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The incidence and prevalence of Huntington's disease (HD) based on a systematic review and meta-analysis of 20 studies published from 1985 to 2010 was estimated at 0.38 per 100,000 person-years (95% confidence interval [CI], 0.16-0.94) and 2.71 per 100,000 persons (95% CI, 1.55-4.72), respectively. Since 2010, there have been many new epidemiological studies of HD. We sought to update the global estimates of HD incidence and prevalence using data published up to February 2022 and perform additional analyses based on study continent. Medline and Embase were searched for epidemiological studies of HD published between 2010 and 2022. Risk of bias was assessed using a quality assessment tool. Estimated pooled prevalence or incidence was calculated using a random-effects meta-analysis. A total of 33 studies published between 2010 and 2022 were included. Pooled incidence was 0.48 cases per 100,000 person-years (95% CI, 0.33-0.63). Subgroup analysis by continent demonstrated a significantly higher incidence of HD in Europe and North America than in Asia. Pooled prevalence was 4.88 per 100,000 (95% CI, 3.38-7.06). Subanalyses by continent demonstrated that the prevalence of HD was significantly higher in Europe and North America than in Africa. The minor increase in prevalence (more so than incidence) demonstrated in this updated review could relate to the enhanced availability of molecular testing, earlier diagnosis, increased life expectancy, and de novo mutations. Limitations include variable case ascertainment methods and lacking case validation data. © 2022 Her Majesty the Queen in Right of Canada. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. Reproduced with the permission of the Minister of Public Health Agency of Canada.
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Enfermedad de Huntington , Humanos , Femenino , Incidencia , Prevalencia , Enfermedad de Huntington/epidemiología , Europa (Continente) , América del NorteRESUMEN
Childhood-onset movement disorders represent a heterogenous group of conditions. Given the complexity of these disorders, the transition of care from pediatric to adult medicine is an important consideration. We performed a scoping review of the literature on transitional care in chronic neurological disease, exploring key transitional issues and proposed transitional care models. Our aim was to describe the current knowledge and gaps about the transition process of young adults with chronic neurological disorders, paying special attention to childhood onset movement disorders. A total of 64 articles were included in the qualitative synthesis; 56 articles reported on transitional care issues, and 8 articles reported on transitional care models. Only 2 articles included patients with movement disorders. The following 4 main transitional issues were identified following synthesis of the available literature: (1) inadequate preparation for the transition process, (2) inappropriate and inconsistent transition practices, (3) inadequate adult services, and (4) heightened emotional response surrounding transition. Of the reported transitional care models, multidisciplinary ambulatory care was the most common approach. In studies evaluating patient-related outcomes, positive health, educational, and vocational outcomes were found. The available literature provides insights on issues that can arise during transition that should be addressed to improve patient and caregiver comfort and satisfaction with care. Further research is needed to evaluate how transitional care programs affect outcomes and their cost effectiveness. More studies are required to determine the needs and outcomes specific to patients with childhood onset movement disorders. © 2020 International Parkinson and Movement Disorder Society.
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Trastornos del Movimiento , Enfermedades del Sistema Nervioso , Cuidado de Transición , Adolescente , Niño , Enfermedad Crónica , Humanos , Trastornos del Movimiento/terapia , Enfermedades del Sistema Nervioso/terapia , Adulto JovenRESUMEN
Background: Tic disorders may reflect impaired inhibitory control. This has been evaluated using different behavioural tasks, yielding mixed results. Our objective was to test inhibitory control in children with tics through simultaneous presentation of multiple, mobile stimuli. Methods: Sixty-four children with tics (mean age 12.4 years; 7.5-18.5) were evaluated using a validated robotic bimanual exoskeleton protocol (Kinarm) in an object-hit-and-avoid task, in which target and distractor objects moved across a screen and participants aimed to hit only the targets while avoiding distractors. Performance was compared to 146 typically developing controls (mean age 13 years; 6.1-19.9). The primary outcome was the percentage of distractors struck. Results: ANCOVA (age as covariate) showed participants struck significantly more distractors (participants without comorbid ADHD, 22.71% [SE 1.47]; participants with comorbid ADHD, 23.56% [1.47]; and controls, 15.59% [0.68]). Participants with comorbid ADHD struck significantly fewer targets (119.74 [2.77]) than controls, but no difference was found between participants without comorbid ADHD (122.66 [2.77]) and controls (127.00 [1.28]). Participants and controls did not differ significantly in movement speed and movement area. Just over 20% of participants with tics fell below the age-predicted norm in striking distractors, whereas fewer than 10% fell outside age-predicted norms in other task parameters. Conclusions: In children with tics (without comorbid ADHD), acting upon both targets and distractors suggests reduced ability to suppress responses to potential triggers for action. This may be related to increased sensorimotor noise or abnormal sensory gating.
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Inhibición Psicológica , Trastornos de Tic/psicología , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Fenómenos Biomecánicos , Niño , Comorbilidad , Videojuego de Ejercicio , Dispositivo Exoesqueleto , Femenino , Mano , Humanos , Masculino , Desempeño Psicomotor , Trastornos de Tic/tratamiento farmacológico , Trastornos de Tic/epidemiologíaRESUMEN
The stereoselective synthesis and anti- Hymenolepis nana activity of six Linezolid-type compounds, obtained by chemical modification of l-Alanine, are reported in this work. The synthetic strategy was to prepare diasteromeric N,N-dibenzylamino oxazolidinones 1 and 2, and coupling with 4-(4-bromophenyl)morpholine (3) to obtain N,N-dibenzylamino Linezolid analogues 4 and 5. A hydrogenolysis reaction over 4 and 5 resulted in amino-free Linezolid analogues 6 and 7, which were acetylated to reach diasteromeric Linezolid analogues 8 and 9. The six Linezolid analogues 4-9 show in vitro antiparasitic activity against Hymenolepis nana cestode, but not against several bacterial strains. Interestingly, compounds 6, 7 and 9 exhibit high potency, having shorter paralysis and death times after exposure (6-10 and 18-21 min, respectively), shorter than those found with antihelmintic compound Praziquantel (20 and 30 min) at 20 mg/mL. In addition, a cytocompatibility assay of 6-9 with human cells (ARPE-19 cells) demonstrate a non-cytotoxic effect at 0.4 mM. These results show the pharmacological potential of the newly reported Linezolid-type analogues as antiparasitic agents against Hymenolepis nana.
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Antibacterianos/farmacología , Antiparasitarios/farmacología , Hymenolepis nana/efectos de los fármacos , Linezolid/farmacología , Staphylococcus aureus/efectos de los fármacos , Animales , Antibacterianos/síntesis química , Antibacterianos/química , Antiparasitarios/síntesis química , Antiparasitarios/química , Línea Celular , Proliferación Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Humanos , Linezolid/síntesis química , Linezolid/química , Pruebas de Sensibilidad Microbiana , Simulación del Acoplamiento Molecular , Estructura Molecular , Pruebas de Sensibilidad Parasitaria , Relación Estructura-ActividadRESUMEN
Worldwide studies towards development of new drugs with a lower rate in emergence of bacterial resistance have been conducted. The molecular docking analysis gives a possibility to predict the activity of new compounds before to perform their synthesis. In this work, the molecular docking analysis of 64 Linezolid dipeptide-type analogues was performed to predict their activity. The most negative scores correspond to six Fmoc-protected analogues (9as, 9bs, 9bu, 10as, 10ax and 10ay) where Fmoc group interacts in PTC for Linezolid. Twenty-six different Fmoc-protected Linezolid dipeptide-type analogues 9(as-bz) and 10(as-bz) were synthesized and tested in antimicrobial experiments. Compounds 9as, 9ay, 9ax, 10as, 10ay and 9bu show significant activity against group A Streptococcus clinical isolated. Analogue 10ay also display high activity against ATCC 25923 Staphylococcus aureus strain and MRSA-3, MRSA-4 and MRSA-5 clinical isolates, with MIC values lower than Linezolid. The highest activity against multidrug-resistant clinical isolates of Mycobacterium tuberculosis was exhibited by 9bu. Finally, a cytotoxicity assay with ARPE-19 human cells revealed a non-cytotoxic effect of 9bu and 10ay at 50 and 25 µM, respectively.
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Antibacterianos/farmacología , Dipéptidos/farmacología , Diseño de Fármacos , Linezolid/farmacología , Mycobacterium tuberculosis/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Antibacterianos/síntesis química , Antibacterianos/química , Línea Celular , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Dipéptidos/síntesis química , Dipéptidos/química , Relación Dosis-Respuesta a Droga , Humanos , Linezolid/síntesis química , Linezolid/química , Pruebas de Sensibilidad Microbiana , Simulación del Acoplamiento Molecular , Estructura Molecular , Relación Estructura-ActividadRESUMEN
The Cu2+, Mn2+, and Fe3+ complexes of a 14 membered macrocycle were synthesized and their antioxidant capacities were evaluated against ABTS and DPPH radicals, with the objective of collecting insights into the biomimetic role of the central metal ions. The macrocycle, abbreviated as H2L14, is a derivative of EDTA cyclized with 1,4-diamine, and the moderately flexible macrocyclic frame permits the formation of [ML14·H2O] chelates with octahedral coordination geometries common among the metal ions. The metal complexes were characterized by electrospray-ionization mass spectrometry, Fourier transform infrared spectroscopy, and Raman and X-ray photoelectron spectroscopic methods, as well as thermogravimetric analysis; the octahedral coordination geometries with water coordination were optimized by DFT calculations. The antioxidant assays showed that [FeL14·H2O]+ was able to scavenge synthetic radicals with moderate capacity, whereas the other metal chelates did not show significant activity. The Raman spectrum of DPPH in solution suggests that interaction was operative between the Fe3+ chelate and the radical so as to cause scavenging capability. The nature of the central metal ions is a controlling factor for antioxidant capacity, as every metal chelate carries the same coordination geometry.
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Antioxidantes/síntesis química , Complejos de Coordinación/síntesis química , Ácido Edético/química , Compuestos Macrocíclicos/síntesis química , Antioxidantes/química , Complejos de Coordinación/química , Cobre/química , Teoría Funcional de la Densidad , Hierro/química , Compuestos Macrocíclicos/química , Manganeso/química , Estructura Molecular , Espectrometría de Masa por Ionización de Electrospray , Espectroscopía Infrarroja por Transformada de Fourier , TermogravimetríaRESUMEN
The cyclophanes 2,9,25,32-tetraoxo-4,7,27,30-tetrakis(carboxymethyl)-1,4,7,10, 24,27,30,33-octaaza-17,40-dioxa[10.1.10.1]paracyclophane (PO) and 2,9,25,32-tetraoxo-4,7,27,30-tetrakis(carboxymethyl)-1,4,7,10,24,27,30,33-octaaza[10.1.10.1]paracyclophane (PC) were coordinated with iron to form cationic binuclear Fe(III) Fe2PO and Fe2PC complexes, respectively. Their antioxidant capacity, superoxide dismutase and peroxidase mimetic activity, as well as their toxicity toward peripheral blood mononuclear cells (PBMCs) were evaluated. Both Fe2PO and Fe2PC are interesting biomimetics with antioxidant capacity similar to that of ascorbic acid that prevent mortality in cultured PBMCs, with the potential to have bioactive and protective functions in disease animal models.
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Antioxidantes/farmacología , Complejos de Coordinación/farmacología , Éteres Cíclicos/farmacología , Hierro/farmacología , Absorción , Complejos de Coordinación/síntesis química , Complejos de Coordinación/química , Citoprotección/efectos de los fármacos , Espectroscopía de Resonancia por Spin del Electrón , Electrones , Éteres Cíclicos/síntesis química , Éteres Cíclicos/química , Humanos , Concentración de Iones de Hidrógeno , Hierro/química , Leucocitos Mononucleares/efectos de los fármacos , Leucocitos Mononucleares/metabolismo , Espectrometría de Masas , Oxidación-Reducción/efectos de los fármacos , Peroxidasa/metabolismo , Protones , Espectrofotometría Infrarroja , Superóxido Dismutasa/metabolismoRESUMEN
A new macrocyclic ligand was synthesized by a reaction between diethylenetriaminepentaacetic (DTPA) dianhydride and trans-1,4-diaminocyclohexane, and the Gd(III) and Yb(III) complexes were prepared. The compounds were characterized by spectroscopic methods. Structural calculation by DFT shows that the amide linkages are arranged in such a way that a conformational strain is minimized in the macrocyclic frame. The coordination modes of the ligand and water in the metal complexes were also determined by DFT. The longitudinal relaxation time T1 was measured for aqueous solutions of the Gd(III) complex. The T1 relaxivity arises from the structural feature that a water molecule coordinated to the paramagnetic metal is surrounded by a large open space, through which the exchange of water occurs readily to shorten the relaxation time of water in the entire region, as a result of the chelate conformation defined strictly by the amide groups and the cyclohexane ring.
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Background: A systematic review of epidemiological studies of primary dystonia from 1985 and 2010 found an overall prevalence of 16.43 per 100,000 (95% CI = 12.09-22.32). Methods: We performed a systematic review of studies from 2010 and 2022 to determine if there are important differences in epidemiology between these time periods. Results: Nineteen studies were included. Incidence of cervical dystonia, blepharospasm, and oromandibular dystonia were each reported in one study; one study reported incidence for all adult onset idiopathic focal dystonias combined. Using data from 11 studies, we performed random effects meta-analyses of the prevalence of cervical dystonia (9.95 per 100,000; 95% CI = 3.51-28.17), blepharospasm (2.82 per 100,000; 95% CI = 1.12-7.12), laryngeal dystonia (0.40 per 100,000; 95% CI = 0.09-1.83), upper limb dystonia (1.27 per 100,000; 95% CI = 0.36-4.52), oromandibular dystonia (0.57 per 100,000; 95% CI = 0.15-2.15), and idiopathic or inherited isolated dystonia all subtypes combined (30.85 per 100,000; 95% CI = 5.06-187.74). All studies reported more cases of dystonia in females. There was no significant difference in prevalence by subgroup analysis based on time of study publication (1985-2010 vs. 2010-2022). Subgroup analysis of differences in prevalence by dystonia subtype by continent using all studies published (1985-2022) revealed significant regional differences in the prevalence of cervical and laryngeal dystonia. Conclusion: The incidence and prevalence of idiopathic or inherited isolated dystonia in the last decade was not significantly different from earlier reports. Population-based studies across multiple geographic areas are needed to obtain a clearer understanding of the epidemiology of this condition.
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Glutathione S-transferases (GSTs) are a family of detoxifying enzymes that catalyze the conjugation of glutathione (GSH) to electrophiles, thereby increasing the solubility of xenobiotics and aiding its excretion from the cell. The present work presents the inhibition of a mu-class GST of the marine shrimp Litopenaeus vannamei by copper (Cu2+) and cadmium (Cd2+). The protein was overexpressed in bacteria and its enzymatic activity measured using 1-chloro-2,4-dinitrobenzene. The mean inhibitory concentration (IC(50)) for shrimp GST against Cu2+) was 4.77 microM and for Cd2+ was 0.39 microM. A molecular model of the protein based on the crystal structure of a maize GST bound to cadmium showed that the metal binds in the GSH-binding site by coordination with Asp and Gln residues. These results are consistent with the experimental data and suggest that sublethal concentration of metals may affect the capacity of the organism to detoxify pesticides or xenobiotics.
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Cadmio/química , Cobre/química , Glutatión Transferasa/antagonistas & inhibidores , Glutatión Transferasa/química , Penaeidae/enzimología , Animales , Sitios de Unión , Glutatión Transferasa/genética , Penaeidae/genética , Plaguicidas/química , Proteínas de Plantas/antagonistas & inhibidores , Proteínas de Plantas/química , Proteínas de Plantas/genética , Proteínas Recombinantes/antagonistas & inhibidores , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Xenobióticos/química , Zea mays/enzimología , Zea mays/genéticaRESUMEN
Introduction: Though many unanswered questions about the pathophysiology of Tourette Syndrome remain, several pharmacotherapies for tics have been studied, with varying results in terms of efficacy and the strength of evidence.Areas covered: This literature review encompasses pharmacotherapies for tics. The pharmacotherapies discussed in this review include: alpha agonists, antipsychotics, topiramate, botulinum toxin, and dopamine depleters.Expert opinion: Once the presence of tics is confirmed and psychoeducation and support are provided to patients and caregivers, one must examine the degree of tic-related impairment and the presence of psychiatric comorbidities. These factors influence treatment decisions as the presence of comorbidity and related impairment may shift the treatment target. When selecting a medication for tics, the presence of ADHD (the most frequent comorbidity) strengthens the case for choosing an alpha agonist. The case for antipsychotic medications is strongest when tic-related impairment is severe and/or the tics are refractory to more conservative measures. All medications require drug safety monitoring procedures and reevaluation over time.
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Agonistas alfa-Adrenérgicos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastornos de Tic/tratamiento farmacológico , Tics/tratamiento farmacológico , Agonistas alfa-Adrenérgicos/administración & dosificación , Agonistas alfa-Adrenérgicos/efectos adversos , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Benzamidas/administración & dosificación , Benzamidas/efectos adversos , Benzamidas/uso terapéutico , Toxinas Botulínicas/administración & dosificación , Toxinas Botulínicas/efectos adversos , Toxinas Botulínicas/uso terapéutico , Comorbilidad , Humanos , Trastornos de Tic/epidemiología , Trastornos de Tic/psicología , Tics/epidemiología , Tics/psicología , Síndrome de Tourette/tratamiento farmacológico , Síndrome de Tourette/epidemiología , Síndrome de Tourette/psicologíaRESUMEN
Synthetic molecules that mimic the function of natural enzymes or molecules have untapped potential for use in the next generation of drugs. Cyclic compounds that contain aromatic rings are macrocyclic cyclophanes, and when they coordinate iron ions are of particular interest due to their antioxidant and biomimetic properties. However, little is known about the molecular responses at the cellular level. This study aims to evaluate the changes in immune gene expression in human cells exposed to the cyclophanes Fe2PO and Fe2PC. Confluent human embryonic kidney cells were exposed to either the cyclophane Fe2PO or Fe2PC before extraction of RNA. The expression of a panel of innate and adaptive immune genes was analyzed by quantitative real-time PCR. Evidence was found for an inflammatory response elicited by the cyclophane exposures. After 8 h of exposure, the cells increased the relative expression of inflammatory mediators such as interleukin 1; IRAK, which transduces signals between interleukin 1 receptors and the NFκB pathway; and the LPS pattern recognition receptor CD14. After 24 h of exposure, regulatory genes begin to counter the inflammation, as some genes involved in oxidative stress, apoptosis and non-inflammatory immune responses come into play. Both Fe2PO and Fe2PC induced similar immunogenetic changes in transcription profiles, but equal molar doses of Fe2PC resulted in more robust responses. These data suggest that further work in whole animal models may provide more insights into the extent of systemic physiological changes induced by these cyclophanes.
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With the objective of studying the conformational and macrocyclic effects of selected metal chelates on their peroxidase activities, Cu2+ and Fe3+ complexes were synthesized with a macrocyclic derivative of ethylenediaminetetraacetic acid and o-phenylenediamine (abbreviated as edtaodH2) and its new open-chain analogue (edtabzH2). The Fe3+ complex of edtaodH2 has a peroxidase-like activity, whereas the complex of edtabzH2 does not. The X-ray study of the former shows the formation of a dimeric molecule {[Fe(edtaod)]2O} in which each metal with an octahedral coordination is overposed over the macrocyclic cavity, as a result of rigid macrocyclic frame, to form an Fe-O-Fe bridge; the exposure of the central metal to the environment facilitates the capture of oxygen to drive the biomimetic activity. The peroxidase-inactive Fe3+ complex consists of a mononuclear complex ion [Fe(edtabz)(H2O)]+, the metal ion of which is suited in a distorted pentagonal bipyramid to be protected from environmental oxygen. The copper(II) complexes, which have mononuclear structures with high thermodynamic stability compared with the iron(III) complexes, show no peroxidase activity. The steric effects play a fundamental role in the biomimetic activity.
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The 2014 Fetal Alcohol Spectrum Disorders Study Group (FASDSG) meeting focused on the dual themes of the risks associated with low to moderate alcohol exposure during pregnancy and knowledge translation practices to enhance the impact of scientific research. The meeting theme was titled "Low drinking versus no drinking: Matching science with policy and public perception." Despite decades of basic science and clinical evidence that has documented the risks associated with prenatal alcohol exposure, there still exists confusion and uncertainty on the part of health professionals and the public regarding the question of whether or not there is a "safe" level of alcohol consumption during pregnancy. The first keynote presentation reviewed the data obtained from large-scale epidemiological studies that have attempted to address the question of relative risk associated with low to moderate alcohol exposure during pregnancy. This presentation was followed by an expert panel discussion of the state of scientific evidence obtained from clinical and basic science investigations concerning this question, and strategies for moving research evidence into policy and practice. The second keynote presentation presented a framework for knowledge translation and mobilization to move research discoveries toward implementation. The conference also featured updates by government agencies, FASt data talks that highlighted new and innovative findings in FASD research, and award presentations, including a lifetime achievement award presented to Dr. Kenneth Warren to acknowledge his longstanding support for FASD research. A highlight of the meeting was the presentation of the 2014 Henry Rosett award to Dr. Philip May in recognition of his substantial contributions to epidemiological studies on FASD.
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Trastornos del Espectro Alcohólico Fetal , Consumo de Bebidas Alcohólicas/epidemiología , Animales , Distinciones y Premios , Femenino , Trastornos del Espectro Alcohólico Fetal/epidemiología , Humanos , Masculino , Embarazo , Investigación Biomédica TraslacionalRESUMEN
Resumen Introducción: El problema que se presenta en la atención de salud en los hospitales públicos es la alta cantidad de pacientes, generando un sostenido crecimiento en las listas de espera y provocando un aumento del tiempo de espera, generando un impacto negativo en los usuarios. Objetivo: Mejorar el proceso clínico de atención del prolapso de órganos pélvicos de un hospital público chileno. Metodología: Se identifican nudos críticos mediante diagramas de flujo, realizando un diagnóstico del proceso desde el ingreso del paciente hasta su alta del hospital. Resultados: Se identifican cada uno de los puntos críticos y se proponen soluciones para agilizar el proceso y con ello mejorar la atención a las usuarias, lo que en definitiva llevó a una disminución del tiempo de espera y, lo más relevante, a una disminución en la cantidad de personas en la lista de espera.
Abstract Introduction: The high number of patients is a common issue in public hospitals that causes a negative impact on the users due to the increment in the waiting lists and in the waiting time to be treated. Objective: To improve the clinical process for caring pelvic organ prolapse in a chilean public hospital. Methodology: The methodology was focused on identifying critical knots using flowcharts and diagnosing the patient's process from their admission until their discharge from the hospital. Results: Some solutions were proposed for each critical point identified so as to accelerate the process, thus improving users' health caring. As a result, the high number of people in the waiting lists and the waiting time decreased substantially.
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Humanos , Prolapso , Tiempo , Atención a la Salud , Prolapso de Órgano Pélvico , Alta del Paciente , Chile , Listas de Espera , HospitalesRESUMEN
Hipócrates padre de la medicina, reconoció la enfermedad cerebrovascular hace más de 2 400 años y utilizó el término apoplejía. En Estados Unidos esta enfermedad es la principal causa de discapacidad, así como la tercera causa de muerte. En Honduras se ha observado que en los últimos años la incidencia hospitalaria del evento cerebrovascular se ha elevado notablemente, lo que constituye la primera causa de morbilidad y mortalidad no traumática en la población adulta y refleja el impacto que la enfermedad tiene en la población. Objetivo: realizar un análisis del primer caso de trombólisis en enfermedad cerebrovascular isquémica en el Hospital Escuela Universitario, Tegucigalpa, Honduras. Caso clínico: paciente femenina de 79 años, quien 40 minutos previos a su ingreso a emergencia de Medicina Interna del Hospital Escuela Universitario, presentó abruptamente afasia neurológica se encontró afasia motora, hemiparesia faciobraquiocrural derecha, con afectación sensitiva superficial ipsilateral y Babinski derecho. La tomografía cerebral simple no fluente y disminución de la fuerza en hemicuerpo derecho. En la evaluación no demostró anormalidades, por lo que cumplió los criterios establecidos y se decide trombolizar. Se logró disminuir el puntaje en la Escala del Instituto Nacional de Salud de 18 a 7 puntos y en la Escala de Rankin Modificada de 4 a 1. Conclusión: la paciente ingresó con déficit motor hemicorporal con afectación del lenguaje; tras la intervención se rescató el área de penumbra y egresó con leve déficit secuelar del lenguaje en la comprensión, sin déficit motor, ni pérdida de la fluidez del lenguaje. El uso de activador recombinante tisular de plasminógeno para ictus isquémico, con tres horas o menos de evolución, aumenta los beneficios del paciente ya que disminuyen las secuelas y reduce los gastos del sistema de salud. Portal razón es catalogado como evidencia clase A...(AU)
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Paresia/complicaciones , Accidente Cerebrovascular/diagnóstico , TrombosisRESUMEN
La Hipertensión Intracraneal Idiopática es un trastorno que afecta típicamente a mujeres jóvenes y obesas, produciendo aumento de la presión intracraneal sin causa identificable. Se deben descartar los trastornos intracraneales como un proceso meníngeo o trombosis venosa cerebral, para hacer un diagnóstico de Hipertensión Intracraneal Idiopática. Los estudios de tratamiento muestran que la punción lumbar es una intervención valiosa más allá de su importancia diagnóstica, el pronóstico es variable, pero la pérdida visual grave se produce en 10 a 25% de los pacientes. La incidencia de la hipertensión intracraneal idiopática va en aumento entre los niños y adolescentes; su cuadro clínico es similar al adulto. Entre los niños se ha asociado con varias etiologías nuevas, incluyendo la hormona de crecimiento recombinante y el ácido todo trans-retinoico. Para la revisión bibliográfica se utilizaron datos más recientes del tema por parte de la revista continuum y bases de datos en Journal of Neurological Science. Caso clínico: paciente femenina de 11 años de edad, con cefalea holocraneana de 3 meses de evolución y visión borrosa concomitante; al examen físico se encontró papiledema bilateral grado IV. Los estudios de imágenes descartaron lesión ocupativa o trombosis cerebral, que provocaron el aumento de la presión intracraneana. La punción lumbar terapéutica y diagnóstica reveló presión de apertura 40cmH2O y citoquímica normal. Conclusión: los pacientes diagnosticados con hipertensión intracraneal...(AU)
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Humanos , Femenino , Niño , Adolescente , Presión del Líquido Cefalorraquídeo , Fondo de Ojo , Presión Intracraneal , Espectroscopía de Resonancia Magnética , Seudotumor CerebralRESUMEN
La encefalitis herpética es un tipo de encefalitis asociada al virus del Herpes Simple (VHS), es una enfermedad grave del sistema nervioso central. El objetivo de este estudio es realizar un análisis de los diferentes métodos diagnósticos de encefalitis herpética. Caso Clínico: paciente femenina de 45 años de edad, con antecedentes personales patológicos negativos; al momento del ingreso presenta cuadro agudo de cefalea, fiebre, alteraciones de conciencia y confusión mental. Con el diagnóstico de ingreso de meningitis bacteriana, previo a su traslado desde el Hospital de San Lorenzo al Hospital Escuela Universitario, fue tratada con antibióticos e ingresada a la sala de mujeres de medicina interna. A las 72 horas no presentó mejoría con los antibióticos administrados y se agregó vancomicina, al tiempo que presentó una crisis convulsiva tónico-clónica, por lo que se realizó punción lumbar encontrándose líquido cefalorraquídeo con predominio de linfocitos, no sangrado, glucorraquia normal, proteinorraquia normal. La Resonancia Magnética (RM), reveló características de encefalitis herpética, diagnostico apoyado por el estudio electroencefalográfico. Confirmado el diagnóstico de encefalitis herpética con los exámenes realizados, se inició tratamiento con aciclovir, con lo que la paciente evolucionó de manera satisfactoria y su única secuela fue disfasia. Conclusión: La RM demostró encefalitis herpética, constituyéndose como el estudio de elección, consensibilidad de 90%-100%, en tanto que la sensibilidad del electroencefalograma es de 84% y la especificidad de 32%. En circunstancias especiales, para realizar el diagnóstico, se puede utilizar la RM junto a la reacción en cadena de polimerasa para herpes, al ser ambas de muy alta sensibilidad...(AU)