Clinical Pathway for the Diagnosis and Management of Patients With Relapsing-Remitting Multiple Sclerosis: A First Proposal for the Peruvian Population.

Background: Relapsing-remitting multiple sclerosis (RRMS) is a subtype of degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system and leads to multifocal neurological impairment. Objectives: To develop a clinical pathway (CP) for the management of Peruvian patients with RRMS. Methods: First, we performed a literature review using Medline, Embase, Cochrane, ProQuest, and Science direct. Then, we structured the information as an ordered and logical series of five topics in a defined timeline: (1) How should MS be diagnosed? (2) How should a relapse be treated? (3) How should a DMT be initiated? (4) How should each DMT be used? and (5) How should the patients be followed? Results: The personnel involved in the care of patients with RRMS can use a series of flowcharts and diagrams that summarize the topics in paper or electronic format. Conclusions: We propose the first CP for RRMS in Peru that shows the essential steps for diagnosing, treating, and monitoring RRMS patients based on an evidence-based medicine method and local expert opinions. This CP will allow directing relevant clinical actions to strengthen the multidisciplinary management of RRMS in Peru.

Radiculopatía lumbar, alteraciones electromiográficas y discapacidad funcional en personal policial con discapacidad laboral. Hospital Nacional PNP 2009-2012 / Lumbar radiculopathy, electromyographic alterations and functional disability in police personnel with occupational disability. National Hospital PNP 2009-2012

OBJETIVOS: Determinar las características de la Radiculopatía lumbar, las alteraciones electromiográficas y la discapacidad funcional en el personal policial con discapacidad laboral. Hospital Nacional PNP 2009-2012. METODOLOGIA: Estudio Observacional, de tipo descriptivo, ambipectivo. Se trabajó con un total de 85 pacientes que formaron parte del personal policial a quienes se les indico discapacidad laboral, entre el periodo de 2009-2011 atendidos en el servicio de Neurología del Hospital Nacional PNP, a quienes posteriormente se le aplicó el test de discapacidad funcional de "Wadell" y "Oswestry". Para evaluar los resultados se estimaron las frecuencias absolutas y relativas así como medidas de tendencia central y de dispersión. Para darle la validez estadística se hará uso del programa SPSS v.20, estimándose frecuencias absolutas y relativas, medidas de tendencia central y dispersión. Se aplicó una prueba de Chi cuadrado con una significancia del 95 por ciento. RESULTADOS: Las características sociodemográficas del personal policial con discapacidad laboral por Radiculopatía lumbar son: La mayoría se encuentra entre las edades de 40 a 50 años (35.3 por ciento) siendo de sexo "Masculino" 76.5 por ciento. El 44.7 por ciento del personal policial tienen grado de "Suboficial" procediendo el 61.2 por ciento de Provincia. La raíz lumbar más afectada fue L4-L5 (31.8 por ciento). El 40 por ciento tuvo un tiempo de enfermedad entre 0 a 6 meses, de los cuales la mayoría presentó Dolor y parestesias (64.7 por ciento). El 35.3 por ciento de los pacientes presentó Hipoestesia en el territorio S1 seguido por el 31.8 por ciento que presentó Hipoestesia en el territorio L5. La alteración de la conducción motora se presentó en el 94.1 por ciento del personal policial, para la alteración electromiográfica con aguja: El 64.7 por ciento tuvo un patrón neuropático y el 41.2 por ciento tuvo un patrón de desnervación. El grado de discapacidad funcional fue 38.8 por ciento...

OBJECTIVE: To determine the characteristics of lumbar radiculopathy, electromyographic abnormalities and functional disability in disability personnel police personnel. "National Hospital PNP" from 2009 to 2012. METHODOLOGY: Observational study, descriptive, ambipectivo. We worked with a total of 85 patients who were part of police personnel who have indicated work disability, between the periods of 2009-2011 attended al the service of "Neurology" at the National Hospital PNP, who was applied later the test of disability function "Wadell" and "Oswestry". To evaluate the results we estimated the absolute and relative frequencies and measures of central tendency and dispersion. To give statistical validity to the data collected, we will make use of SPSS version 20, estimated absolute and relative frequencies, measures of central tendency and dispersion. We applied a chi-square test with a significance of 95 per cent. RESULTS: The demographic characteristics of police personnel with work disability for lumbar radiculopathy are: Most of them are between the ages of 40-50 years (35.3 per cent) being sex "Male" 76.5 per cent. The 44.7 per cent of police personnel have degree of "Official sub" proceeding the 61.2 per cent of Province. The most affected was lumbar root L4-L5 (31.8 per cent). 40 per cent had disease duration between 0-6 months, of which most were of pain and paresthesia (64.7 per cent). The 35.3 per cent of patients had hypoaesthesia in the territory S1, followed by 31.8 per cent who presented hypoaesthesia in the territory L5 and 27.1 per cent in the territory Hypoesthesia L4. The motor conduction disturbance occurred in 94.1 per cent of police personnel, for needle electromyographic alteration: The 64.7 per cent had a neuropathic pattern and 41.2 per cent had a pattern of denervation. Furthermore, 82.4 per cent had a Paraespinal muscle disorder Lumbar; the 76.5 per cent had lateral gastrocnemius. The degree of functional disability was 38.8 per cent...