizados en los servicios de Medicina Interna y Geriatría del Hospital Clínico Quirúrgico Docente Dr. León Cuervo Rubio de Pinar del Río, durante los años 2017 y 2018. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y prospectivo. El universo estuvo conformado por 31 pacientes con diagnóstico de mieloma múltiple, la muestra se conformó por 25 pacientes mediante un muestreo simple aleatorio. Resultados: se observó predominio de la enfermedad en los pacientes masculinos y de los grupos de edades de 70-79 años, se obtuvo como principales comorbilidades y complicaciones la anemia y la insuficiencia renal. Conclusiones: es importante el conocimiento del comportamiento clínico epidemiológico del mieloma múltiple para un diagnóstico oportuno e integral y el mejoramiento de la calidad de vida del paciente.

ABSTRACT Introduction: multiple myeloma is a tumor derived from plasma cells, a type of blood cell in the bone marrow that produces antibodies to fight the germs. Objective: to describe the clinical epidemiological behavior of multiple myeloma in patients hospitalized in the Internal Medicine and Geriatrics services at Dr. León Cuervo Rubio Clinical Surgical Teaching Hospital during the years 2017 and 2018, in Pinar del Río. Methods: an observational, descriptive, longitudinal and prospective study was conducted. The target group included 31 patients diagnosed with multiple myeloma; the sample comprised 25 patients by simple random sample. Results: a prevalence of the disease was observed in male patients and in the age group from 70-79 years old. The main comorbidities and complications presented by patients with multiple myeloma were anemia in all of them, and kidney failure. Conclusions: knowledge of the clinical epidemiological behavior of multiple myeloma is important in order to achieve a timely and comprehensive diagnosis to improve the patient's quality of life.

Caracterización clínica y terapéutica del episodio depresivo en pacientes hospitalizados / Clinical and therapeutic characterization of depressive episodes in hospitalized patients

RESUMEN Introducción: la depresión es la enfermedad psiquiátrica más frecuente y puede sufrirse a cualquier edad. Cerca del 20 % de las personas padecen durante su vida una depresión, de ellos el 70 % son mujeres. Objetivo: caracterizar los pacientes hospitalizados con diagnóstico de episodio depresivo según síntomas clínicos, terapia utilizada y presencia de complicaciones, en el Hospital Clínico Quirúrgico Docente Dr. León Cuervo Rubio de Pinar del Río durante los años 2017-2018. Métodos: se realizó un estudio observacional, descriptivo y transversal. El universo quedó constituido por 116 pacientes con el diagnóstico clínico de episodio depresivo que necesitaron tratamiento psicológico durante la hospitalización. Los datos fueron obtenidos de las historias clínicas, mediante la entrevista y la observación. Resultados: se evidenció que el sexo femenino fue el mayor afectado, en edades entre 40-59 años. Como factores de riesgo sociales se incluyeron estados familiares de salud; económicos relacionados con la personalidad del paciente, y los factores biológicos. La disminución de la atención y concentración, perdida de la confianza en sí mismo, sentimientos de inferioridad, ideas de culpa e inutilidad, fueron los principales síntomas. Conclusiones: la disminución de la atención y concentración, estuvieron presentes en todos los pacientes con predominio de ideas de culpa y de inutilidad, las complicaciones escasas fueron escasas, siendo la terapia cognitivo conductual el tratamiento de elección utilizado.

ABSTRACT Introduction: depression is the most common psychiatric illness. About 20% of people suffer from depression during their lifetime, of which 70 % are women and can be suffered at any age. Objective: to characterize hospitalized patients with diagnosis of depressive episode based on clinical symptoms, therapy applied and presence of complications at Dr. León Cuervo Rubio Teaching Clinical Surgical Hospital. Pinar del Río during the years 2017-2018. Methods: an observational, descriptive and cross-sectional study was performed. The target group included 116 patients with clinical diagnosis of depressive episode who needed psychological treatment during hospitalization. Data were obtained from clinical histories, and through interview and observation. Results: it was evidenced that female gender was mostly affected, in ages between 40-59 years. The main risk factors identified were social factors, such as health relatives, economic factors related to the patient's personality, and biological factors. The main symptoms were reduced attention and concentration, loss of self-confidence and feelings of inferiority, guilt and uselessness. Conclusions: decreased of attention and concentration were present in all patients with predominance of guiltiness and uselessness ideas, scarce complications, cognitive behavioral therapy was the treatment of choice.

Onicomicosis, factores predisponentes, características y dermatosis asociadas / Onychomycosis, predisposing factors, characteristics and associated dermatosis

RESUMEN Introducción: las infecciones fúngicas en piel, cabello y uñas son comunes a nivel mundial, en este marco, la onicomicosis constituye la enfermedad más prevalente de la que la provincia no es ajena. Objetivo: describir factores de riesgo, características y dermatosis asociadas en pacientes mayores de 18 años con onicomicosis en un área de salud. Métodos: estudio observacional, descriptivo y transversal en la consulta de Dermatología del Policlínico Universitario "Raúl Sánchez Rodríguez", en el período 2017-2018. Resultados: predominó el sexo femenino (55,1 %) y el grupo de edades entre 40 y 59 años (43,8 %), el factor de riesgo predominante fue el empleo de calzado oclusivo (84,9 %). Predominó la localización en pies (unilateral) (45,9 %), la forma clínica lateral + superficial distal (33 %), así como de la onicolisis + incurvación (54,6 %) como principal alteración ungueal. La principal modificación ungueal fueron las líneas longitudinales (70,8 %), en cuanto a la consistencia un engrosamiento de las uñas (68,1 %), siendo la leuconiquia (47 %) y melnoniquia (36,8 %) las principales coloraciones detectadas. La tiña pedis (55 %) y la crural (10,8 %) fueron las dermatosis asociadas más frecuentes. Conclusiones: es importante el conocimiento del comportamiento clínico epidemiológico de las onicomicosis para de esta manera poder actuar y modificar los factores de riesgo e incidir sobre las dermatosis asociadas y de alguna manera disminuir la incidencia de onicomicosis.

ABSTRACT Introduction: fungal infections in skin, hair and nails are common worldwide, in this context, onychomycosis is the most prevalent disease where the province is no exception. Objective: to describe the risk factors, characteristics and associated dermatosis in patients older than 18 years old with onychomycosis in a health area. Methods: observational, descriptive and cross-sectional study conducted at Raúl Sánchez Rodríguez University Polyclinic, Dermatology Clinic during the period 2017-2018. Results: female sex predominated (55,1 %) and the age group between 40 and 59 years (43,8 %), the predominant risk factor was the use of occlusive footwear (84,9 %). Localization in feet (unilateral) (45,9 %), lateral plus distal superficial clinical type (33 %), as well as onycholysis plus incurvation (54,6 %) predominated as the main ungueal alteration. The main ungueal modification belonged to the longitudinal lines (70,8 %), in terms of consistency a thickening of the nails (68,1 %), with leukonychia (47 %) and melanonychia (36,8 %), which were the main colors detected. Tinea pedis (55 %) and crural (10,8 %) were the most frequent associated dermatosis. Conclusions: it is important to distinguish the clinical epidemiological behavior of onychomycosis in order to be able to act and modify the risk factors and influence of the associated dermatosis and in one way or another to reduce the incidence of onychomycosis.

La medicina tradicional en afecciones lumbosacras en el adulto mayor / Traditional medicine for lumbosacral conditions in the elderly

RESUMEN Introducción: los métodos empleados por la Medicina Natural y Tradicional son terapéuticos, económicos e inocuos. La lumbalgia es una afección que padecen los adultos mayores en algún momento de la vida. Objetivo: determinar la efectividad de la medicina tradicional en afecciones lumbosacras en el adulto mayor, del Policlínico Universitario Pedro Borrás Astorga, en el período de septiembre de 2016 a junio de 2017. Métodos: se realizó una investigación observacional, analítica, de casos y controles, con un universo de 562 adultos mayores que asistieron a consulta de medicina tradicional con dolor lumbosacro, se seleccionó una muestra aleatoria simple de 200 pacientes, separados en dos grupos, de 100 cada uno, el de casos que recibió tratamiento con medicina tradicional y el grupo de controles tratado con medicina convencional; se utilizaron métodos teóricos, empíricos la revisión de la historia clínica, la escala de Oswestry e índice Womac, se aplicaron técnicas estadísticas (porciento y Chi cuadrado). Resultados: predominaron en ambos grupos las edades entre 60-64 años, el sexo femenino, la ocupación de ama de casa en las féminas y trabajador agrícola en los hombres, la evolución de los síntomas utilizando la medicina tradicional resultó satisfactoria en un 95 %, el 36 % utilizó de 3 a 6 sesiones con ventosas, el 52 % de 7 a 10 sesiones con ventosas, el 88 % recibió tratamiento con digitopuntura y un 48 % presentó gastritis como reacción adversa ante el tratamiento convencional. Conclusiones: la medicina tradicional resultó ser un tratamiento efectivo para los adultos mayores aquejados de afecciones lumbosacras.

ABSTRACT Introduction: the methods used by Natural and Traditional Medicine are therapeutic, economical and harmless. Low back pain is a condition the elderly suffer from at certain moments throughout their lives. Objective: to determine the effectiveness of traditional medicine in lumbosacral conditions in the elderly, at Pedro Borrás Astorga University Polyclinic, from September 2016 to June 2017. Methods: an observational, analytical, case and control research was carried out with a target group of 562 old people who attended a traditional medicine consultation with low back pain, a simple random sample of 200 patients was chosen, who were separated into two groups, of 100 each of cases treated with traditional medicine and the control group treated with conventional medicine; theoretical methods were used, empirical review of clinical history, Oswestry scale and Womac index, along with statistical techniques were applied (percentage and Chi-square). Results: in both groups the ages between 60-64 years predominated, female sex prevailed, the occupation of housewives in women and agricultural workers in men, the development of symptoms using traditional medicine was satisfactory in 95 %, 36 % needed from 3 to 6 sessions with cups, 52 % from 7 to 10 sessions with cups, 88 % underwent treatment with acupressure and 48 % suffered from gastritis as an adverse reactions regarding the conventional treatment. Conclusions: traditional medicine proved to be an effective treatment for the elderly suffering from lumbosacral conditions.

Cistoadenoma seroso gigante de ovario derecho. Reporte de un caso / Right ovary´s giant serous cystadenoma. Case report

El aumento de volumen de los ovarios es una de las más frecuentes afecciones ginecológicas. Se presenta el caso de una paciente blanca, de 59 años de edad, que acudió al cuerpo de guardia del Hospital Provincial Docente Clínico Quirúrgico "Dr. León Cuervo Rubio" de Pinar del Río, Cuba, refiriendo aumento de volumen abdominal y dolor ligero en fosa ilíaca derecha que se irradiaba a flanco, hipocondrio derecho y epigastrio. Presentó dos quistes de ovario, uno de ellos gigante. Se procedió a realizar ooforectomía derecha, y exéresis del mismo. El resultado del estudio anatomopatológico de las piezas quirúrgicas informó: cistoadenomas serosos benignos de ovarios.

The expansion of ovarian volume is one of the most common gynecological conditions. A 59 year-old white female patient, attended emergency room at "Dr. Leon Cuervo Rubio Provincial Surgical Clinical and Academic hospital" at Pinar del Río, Cuba. She showed unusual abdominal volume, and moderate pain in the right iliac fossa, which irradiated the flank on the right hypochondriac region and epigastrio. The patient presented two ovarian cysts, one of them was giant. Right oophorectomy and excision were performed. The result of the pathological study of the surgical specimens reported was: benign ovarian serous cystadenomas.

Subthalamotomy for Parkinson's disease: clinical outcome and topography of lesions.

OBJECTIVE: Subthalamotomy is an effective alternative for the treatment of Parkinson's disease (PD). However, uncertainty about the optimal target location and the possibility of inducing haemichorea-ballism have limited its application. We assessed the correlation between the topography of radiofrequency-based lesions of the subthalamic nucleus (STN) with motor improvement and the emergence of haemichorea-ballism. METHODS: Sixty-four patients with PD treated with subthalamotomy were evaluated preoperatively and postoperatively using the Unified Parkinson's Disease Rating Scale motor score (UPDRSm), MRI and tractography. Patients were classified according to the degree of clinical motor improvement and dyskinesia scale. Lesions were segmented on MRI and averaged in a standard space. We examined the relationship between the extent of lesion-induced disruption of fibres surrounding the STN and the development of haemichorea-ballism. RESULTS: Maximum antiparkinsonian effect was obtained with lesions located within the dorsolateral motor region of the STN as compared with those centre-placed in the dorsal border of the STN and the zona incerta (71.3%, 53.5% and 20.8% UPDRSm reduction, respectively). However, lesions that extended dorsally beyond the STN showed lower probability of causing haemichorea-ballism than those placed entirely within the nucleus. Tractography findings indicate that interruption of pallidothalamic fibres probably determines a low probability of haemichorea-ballism postoperatively. CONCLUSIONS: The topography of the lesion is a major factor in the antiparkinsonian effect of subthalamotomy in patients with PD. Lesions involving the motor STN and pallidothalamic fibres induced significant motor improvement and were associated with a low incidence of haemichorea-ballism.

Tumor de Buschke-Löwenstein. presentación de un caso / Tumor de Buschke-Löwenstein. apresentação de um caso / uschke-Löwenstein tumor. case report

Se presentó un paciente masculino de 68 años, que acudió a consulta de Dermatología por presentar lesiones vegetantes en coliflor en región inguinal izquierda, pubis y perineales, de 10 años de evolución y nunca tratadas. El tumor de Buschke-Löwenstein o condiloma acuminado gigante es una tumoración epitelial benigna, causada por el virus del papiloma humano, trasmisible sexualmente, en raros casos puede malignizar. Se realizó escisión quirúrgica y estudio histopatológico de la lesión inguinal, las restantes lesiones fueron eliminadas con ácido tricloroacético, tratamiento tópico, logrando regresión total de las mismas y se le administró levamisol, inmunomodulador sistémico. La evolución posquirúrgica fue satisfactoria(AU)

A male patient of 68 years was presented who consulted Dermatology to present vegetating and cauliflower lesions in the left inguinal, pubic and perineal region, 10 years of evolution and never treated. Tumor of Buschke-Löwensteinor giant condyloma is a benign epithelial tumor is caused by the human papillomavirus, sexually transmitted and in rare cases can become it in malignant. Surgical excision and histopathological examination of the inguinal lesion was done, the remaining lesions were removed with trichloroacetic acid, topical treatment, achieving complete regression thereof and administered levamisole and systemic immunomodulator. The postoperative course was satisfactory(AU)

Paciente do sexo masculino, 68 anos, apresentou-se aoServiço de Dermatologiadevido a lesões vegetantes nacouve-flor naregião inguinal esquerda, púbis e períneo, comduração de 10 anose nunca tratadas. O tumor de Buschke-Löwenstein ou o condiloma acuminado gigante é um tumor epitelial benigno, causado pelo papilomavírus humano sexualmente transmissível, podendo, em casos raros, malignizar. Excisãocirúrgica e estudo histopatológico da lesão inguinal foram realizados, as lesõ es remanescentesforam eliminadas com ácido tricloroacético, tratamento tópico, obtendoregressão total das mesmas e foi administrado levamisol, imunomodulador sistêmico. A evoluçãopós-operatória foi satisfatória(AU)

The subthalamic nucleus and inhibitory control: impact of subthalamotomy in Parkinson's disease.

The aim of our study was to investigate two inter-related hypotheses about the role of the subthalamic nucleus. First that the subthalamic nucleus plays a role in adjusting response thresholds and speed-accuracy trade-offs and second that it is involved in reactive and proactive inhibition and conflict resolution. These were addressed by comparing the performance of 10 patients with Parkinson's disease treated with right subthalamotomy and 12 patients with left subthalamotomy, to 14 unoperated patients with Parkinson's disease and 23 age-matched healthy control participants on a conditional stop signal task and applying the drift diffusion model. Unilateral subthalamotomy significantly improved Parkinson's disease motor signs. Patients with right subthalamotomy had significantly faster Go reaction times with their contra-lesional hand than the unoperated patients and did not differ from the control participants, indicating their speed of response initiation was 'normalized'. However, operated patients made significantly more discrimination errors than unoperated patients and controls, suggesting that subthalamotomy influenced speed-accuracy trade-offs. This was confirmed by the drift diffusion model, revealing that while the unoperated patients had significantly lower drift rate and higher response thresholds than the control participants, the response thresholds for the operated groups did not differ from the controls and the patients with right subthalamotomy had a significantly higher drift rate than unoperated patients and similar to that of controls. The drift diffusion model further established that unlike the control participants, operated patients failed to show context-dependent strategic modulation of response thresholds. The patients with right subthalamotomy could not engage in late phase, fast inhibition of the response and showed minimal proactive inhibition when tested with the contra-lesional hand. These results provide strong evidence that the subthalamic nucleus is involved in response inhibition, in modulating the rate of information accumulation and the response threshold and influencing the balance between speed and accuracy of performance. Accordingly, the subthalamic nucleus can be considered a key component of the cerebral inhibitory network.

Zolpidem induces paradoxical metabolic and vascular changes in a patient with PVS.

INTRODUCTION: Zolpidem is a non-benzodiazepine drug used for the therapy of insomnia, which has selectivity for stimulating the effect of GABA-A receptors. Recently, a paradoxical arousing effect of zolpidem in patients with severe brain damage has been repeatedly reported. METHODS: A placebo-controlled magnetic resonance study was conducted to evaluate its effect on BOLD and metabolites spectral signals in a patient with severe brain injuries and an age-matched healthy volunteer. A multi-modal analysis was used to assess aspects in the pharmacologically-induced changes in the resting-state brain metabolism. RESULTS: A significantly increased BOLD signal was transiently localized in the left frontal cortices, bilateral anterior cingulated areas, left thalamus and right head of the caudate nucleus. The healthy subject showed a deactivation of the frontal, parietal and temporal cortices. BOLD signal changes were found to significantly correlate with concentrations of extravascular metabolites in the left frontal cortex. It is discussed that, when zolpidem attaches to modified GABA receptors of neurodormant brain cells, brain activation is induced. This might explain the significant correlations of BOLD signal changes and proton-MRS metabolites in this patient after zolpidem. CONCLUSION: It was concluded that proton-MRS and BOLD signal assessment could be used to study zolpidem-induced metabolic modulation in a resting state.

Semantic and phonemic verbal fluency in Parkinson's disease: Influence of clinical and demographic variables.

Changes of cognitive function in PD have been extensively documented and defined as a 'frontal' type executive dysfunction. One of the main components of this executive dysfunction is the impairment of verbal fluency. The aim of the present study was to assess semantic and phonemic fluency in a large sample of PD patients and to investigate the effect of clinical and sociodemographic variables on verbal fluency in this patient group. Three hundred patients with idiopathic Parkinson's disease who were consecutive referrals to our clinic and 50 age and education matched healthy controls completed the phonemic and semantic verbal fluency tasks. Both phonemic and semantic verbal fluency were significantly impaired in PD patients relative to matched controls. Stage of illness, presence of depression, education and age influenced verbal fluency measures. Regression analyses established that global measures of cognitive ability (MMSE) and executive function (FAB) and side of onset of motor symptoms predicted 36-37% of variance of phonemic or semantic verbal fluency measures. Thus, future studies aimed at assessing cognitive functioning in PD patients treated by deep brain stimulation (DBS) should adequately take into account several factors (stage of illness, depression, executive functioning) which may potentially influence performance on verbal fluency tasks.

Intervention for control of hypertension in Catalonia, Spain (INCOTECA Project): results of a multicentric, non-randomised, quasi-experimental controlled intervention study.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a quality improvement (QI) plan aimed at primary healthcare teams (PHCTs) to optimise hypertension control and to compare it with standard clinical care. METHODS: Design Multicentric, non-randomised, quasi-experimental controlled intervention study. Setting 5 PHCTs in the intervention and 13 in the standard care group in the province of Barcelona, Catalonia, Spain. Participants This is a population-based study in which all patients over 18 years of age with a diagnosis of hypertension before 1 January 2006 were included (n=9877 in the intervention group and n=21 704 in the control group). Intervention A QI plan that targeted primary care professionals. The plan included training sessions, implementation of recommended clinical practice guidelines for the management of hypertensive patients and audit and feedback to health professionals. Main outcome measure Prevalence of hypertensive patients with an adequate blood pressure (BP) control. RESULTS: The adjusted difference between intervention and standard care groups in the odds of BP control was 1.3 (95% CI 1.1 to 1.6, p=0.003). Results of the mixed model on repeated measures showed that, on average, an individual in the intervention group had an increase of 92% in the odds of BP control (OR 1.9, 95% CI 1.7 to 2.1). CONCLUSIONS: The implementation of a QI plan can improve BP control. This strategy is potentially feasible for up-scaling within the existing PHCTs. TRIAL REGISTRATION: ClinicalTrials.gov MS: 1998275938244441.

Use of Cuban recombinant human erythropoietin in Parkinson's disease treatment.

INTRODUCTION: Recombinant human erythropoietin is used primarily to treat anemia. There is evidence of its neuroprotective capacity from preclinical studies in Parkinson's disease and other neurodegenerative diseases. Recombinant human erythropoietin produced in Cuba (ior-EPOCIM) is registered and approved for use in humans in Cuba and in a number of other countries. OBJECTIVE: Assess safety and possible neuroprotective effect of ior-EPOCIM in a group of Parkinson's disease patients. METHODS: A three-phase exploratory study (proof of concept) was conducted from August 2008 to April 2009: preliminary assessment, treatment (weeks 1-5), and post-treatment (weeks 6-35). Participants were 10 Parkinson's disease patients (8 men, 2 women) from the outpatient clinic at the International Neurological Restoration Center, all at least one year post onset, aged 47-65 years. The ior-EPOCIM was administered subcutaneously in a once-weekly dose (60 IU/kg body weight) for five weeks. Therapy with patients' antiparkinsonian drugs was maintained throughout the study, except during motor examination, conducted following a 12-hour withdrawal (OFF condition). Safety was evaluated primarily by recording adverse events (by intensity and causality) from start of treatment until the study's completion. Hematological parameters and blood pressure were also measured because of their direct relationship to the medication's action. To evaluate possible neuroprotective activity, variables were included related to patients' motor function and cognitive and affective status, measured using internationally recognized scales. All variables were evaluated before, during and after treatment. Data were processed using a fixed-effects linear model, with a repeated-measures design (significance level p ≤ 0.05). RESULTS: Three patients experienced mild adverse events (precordial discomfort and hypertension in one; leg fatigue in another; renal colic in a third), with a possible causal relationship in the first two that was neither life threatening nor required hospitalization. Hemoglobin was the only hematological parameter that showed a growing and significant increase (p < 0.001), but without reaching pathological levels. The other variables presented clinically positive and statistically significant changes compared to pretreatment assessment: motor function (p < 0.001), cognitive status (p < 0.001) and mood (p = 0.013). CONCLUSIONS At the dosage used, ior-EPOCIM was safe and well tolerated in these Parkinson's disease patients. Further studies are needed to corroborate these results and evaluate the medication's possible neuroprotective effect. KEYWORDS Parkinson disease, erythropoietin, recombinant proteins, neuroprotective agents, clinical trial, safety, ior-EPOCIM, Cuba.

Deficits in inhibitory control and conflict resolution on cognitive and motor tasks in Parkinson's disease.

Recent imaging studies in healthy controls with a conditional stop signal reaction time (RT) task have implicated the subthalamic nucleus (STN) in response inhibition and the pre-supplementary motor area (pre-SMA) in conflict resolution. Parkinson's disease (PD) is characterized by striatal dopamine deficiency and overactivity of the STN and underactivation of the pre-SMA during movement. We used the conditional stop signal RT task to investigate whether PD produced similar or dissociable effects on response initiation, response inhibition and response initiation under conflict. In addition, we also examined inhibition of prepotent responses on three cognitive tasks: the Stroop, random number generation and Hayling sentence completion. PD patients were impaired on the conditional stop signal reaction time task, with response initiation both in situations with or without conflict and response inhibition all being significantly delayed, and had significantly greater difficulty in suppressing prepotent or habitual responses on the Stroop, Hayling and random number generation tasks relative to controls. These results demonstrate the existence of a generalized inhibitory deficit in PD, which suggest that PD is a disorder of inhibition as well as activation and that in situations of conflict, executive control over responses is compromised.