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Irritable bowel syndrome (IBS) is a common gut brain interaction disorder that is diagnosed via patient-reported symptoms and various diagnostic criteria. Multiple factors, such as visceral hypersensitivity, gut dysbiosis, dysmotility, gut-brain dysregulation, lifestyle, and dietary habits, are involved in the development of IBS and manifestation of its symptoms of abdominal pain, bloating, and abnormal bowel movements. Lifestyle modifications and dietary changes, behavioral therapy, and pharmacological treatments, namely antispasmodics and antianxiety drugs, are commonly prescribed for IBS management. Pinaverium bromide is a selective calcium channel blocker that acts locally in the gastrointestinal tract and relieves spasms making it an effective agent for the treatment of IBS. This review provides a background on the diagnostic criteria and pathogenic mechanisms of IBS from an Indian clinician standpoint and provides an in-depth overview on clinical studies of pinaverium emphasizing its role in IBS treatment.
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Brain abscess is a rare and often life-threatening sequelae, observed in 5-20% of the patients with cyanotic congenital heart diseases (CHD). Cyanotic heart diseases involve a right-to-left shunt by-passing the pulmonary vascular bed, culminating in tissue hypoxia. We present a case of an uncorrected atrioventricular canal defect (AVCD) with a double outlet right ventricle (DORV) complicated by a brain abscess in a 12-year-old girl. This patient was a known case of CHD diagnosed at 2 years of age and presented to the neurology out-patient department with a holocranial headache, vomiting, and low-grade fever for 5 days. General examination was suggestive of cyanosis and low-set ears. Systemic examination revealed a pansystolic murmur with bilateral extensor plantar reflexes. MRI brain with contrast revealed an abscess in the right temporoparietal lobe with perilesional edema. The patient was managed conservatively. Nine days post-discharge, the patient presented with generalized tonic-clonic seizures and was readmitted and managed accordingly. Subsequently, she was referred to the cardiothoracic surgery department for correction of the CHD. However, the family gave negative consent for the same. The relatives of the case described here were counseled to get a surgical correction done for the cardiac defect at the time of diagnosis but with no success. The aim of publishing this case is to emphasize the need for timely diagnosis and correction of such anomalies to curb serious complications causing profound morbidity and mortality.
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A lo largo de la historia, el conocimiento sobre las meninges ha evolucionado desde los primeros registros en el papiro de Edwin Smith hasta la actualidad, donde se ha descrito SLYM, una cuarta meninge que separa el espacio subaracnoideo en un compartimiento superficial y otro profundo, a la que se le atribuyen funciones de barrera semipermeable y de nicho de células inmunes para la vigilancia y protección del sistema nerviosos central. La FIPAT contiene un grupo de terminologías que son mundialmente aceptadas para la descripción de las estructuras del cuerpo humano, sin embargo, en Terminologia Anatomica, Ter- minologia Neuroanatomica y Terminologia Histologica, aún no se encuentra incluido el término SLYM para representar una cuarta meninge, quizás porque sea un reciente descubrimiento. El objetivo de este estudio fue sugerir un nuevo término que concuerde con los lineamientos de la FIPAT y con las reglas de Terminología Anatómica Regular (RAT) en reemplazo de SLYM, además de proponer su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, previa revisión y aprobación por parte del comité respectivo de la FIPAT. Se revisó el acrónimo SLYM y los elementos que lo conforman (membrana subaracnoidea de tipo linfática), desde un enfoque etimológico, este análisis estuvo acompañado de una revisión a las reglas RAT aceptadas por la FIPAT, que fueron consideradas para examinar su cumplimiento por parte del acrónimo SLYM. Se encontró que SLYM, al igual que los términos que lo componen no cumplen totalmente con las reglas RAT. El acrónimo SLYM no proporciona una descripción adecuada de la estructura que representa, lo que contradice las reglas RAT. Se propone el término Suprapiamater como alternativa, para su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, basado en elementos latinos que describen su ubicación y función, mejorando la precisión y claridad en la comunicación científica.
SUMMARY: Throughout history, knowledge about the meninges has evolved from the first records in the Edwin Smith papyrus to the present, where SLYM, a fourth meninge that separates the subarachnoid space into a superficial compartment and another, has been described deep, to which semipermeable barrier and immune cell niche functions are attributed for the surveillance and protection of the central nervous system. The FIPAT contains a group of terminologies that are globally accepted for the description of the structures of the human body, however, in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, the term SLYM to represent a fourth meninge is not yet included, perhaps because be a recent discovery. The objective of this study was to suggest a new term that agrees with the FIPAT guidelines and with the Regular Anatomical Terminology (RAT) rules to replace SLYM, in addition to proposing its inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, previously review and approval by the respective FIPAT committee. The acronym SLYM and the elements that make it up (Subarachnoid Lymphatic-like Membrane) were reviewed from an etymological approach. This analysis was accompanied by a review of the RAT rules accepted by FIPAT, which were considered to examine their compliance by the acronym SLYM. It was found that SLYM, like the terms that compose it, do not fully comply with the RAT rules. The SLYM acronym does not provide an adequate description of the structure it represents, which contradicts the RAT rules. The term suprapiamater is proposed as an alternative, for inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, based on Latin elements that describe its location and function, improving precision and clarity in scientific communication.
Sujet(s)
Humains , Méninges/anatomie et histologie , Terminologie comme sujet , Espace sous-arachnoïdienRÉSUMÉ
Background: This prospective observational study aims to study magnetic resonance imaging (MRI) findings in the setting of acute febrile encephalopathy in children between 1 month to 18 year of age group.Methods: This study was conducted in patients of acute febrile encephalopathy admitted in pediatric intensive care unit (PICU) at tertiary care centre during January 2019 to December 2019 in age group one month to 18 years. 32 patients satisfied the inclusion criteria.Results: Of the 32 patients included in the study MRI was done in 28 patients. MRI brain was normal in 17 patients and abnormalities were found in 11 patients. Majority findings were cerebral enema and restricted diffusion 3 (10.5%). Other findings were T2 hyperintensity and FLAIR hyperintensity lesion in basal ganglia and thalami region 2 (7%), T2 and FLAIR hyperintensity hippocampal lesion in hippocampus 2 (7%), haemorrhagic lesion 1 (3.5%).Conclusions: Acute febrile encephalopathy is a life-threatening condition. It is important to identify the possible aetiology for directing specific treatment. Amongst others MRI is one modality that has the potential to identify possible aetiology. Paediatric intensive care physicians are not always updated regarding utility of MRI and its findings in acute febrile encephalopathy. The main reason being non-inclusion of this subject in curriculum. This study was intended to understand all the possible MRI findings in acute febrile encephalopathy, correlate it with clinical findings and ultimately aid in management of these cases.
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Spontaneous rupture of brain aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating disease, half of which occurs in individuals under 50 years old. Challenges in its management arise from the decision-making process regarding the preferred method of definitive aneurysm obliteration, whether through surgical intervention or endovascular approach. This study described the role of flow diverter stent as an effective endovascular approach to obliterate aSAH in the acute phase. A 70-yearold female presented with thunderclap headache, slight right hemiparesis, and pupillary-sparing left oculomotor palsy corresponding with ruptured brain aSAH. Endovascular management of flow diverter stent was preferred and inserted within the third day onset. Double antiplatelet was administered prior to and following the procedure. Three-day follow-up showed resolution of brain aSAH with no neurological sequelae. Flow diverter stent offers several advantages over coiling when treating wide-neck, giant, saccular, or fusiform aneurysm. It is also safer for elderly, especially with multiple comorbids, compared with clipping. However, it has risks of either parent/ distal artery occlusion due to its thrombogenic properties or the potential for rebleeding following dual antiplatelet administration. Effective management and thorough evaluation are essential to maximize the likelihood of favorable outcomes when employing this approach. Flow diverter stent is a promising endovascular management for ruptured brain aSAH, particularly in elderly with many comorbids and wide neck/ giant aneurysm at anterior circulation which is not candidate for coiling or clipping. It is also crucial to monitor, evaluate, and manage risk of rebleeding and thrombosis to ensure long-term success of this management approach.
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Background: Brain metastasis is a common problem in patients with NSCLC. This study was done to study the risk factors associated with the development of brain metastasis and assess treatment response in NSCLC to improve patient survival. Methods: This was a retro-prospective study in which 126 patients with non-small cell lung carcinoma with brain metastasis were taken for the study. Results: The mean age in study group was 56.1±12.72 years. Adenocarcinoma was found in 57.1% and squamous cell carcinoma in 41.3% patients. 65.9% patients received chemotherapy for primary disease followed by targeted therapy in 34 (27.0%) patients. 53.9% patients received WBRT after diagnosis of brain metastasis and 23% WBRT and systemic chemotherapy while as14.3% received WBRT and targeted therapy and 2.4% received WBRT, systemic chemotherapy and targeted therapy, 1.6% patients received systemic chemotherapy, WBRT and local RT to the primary site and 0.8% each was treated with gamma knife therapy; surgery, WBRT and targeted therapy; SRS and WBRT. Median overall survival of patients with brain metastasis who received WBRT was 2.5 months and patients who received WBRT and systemic chemotherapy was 9.0 months while patients with brain metastasis who received WBRT and targeted therapy was 14.3 months. Conclusions: The median overall survival as per treatment received after diagnosis of brain metastasis was higher in patients who received WBRT and targeted therapy as compared to patients who received WBRT and systemic chemotherapy and patients who received WBRT only.
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Background: The common psychological difficulties in adolescents are anxiety states or minor depression and apart from that the attention span in adolescents is also shrinking as reported. The Brain Gym exercise is said to release learning blocks and cause improvement in areas such as memory, concentration, and focus. The goal of this study is to improve anxiety and attention in adolescents by performing brain gym exercises. Aim: To study the effects of brain gym exercise on attention and anxiety in adolescents. Methodology: The study employed an experimental study including 134 students within a 15-19 years age group, selected through purposive sampling. The primary outcomes are the Hamilton anxiety rating scale and the mindful attention awareness scale. Brain gym exercise was performed thrice a week for four weeks. Results: A statistically significant improvement in anxiety and attention is observed with using brain gym exercise. The pretest mean anxiety score at week 1 was 18.46 and after four weeks the results showed a statistically significant decrease in anxiety with a mean score of 16.14. The pretest attention score in week 1 was 3.67 and the post-intervention score in week 4 was 3.98 showing a statistically significant increase in attention. The data was statistically significant with a p-value of <0.05.Conclusion: The study concludes there’s a significant effect of brain gym exercises in improving attention and anxiety.
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Resumen El absceso cerebral es un proceso supurativo focal producido en la mayoría de los casos por agentes bacte rianos. Aggregatibacter aphrophilus es una bacteria gram negativa perteneciente al grupo HACEK, causante de endocarditis infecciosa, abscesos hepáticos, entre otras. Los abscesos cerebrales secundarios a este germen son infrecuentes y en la mayoría de los casos asociados a contactos con animales domésticos, pobre higiene dental o procedimientos odontológicos. El tratamiento consiste en drenaje del absceso (mayores de 2.5 cm) combinado con terapia antibiótica, idealmente betalactámicos. Se presenta el caso de un paciente varón de 64 años sin antecedentes de relevancia quien ingresó al servicio de emergencias por cuadro de cefalea, hemianopsias de una semana de evolución y posteriormente crisis tónico clónicas, en quien posteriormente en estudios imageno lógicos y cultivo de lesión cerebral se arribó al diagnóstico de absceso cerebral por A. aphrophilus. Este informe tiene como objetivo ilustrar al lector sobre la rareza de esta infección, debido a que A. aphrophilus forma parte normal de la flora orofaríngea y del tracto respiratorio, en los que rara vez ocasiona bacteriemias invasivas.
Abstract Brain abscess is a focal suppurative process pro duced in most cases by bacterial agents. Aggregati bacter aphrophilus is a gram-negative bacteria belong ing to the HACEK group, which causes infective endo carditis, liver abscesses, among others. Brain abscesses secondary to this germ are rare and, in most cases, it is associated with contact with pets, poor dental hygiene or dental procedures. Treatment consists of drainage of the abscess (greater than 2.5 cm) combined with antibiotic therapy, ideally beta-lactams. The case of a 64-year-old male patient with no relevant history is here presented. He was admitted to the emergency service due to headache, hemianopsia of a week's duration and later tonic-clonic seizures, in whom imaging studies and culture of a brain lesion subse quently revealed a brain abscess due to A. aphrophilus. This case aims to illustrate about the rarity of this infection, because A. aphrophilus is a normal part of the oropharyngeal flora and respiratory tract, in which it rarely causes invasive bacteremia.
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Abstract The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the pa tient from invasive mechanical ventilation (iMV) for ap proximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance to mography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effec tively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.
Resumen La prueba de apnea es una técnica diagnóstica am pliamente utilizada para la evaluación de la muerte cerebral, con el objetivo de demostrar la ausencia de impulso respiratorio debido a la hipercapnia. La variante de la prueba de apnea con insuflación de oxígeno traqueal (I-AT) implica desconectar al pacien te de la ventilación mecánica invasiva (iVM) durante aproximadamente 8 minutos, manteniendo la oxigena ción mediante un catéter de insuflación. Esta prueba respalda el diagnóstico de muerte cerebral cuando se determina un aumento de la PaCO2 superior a 20 mmHg en comparación con el valor inicial o un nivel de PaCO2 superior a 60 mmHg al final de la prueba. En nuestra serie de casos, la implementación de la tomografía de impedancia eléctrica (EIT) reveló que la prueba de apnea con presión positiva continua (CPAP-AT) mitiga eficazmente el colapso pulmonar. Este enfo que resulta en una mejora en la tensión pulmonar en comparación con la desconexión de iMV, demostrando su relevancia en el contexto de potenciales donantes de pulmones.
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Abstract Introduction: This review article develops the basic principles for the use and action mechanisms of neuromodulators applied in clinical practice and their role in treating different disorders of gutbrain interaction (DGBI), particularly, esophageal disorders in part I. Materials and methods: The working group reviewed the most frequent pathologies and medications used according to the most recent literature and presented those with the best clinical evidence in each case. Results: Due to the diversity of disorders, types of studies, and therapeutic options, we decided to present the evidence with the best results for each case. We determined the doses used, their results, and the side effects of each one. Conclusions: The basic principles of the use and mechanisms of action of the main neuromodulators were reviewed, including their use in this section in the main esophageal gastrointestinal functional disorders. Given that the available evidence is not definitive, more controlled clinical trials are needed for each condition to confirm the effectiveness and safety of neuromodulators.
Resumen Introducción: En este artículo de revisión se desarrollan los principios básicos para el uso y los mecanismos de acción de los neuromoduladores utilizados en la práctica clínica y su papel en el tratamiento de los diferentes trastornos de la interacción cerebro-intestino (TICI), particularmente los esofágicos en la parte I. Materiales y métodos: El grupo de trabajo revisó las patologías más frecuentes y los medicamentos utilizados según la bibliografía más reciente, y presenta a los que tienen la mejor evidencia clínica en cada caso. Resultados: Debido a la diversidad de trastornos, tipos de estudios y opciones terapéuticas, se decide presentar las evidencias con los mejores resultados para cada caso, y en cada uno se determinan las dosis utilizadas, sus resultados y efectos colaterales. Conclusiones: Se revisan los principios básicos del uso y mecanismos de acción de los principales neuromoduladores, así como la utilización de los mismos en esta sección en los principales trastornos funcionales gastrointestinales esofágicos. Dado que la evidencia disponible no resulta definitiva, para cada condición se requieren más experimentos clínicos controlados que puedan confirmar la efectividad y seguridad de los neuromoduladores.
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El absceso cerebral es una infección localizada, una colección de material purulento en el parénquima cerebral, que puede surgir como complicación de otra infección o por traumatismo o cirugía. La infección por Nocardia spp. es poco común en pacientes inmunocompetentes, considerándose un agente oportunista. Se describe el caso de un paciente de 51 años, previamente sano, que consultó por cuadro insidioso de meses de evolución de cefalea holocraneana, además de convulsiones tónico-clónicas generalizadas, con picos febriles persistentes, en quien se diagnosticaron abscesos múltiples en el sistema nervioso central a un germen infrecuente.
Brain abscess is a localized infection, a collection of purulent material in the brain parenchyma, which can arise as a complication of another infection or from trauma or surgery. Infection by Nocardia spp. is uncommon in patients without immunocompromised, being considered an opportunistic agent. We present a case of a 51-year-old patient, previously healthy, who consulted for an insidious picture of holocranial headache of months of evolution, in addition to generalized tonic-clonic seizures, with persistent feverish peaks, in whom multiple abscesses were diagnosed in the central nervous system to an infrequent germ, such as Nocardia spp.
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Parkinson's disease patients experience motor signs and non-motor symptoms caused by the disease. Deep brain stimulation of the Subthalamic Nucleus (STN) itself or its ventral or dorsal borders is one of the treatment options indicated to treat the refractory symptoms of this disease. However, it is still unknown which edge, when stimulated, generates more beneficial effects for these patients, which is the objective of this systematic review. To answer this question, electronic and manual searches were conducted in five databases and gray literature to identify studies that answered the question in this review. The selection of studies, data extraction, and analysis of the risk of bias of the included studies were performed. In total, seven studies were included in this systematic review. Most studies presented a minimal risk of bias, and their main methodological limitation was related to the sample inclusion criteria. Stimulation of the dorsal or ventral borders of the STN resulted in improved motor signs of Parkinson's disease, with some of the studies tending towards the choice of dorsal border stimulation for better motor effects, while the improvement in non-motor symptoms and inhibitory control was due to stimulation of the ventral border. The findings of this systematic review suggest that the improvement in the motor signs of Parkinson's disease can be brought about by stimulating the dorsal or ventral borders of the subthalamic nucleus, whereas non-motor symptoms such as anxiety improve with stimulation of the ventral border.
Pacientes com doença de Parkinson frequentemente experimentam sinais motores e sintomas não motores ocasionados pela doença. A estimulação cerebral profunda do Núcleo Subtalâmico (NST) ou de suas bordas ventral ou dorsal é uma das opções de tratamento indicada para tratar sintomas refratários dessa doença. No entanto, ainda não se sabe qual a borda que, ao ser estimulada, gera mais efeitos benéficos a esses pacientes, sendo esse o objetivo dessa revisão sistemática. Para responder essa questão foram realizadas buscas eletrônicas e manuais em cinco bancos de dados e na literatura cinzenta para identificar estudos que abordassem essa temática. Foram executados a seleção dos estudos, extração de dados e análise do risco de viés dos estudos incluídos. No total, sete artigos foram selecionados para comporem o estudo. A maioria dos estudos apresentou baixo risco de viés, sendo que a principal limitação metodológica deles se relacionou com os critérios de inclusão da amostra. A estimulação da borda dorsal ou ventral do NST resultou na melhora dos sinais motores da doença de Parkinson, com alguns dos estudos inclusos com tendência para a escolha da estimulação da borda dorsal para melhores efeitos motores, enquanto a melhora dos sintomas não motores e do controle inibitório foi devido à estimulação da borda ventral. Os achados sugerem que a melhora dos sinais motores da doença de Parkinson pode ser ocasionada ao estimular a borda dorsal ou ventral do Núcleo subtalâmico, enquanto os sintomas não motores, como a ansiedade, melhoram com a estimulação da borda ventral.
Sujet(s)
Maladie de Parkinson/thérapie , Noyau subthalamique , Stimulation cérébrale profonde , Études transversales , Études observationnelles comme sujetRÉSUMÉ
Introducción: La hiponatremia se encuentra asociada aproximadamente con el 10% de los pacientes con traumatismo craneoencefálico, su baja frecuencia y la intuición clínica de esta relación la hace importante en el presente informe de caso. Objetivo: Describir la asociación de la hiponatremia con el traumatismo craneoen-cefálico con la finalidad de mejorar la comprensión de esta relación en el personal de salud y promover la implementación de estrategias de diagnóstico y manejo más efectivas basadas en predicciones bioquímicas y anatómicas actualizadas. Presentación del caso: Paciente masculino, adulto joven, con antecedentes de dos traumatismos craneoencefálicos, con hiponatremia sérica severa y síntomas persistentes de mareo y cefalea, tratado con diuréticos de asa y cloruro de sodio vía oral, con mejoría posterior al vigésimo día de hospitalización. Discusión: Ciertas alteraciones neurológicas con manifestación clínica evidente, se presentan por bajos niveles de sodio sérico, o por causas anatómicas y fisioló-gicas diferentes. Se ha demostrado una relación causal con mecanismo fisiopato-lógico no bien descrito sobre la hiponatremia y el traumatismo craneoencefálico. Conclusión: Es crucial tener una vigilancia meticulosa en pacientes con hipona-tremia severa, aunque presenten pocos síntomas clínicos (considerando antece-dentes como el traumatismo craneoencefálico en la anamnesis inicial y de segui-miento) como en este caso. Además, se destaca la necesidad de investigar las vías metabólicas que podrían verse afectadas por traumatismos craneoencefálicos, y que podrían tener un impacto directo en los niveles de sodio en sangre.
Introduction: Hyponatremia is found to be associated with approximately 10% of patients with traumatic brain injury. Despite its low frequency, the clinical intuition regarding this relationship underscores its significance in this case report. Objective: Describe the association between hyponatremia and traumatic brain in-jury, aiming to enhance healthcare professionals' understanding of this correlation and to advocate for the implementation of more effective diagnostic and manage-ment strategies based on updated biochemical and anatomical predictions. Case Presentation: A young adult male patient with a history of two traumatic brain injuries, severe serum hyponatremia, and persistent symptoms of dizziness and headache, treated with loop diuretics and oral sodium chloride, exhibited improvement after twenty days of hospitalization. Discussion: Certain neurological alterations with evident clinical manifestation are characterized by low levels of serum sodium, possibly stemming from distinct ana-tomical and physiological causes. A causal relationship with a poorly described pathophysiological mechanism between hyponatremia and traumatic brain injury has been suggested. Conclusion: Meticulous monitoring is imperative for patients with severe hypona-tremia, even when clinical symptoms are minimal, as observed in this case. Fur-thermore, emphasis is placed on the need to investigate metabolic pathways that may be affected by traumatic brain injuries, potentially exerting a direct impact on blood sodium levels.
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Humains , Mâle , Adulte , Jeune adulte , Hyponatrémie/étiologieRÉSUMÉ
Las infecciones del sistema nervioso central son potencialmente mortales, causadas por patógenos, como bacterias, virus y hongos. Para llegar hasta el cerebro, los microorganismos utilizan diversas vías y formas. Este patogeno es una bacteria grampositiva corta, flagelar e intracelular, con la capacidad de inducir su internalización en células fagocíticas (monocitos/macrófagos) y no fagocíticas (células endoteliales). Al infectar los macrófagos, estos microorganismos se valen de su capacidad de fijación, adhesión y migración transendotelial, para cruzar la barrera hematoencefálica, finalmente, generando meningitis bacteriana. En esta revisión describimos el mecanismo de caballo de Troya usado por Listeria monocytogenespara invadir el cerebro en el desarrollo de enfermedades infecciosas e incorporamos nuevos conocimientos sobre moléculas que intervienen en dicho mecanismo(AU)
Central nervous system infections are life-threatening, caused by pathogens such as bacteria, viruses and fungi. To access the brain, microorganisms use various mechanisms. Listeria monocytogenes is a short, flagellar and intracellular gram-positive bacterium, with the ability to induce its internalization in phagocytic (monocytes/macrophages) and non-phagocytic (endothelial cells) cells. By infecting macrophages, these microorganisms take advantage of their binding, adhesion, and transendothelial migrationcapacity to cross the blood-brain barrier, finally generating bacterial meningitis. In this review we describe the Trojan horse mechanism used by Listeria monocytogenesto invade the brain in the development of infectious diseases and we incorporate new knowledge about molecules that intervene in this mechanism(AU)
Sujet(s)
Barrière hémato-encéphalique , Système nerveux central , Méningite bactérienne , Listeria monocytogenes , Encéphalite viraleRÉSUMÉ
The field of psychology has advanced over the years in treating psychiatric disorders such as major depressive disorder (MDD), Schizophrenia, and Alzheimer's disease (AD). Depression or clinical depression is a major mental health issue characterized by chronic sadness, hopelessness, and emptiness, which diminishes the patient's quality of life. According to WHO, an estimated 3.8% of the world's population experience depression, in which 15% of depressed patients eventually die by suicide. Recent studies in treating depressive patients have progressed with the usage of psychobiotics. Psychobiotics contain both probiotics and prebiotics, meaning psychobiotics possess the ability to introduce beneficial bacteria in the gut as well as support the growth of existing bacteria in the human gut. The gut-brain axis, which mediates the mechanism of action of psychobiotics in treating clinical depression, has been cleverly studied, and it provides promising results in the improvement of a patient's mental health status. Psychobiotics have proven their worth not only in upgrading the patient's mental health in psychological disorders but also in the enhancement of overall patient health by improving one's gut health.
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Resumen: La microbiota intestinal tiene un impacto bien documentado en diversos aspectos de la salud. En este estudio se recoge la evidencia disponible acerca de la repercusión de la dieta individual y de la microbiota en la percepción del dolor visceral.
Abstract: The gut microbiota has a well-documented impact on various aspects of health. In this study we review the available evidence on the impact of individual diet and microbiota on visceral pain perception.
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Resumen: El neuromonitoreo intraoperatorio con electroencefalograma (EEG) y electroencefalograma procesado (pEEG) permite la evaluación de cambios en la actividad eléctrica cerebral generados por los anestésicos, además de prevenir eventos adversos como recuerdo intraoperatorio, sobredosis farmacológica, compromiso hemodinámico y/o neurológico, delirio y disfunción cognitiva postoperatoria. Sin embargo, la actividad eléctrica cortical puede estar modulada y ser afectada por alteraciones fisiopatológicas, independientemente del efecto de los fármacos anestésicos, por lo que, tanto el EEG como el pEEG pueden ser auxiliares en el diagnóstico oportuno de trastornos metabólicos, hipóxicos, supresión de la actividad eléctrica cerebral, estados epilépticos no convulsivos, hipertensión intracraneal, hipoperfusión o isquemia cerebral. El neuromonitoreo de rutina con el monitor disponible es recomendable con el fin de mejorar nuestra experiencia en su uso para una anestesia personalizada y de precisión, estableciendo estado de profundidad anestésica y dosis farmacológica óptima para el mantenimiento de los mecanismos implicados en la autorregulación de la perfusión cerebral, mejor comprensión de la fisiología, función cerebral y su interacción con los anestésicos e impacto hemodinámico del paciente neuroquirúrgico y no neuroquirúrgico, identificando signos precoces de posibles complicaciones derivadas del procedimiento o por efecto farmacológico y su rápida resolución.
Abstract: Intraoperative neuromonitoring with electroencephalogram (EEG) and processed electroencephalogram (pEEG) allows the evaluation of changes in brain electrical activity and unconsciousness generated by anesthetics, as well as preventing adverse events such as intraoperative recall, drug overdose, hemodynamic and/or neurological compromise, delirium and postoperative cognitive dysfunction. However, cortical electrical activity can be modulated and affected by pathophysiological alterations, independently of the effect of anesthetic drugs, both EEG and pEEG can be helpful in the timely diagnosis of metabolic, hypoxic, and suppression of electrical activity disorders brain, non-convulsive status epilepticus, intracranial hypertension, hypoperfusion or cerebral ischemia. Routine neuromonitoring with the available monitor is recommended in order to improve our experience in order to achieve a patient personalized and precise anesthesia level, arriving to an optimal dose for the maintenance of the mechanisms involved in the autoregulation of cerebral perfusion, understanding brain physiology, function as well as its interaction with drugs and hemodynamic impact to neurosurgical and non-neurosurgical patients, identifying early signs of possible complications derived from the procedure or due to pharmacological effect and their rapid resolution.
RÉSUMÉ
Resumen: La morbimortalidad perioperatoria en cirugía oftalmológica es baja, considerando que la mayor parte de la población que requiere estos procedimientos son pacientes de edad avanzada con múltiples comorbilidades. Embriológicamente el nervio óptico y las capas meníngeas que lo recubren se derivan del ectodermo y están estrechamente relacionadas con las capas meníngeas que recubren al sistema nervioso central, de esta forma la punción inadvertida de las mismas durante los bloqueos orbitarios provocan diseminación del fármaco por medio del líquido cefalorraquídeo a través del espacio subaracnoideo hasta el tronco encefálico. Se reporta el caso de paciente femenino de 61 años de edad, programada para lavado de cámara vítrea en ojo izquierdo. La técnica anestésica fue sedación más bloqueo retrobulbar; posterior a dicho procedimiento, se observa deterioro neurológico, alteraciones cardiovasculares, disminución de la saturación de oxígeno manteniendo ventilación espontánea, pero con obstrucción de la vía aérea; se da apoyo ventilatorio y se administra antihipertensivo, respondiendo favorablemente 40 minutos después del bloqueo retrobulbar. La relación entre un bloqueo orbitario y la aparición de sintomatología neurológica, cardiovascular y/o respiratoria debe suscitar sospechas de anestesia del tronco encefálico. Lo más importante es el reconocimiento y atención temprana de esta complicación para evitar secuelas neurológicas, cardiovasculares o incluso la muerte.
Abstract: Perioperative morbidity and mortality in ophthalmic surgery is low, considering that most of the population that requires these procedures are elderly patients with multiple comorbidities. Embryologically, the optic nerve and the meningeal sheaths that cover it originate from the ectoderm, are closely related to the meningeal layers that cover the central nervous system, whereby their inadvertent puncture during orbital blocks causes drug spread by the cerebrospinal fluid through the subarachnoid space to the brainstem. The case of a 61-year-old female patient is reported, programmed for lavage of the left eye vitreous chamber. The anesthetic technique was sedation and retrobulbar block; after this procedure, neurological impairment, cardiovascular alterations, decreased oxygen saturation were observed, maintaining spontaneous ventilation but with airway obstruction; ventilatory support is given and antihypertensive is administered, responding favorably 40 minutes after retrobulbar block. The relationship between an orbital block and the appearance of neurological, cardiovascular or respiratory symptoms should raise suspicion of brainstem anesthesia. The most important thing is early recognition and attention to this complication, to avoid neurological and cardiovascular sequelae or even death.
RÉSUMÉ
Resumen Introducción: El manejo de los aneurismas cerebrales ha ido evolucionando con el paso de los siglos, se busca evaluar el manejo médico, endovascular y quirúrgico de los aneurismas cerebrales rotos y no rotos a lo largo del tiempo, desde las primeras veces en que fueron tratados hasta las innovaciones que se están llevando a cabo. Materiales y métodos: Se realizó una revisión de artículos buscados en la base de datos de PubMed, buscando "Mesh Terms" (o descriptores en ciencias de la salud) con palabras seleccionadas relacionadas al tema y también se seleccionaron artículos según el criterio de los autores; además de la extracción de datos en Rayyan. Resultados: Se seleccionaron 48 artículos dentro de la búsqueda en Pubmed y según criterios propios de los autores, de los cuales 8 artículos se incluyeron en la sección "pasado", 35 artículos en la sección "presente" y 5 artículos en la sección "futuro". Discusión: Se dividió el manejo de aneurismas en tres secciones: pasado (pasado-1999), presente (20002020) y futuro (2021-futuro). Cada sección tuvo tres grupos: manejo médico, endovascular y quirúrgico. Conclusiones: El manejo de los aneurismas no rotos y rotos tiene métodos farmacológicos, de neuro-intervencionismo y neuro-quirúrgicos para abordar, de la mejor manera, la patología de cada paciente de forma individualizada e integral.
Abstract Introduction: The management of brain aneurysms has evolved over the centuries, it seeks to evaluate the medical, endovascular and surgical management of the broken and not broken brain aneurysms over time, from the first times they were treated even the innovations that are being carried out. Materials and methods: A review of articles searched in the PubMed database was carried out, searching for Mesh Terms with selected words related to the topic and articles were also selected according to the author's criteria. Data extraction in Rayyan. Results: 48 articles were selected within the Pubmed search and according to the author's own criteria. 8 articles were included in the Past section, 35 articles in the Present section, and 5 articles in the Future section. Discussion: Aneurysm management was divided into 3 sections: past (past-1999), present (2000-2020) and future (2021-future). Each section had 3 groups: medical, endovascular and surgical management. Conclusions: The management of non-broken and broken aneurysms has pharmacological, neuro-interventionism and neuro-surgical methods to be able to address each patient's pathology in an individualized and integral way.