Perfil de seguridad y satisfacción con la combinación fija de memantina-donepezilo en pacientes con diagnóstico de Alzheimer moderado a severo / Safety and satisfaction profile with the fixed combination of memantine-donepezil in patients diagnosed with moderate to severe Alzheimer's disease

Introducción: La enfermedad de Alzheimer es un trastorno neurodegenerativo de inicio insidioso y progresión lenta. Epidemiológicamente representa 60% a 70% de los casos de demencia.Objetivo: Determinar el grado de satisfacción y seguridad con la combinación fija de memantina-donepezilo durante 6 meses.Material y métodos: Se llevó a cabo un estudio observacional, transversal y analítico con base a un diseño de Real World Evidence (RWE), para evaluar la satisfacción del tratamiento a través de preguntas con una escala de Likert para la valoración de la satisfacción de 31 pacientes que recibieron como parte de su tratamiento habitual la combinación fija de memantina + donepezilo una vez al día durante seis meses previos a la aplicación de la escala de satisfacción. La información se recopiló de febrero a noviembre del 2021. Resultados: 60% de los eventos adversos fueron leves, 40% moderados. La tolerabilidad luego de 3 meses fue percibida como muy buena o excelente por 81% de pacientes. A seis meses 87,1% calificó como muy bueno o excelente el tratamiento. Satisfacción con el tratamiento a 3 meses fue, "satisfecho en su mayoría" o "totalmente satisfecho" para el 87,1%. Discusión: Prevalencia en el género femenino de 77,4% mayor a la reportada para todo el país de 54,8%, comorbilidades reportadas similares a las descritas por la literatura. Tolerabilidad calificada como excelente en comparación con otros estudios que calificaron como buena tolerabilidad. Conclusión: La administración de la combinación fija de memantina 14 mg + donepezilo 10 mg o memantina 28 mg + donepezilo 10 mg, fue una opción segura y bien tolerada.

Introduction:Alzheimer's disease is a neurodegenerative disorder of insidious onset and slow progression. Epidemiologically it accounts for 60% to 70% of cases of dementia.Objective:Determine the degree of satisfaction and safety with the fixed combination of memantine-donepezil for 6 months.Materials and methods: A cross-sectional, observational, and analytical study was conducted based on a Real World Evidence (RWE) design to assess treatment satisfaction through Likert-scale questions of 31 patients who, as part of their regular treatment, received the fixed combination of memantine + donepezil once daily for six months before the administration of the satisfaction scale. Data collection took place from February to November 2021.Results: 60% of adverse events were mild, 40% moderate. Tolerability after 3 months was perceived as very good or excellent by 81% of patients. At six months 87,1% rated the treatment as very good or excellent. Satisfaction with treatment at 3 months was, "mostly satisfied" or "totally satisfied" for 87,1%. Discussion: Prevalence in the female gender of 77,4% higher than that reported for the whole country of 54,8%, reported comorbidities similar to those described in the literature. Tolerability rated as excellent compared to other studies which rated as good tolerability. Conclusions:Administration of the fixed combination of memantine 14 mg + donepezil 10 mg or memantine 28 mg + donepezil 10 mg was a safe and well-tolerated option.

Adherence to Oral Pre-Exposure Prophylaxis Intervention by Transgender Women: A Systematic Review.

Prevalence of human immunodeficiency virus (HIV) is higher in transgender populations. Pre-exposure prophylaxis (PrEP) intervention is successful in reducing HIV acquisition. We aimed to investigate the adherence to oral PrEP by HIV-negative transgender women (TW). We followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement. We searched in WoS, OVID, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials databases. Participation and adherence to the intervention were low for TW compared to cisgender men who have sex with men (cMSM), and it was measured mostly by self-report (72.7%) or tenofovir-diphosphate/emtricitabine triphosphate dried blood spot (45.5%). Awareness should increase and the effect of oral PrEP on gender-affirming hormone therapy should be explained to TW at the beginning of the trials. One limitation is that our sample size was dominated by two Thai studies with TW sex workers. Future studies should evaluate adherence to new PrEP modalities.

Criterios de inelegibilidad al uso de platinos en cáncer otorrinolaringológico, Guías 2021 / Criteria for ineligibility for the use of platinums in otorhino-laryngological cancer, Guidelines 2021

Introducción: el uso de sales de platinos en patologías oncológicas es ampliamente usado, una de las preocupaciones de los profesionales de la salud es la presencia de eventos adversos en este grupo de pacientes que suelen ser vulnerables, por lo que es necesario la generación de consensos para realizar una selección óptima de pacientes candidatos a terapias basadas en platinos Objetivo: Realizar un consenso de expertos para la inelegibilidad al uso de platinos de acuerdo a varios criterios para realizar un tratamiento óptimo de acuerdo a la selección y categorización de pacientes Pregunta de salud cubierta por la Guía: ¿Qué pacientes portadores de cáncer de origen otorrinolaringológico no son elegibles para tratamiento con platinos? Población: La población objetivos son pacientes adultos con cáncer otorrinolaringológico. Resultados: Se establecieron consensos para la inelegibilidad al uso de platinos sobre los siguientes criterios: Edad >70 años, ECOG >1, Pérdida involuntaria de peso >20%, función auditiva "borderline": alteraciones Grado I, Alteraciones neurológicas Grado I, Trastornos de la función renal: CrCL <60 ml/min, Alteración hepática ≥ grado II Child-Pugh B, Comorbilidades: diabetes, HTA, alteraciones pulmonares, anemia e Insuficiencia cardiaca

Introduction: the use of platinum salts in oncological pathologies is widely used, one of the concerns of health professionals is the presence of adverse events in this group of patients who are usually vulnerable, so it is necessary to generate of consensus to make an optimal selection of candidate patients for platinum-based therapies Objective: To carry out a consensus of experts for the ineligibility for the use of points according to several criteria to carry out an optimal treatment according to the selection and categorization of patients Health question covered by the Guide: Which patients with otorhinolringological origin cancer are not eligible for treatment with platinums? Population: The target population is adult patients with ENT cancer. Results: consensus was established for the ineligibility for the use of lenses on the following crite-ria: Age> 70 years, ECOG> 1, Involuntary weight loss> 20%, "borderline" hearing function: Grade I al-terations, Neurological alterations Grade I, Renal function disorders: CrCL <60 ml / min, Hepatic im-pairment ≥ grade II Child-Pugh B, Comorbidities: diabetes, hypertension, pulmonary disorders, anemia and heart failure.

Phase III Trial of Adjuvant Capecitabine After Standard Neo-/Adjuvant Chemotherapy in Patients With Early Triple-Negative Breast Cancer (GEICAM/2003-11_CIBOMA/2004-01).

PURPOSE: Operable triple-negative breast cancers (TNBCs) have a higher risk of relapse than non-TNBCs with standard therapy. The GEICAM/2003-11_CIBOMA/2004-01 trial explored extended adjuvant capecitabine after completion of standard chemotherapy in patients with early TNBC. PATIENTS AND METHODS: Eligible patients were those with operable, node-positive-or node negative with tumor 1 cm or greater-TNBC, with prior anthracycline- and/or taxane-containing chemotherapy. After central confirmation of TNBC status by immunohistochemistry, patients were randomly assigned to either capecitabine or observation. Stratification factors included institution, prior taxane-based therapy, involved axillary lymph nodes, and centrally determined phenotype (basal v nonbasal, according to cytokeratins 5/6 and/or epidermal growth factor receptor positivity by immunohistochemistry). The primary objective was to compare disease-free survival (DFS) between both arms. RESULTS: Eight hundred seventy-six patients were randomly assigned to capecitabine (n = 448) or observation (n = 428). Median age was 49 years, 55.9% were lymph node negative, 73.9% had a basal phenotype, and 67.5% received previous anthracyclines plus taxanes. Median length of follow-up was 7.3 years. DFS was not significantly prolonged with capecitabine versus observation [hazard ratio (HR), 0.82; 95% CI, 0.63 to 1.06; P = .136]. In a preplanned subgroup analysis, nonbasal patients seemed to derive benefit from the addition of capecitabine with a DFS HR of 0.53 versus 0.94 in those with basal phenotype (interaction test P = .0694) and an HR for overall survival of 0.42 versus 1.23 in basal phenotype (interaction test P = .0052). Tolerance of capecitabine was as expected, with 75.2% of patients completing the planned 8 cycles. CONCLUSION: This study failed to show a statistically significant increase in DFS by adding extended capecitabine to standard chemotherapy in patients with early TNBC. In a preplanned subset analysis, patients with nonbasal phenotype seemed to obtain benefit with capecitabine, although this will require additional validation.

New diagnostic criteria for neurocysticercosis: Reliability and validity.

OBJECTIVE: The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease. METHODS: A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed-effects logistic regression models were used to estimate sensitivity and specificity. RESULTS: Inter-rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%. INTERPRETATION: These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434-442.

Eye movement abnormalities.

Generation and control of eye movements requires the participation of the cortex, basal ganglia, cerebellum and brainstem. The signals of this complex neural network finally converge on the ocular motoneurons of the brainstem. Infarct or hemorrhage at any level of the oculomotor system (though more frequent in the brain-stem) may give rise to a broad spectrum of eye movement abnormalities (EMAs). Consequently, neurologists and particularly stroke neurologists are routinely confronted with EMAs, some of which may be overlooked in the acute stroke setting and others that, when recognized, may have a high localizing value. The most complex EMAs are due to midbrain stroke. Horizontal gaze disorders, some of them manifesting unusual patterns, may occur in pontine stroke. Distinct varieties of nystagmus occur in cerebellar and medullary stroke. This review summarizes the most representative EMAs from the supratentorial level to the brainstem.

Midbrain infarcts and hemorrhages.

The vascular supply of this small brainstem structure is complex. Although midbrain infarcts and particularly hemorrhages are uncommon, their clinical manifestations are diverse mainly because the vertical gaze centers and two of three nuclei of the extraocular muscles lie primarily in the midbrain. Consequently, eye movement disturbances are often the hallmark clinical findings in midbrain stroke. The main clinical patterns, etiology and outcome of infarcts limited to the midbrain are summarized according to defined vascular territories along with the clinical findings of midbrain hemorrhage.

Pontine infarcts and hemorrhages.

Pontine infarcts are often part of a large ischemia involving the brainstem, although infarcts may be restricted to the pons. In both cases, infarcts in the pons are characterized by interesting clinical patterns resulting from a variety of cranial nerve dysfunctions, eye movement disorders and motor, sensory and cerebellar manifestations, either isolated or in combination. The anteromedial and anterolateral territories are the most commonly involved. Penetrating branch artery disease is the most common etiology. Ten percent of all intracerebral hemorrhages are located in the pons, and small hemorrhages in this brainstem structure may, in some instances, give rise to unusual clinical manifestations.

Vertebro-basilar syndromes causing oculo-motor disorders.

PURPOSE OF REVIEW: All functional classes of eye movements require exquisite coordination between cortical, basal ganglia and brainstem centers involved in ocular motor control. Vertebrobasilar stroke may produce a wide spectum of isolated or combined eye-movement disorders. The intent of this article is to summarize the curent knowledge of eye-movement disorders occurring in infarcts involving the different arterial territories of the vertebrobasilar circulation. RECENT FINDINGS: In the last few years there has been an improvement in our understanding of pathophysiological mechanisms that are related mainly to abnormal vergence disorders due to thalamic-subthalamic infarcts, as well as of the peculiar symptoms resulting from otolith pathway involvement occurring in lateral medullary infarcts. Moreover, progress in neuroimaging technology has implicated neurovascular contact of the trochlear nerve in instances of superior oblique myokimia. SUMMARY: Eye-movement disorders commonly occur in vertebrobasilar stroke, although they are often unappreciated. They may make it possible to establish specific anatomical correlates, as well as the probable nature of the underlying pathology.

Causas coexistentes de infarto cerebral / coexisting Causes of cerebral infarct

Antecedentes: La coexistencia de múltiples potenciales causas de infarto cerebral (MPCI) ha sido raramente estudiada. Objetivo: Determinar los factores de riesgo, hallazgos clínicos y patrones topográficos en pacientes con al menos dos potenciales causas de infarto cerebral. Diseño: Análisis de los datos de un registro prospectivo de enfermedad cerebro vascular aguda (el registro de enfermedad cerebro vascular de Lausana, Suiza). Resultados: Entre 3525 pacientes con un primer IC admitidos consecutivamente en el Registro de Enfermedad Cerebro Vascular de Lausana, 250 pacientes (7 por ciento) tuvieron al menos dos MPCI, con los siguientes subgrupos: enfermedad de grandes arterias y una fuente cardiaca de embolismo...

Tratamiento de la Corea Reumática con ácido valproico

Antecedentes y propósito.- La corea es una manifestación infrecuente de la fiebre reumática. En su tratamiento han sido utilizados diversos fármacos. el propósito de este estudio es establecer en nuestros pacientes con corea reumática la respueta al Acido Valproico. Pacientes y Métodos.- Se realizó un estudio simple abierto en el que se incluyeron quince pacientes que reunieron los criterios de corea reumática del protocolo estandar establecido en nuestro servicio. Evaluamos la severidad de la corea antes y durante el tratamiento. Todos los pacientes fueron tratados unicamente con Acido Valproico en dosis progresivas hasta lograr el control de los movimientos coreicos. Resultados.- Un alto porcentaje (73por ciento) de los pacientes fueron adolescentes. Predominó el sexo femenino (67por ciento) y la distribución unilateral de la corea (60 porciento). Los movimientos coreicos tuvieron una evolución promedio de 28 días antes del inicio del tratamiento. en trece pacientes (86 porciento) los movimientos coreicos remitieron y en uno (7 porciento) disminuyeron de severidad. En dos pacientes (13 porciento) los movimientos coreicos recurrieron. Conclusiones.- Nuestros resultados sugieren que el Acido Valproico podría ser el medicamento de primera elección en el tratamiento de la corea reumática.

Mielinolisis central pontina: reporte de un caso

La mielinólisis Central Pontina (MCP) fue descrita por primera vez Adams, Victor y Mancall en 1959 en cuatro pacientes alcohólicos y desnutridos (1,2,3,4,5). La etiología de la MCP es desconocida; en la mayoría de reportes se la relaciona con la corrección rápida de la hiponatremia y enfermedades crónicas (3,4,5,6,7,8,9). Reportamos un paciente alcoholico que ingresó al Hospital Eugenio Espejo con diagnóstico de colera y desarrolló una mielinólisis Central Pontina luego de la corrección de su hiponatremia.

Estudio sobre crecimiento físico de los niños en el Ecuador / Study on physical growth of the children in Ecuador

Expone los conceptos e información básica sobre el estado nutricional de la población ecuatoriana, particularmente de la infancia. Analiza los trastornos o deficiencias en el crecimiento físico de los niños, causados por la mala práctica alimentaria e ingestión de productos mal elaborados o de muy poco valor nutritivo...