RESUMEN
Background: Multiple Sclerosis (MS) is a common neurological disease among white populations of European origin. Frequencies among Latin Americans continue to be studied, however, epidemiologic, and clinical characterization studies lack from Central American and Caribbean countries. Ethnicity in these countries is uniformly similar with a prevalent Mestizo population. Methods and results: Data from January 2014 to December 2019 from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic, and Aruba on demographic, clinical, MRI and phenotypic traits were determined in coordinated studies: ENHANCE, a population-based, retrospective, observational study on incidence and clinical characteristics, and from the subgroup with MS national registries (Aruba, Dominican Republic, Honduras, and Panama), data on prevalence, phenotypes and demographics. Expanded Disability Status Scale (EDSS), and therapeutic schemes were included. ENHANCE data from 758 patients disclosed 79.8% of Mestizo ethnicity; 72.4% female; median age at onset 31.0 years and 33.2 at diagnosis. The highest incidence rate was from Aruba, 2.3-3.5 × 100,000 inhabitants, and the lowest, 0.07-0.15 × 100,000, from Honduras. Crude prevalence rates per 100,000 inhabitants fluctuated from 27.3 (Aruba) to 1.0 (Honduras). Relapsing MS accounted for 87.4% of cases; EDSS <3.0 determined in 66.6% (mean disease duration: 9.1 years, SD ± 5.0); CSF oligoclonal bands 85.7%, and 87% of subjects hydroxyvitamin D deficient. Common initial therapies were interferon and fingolimod. Switching from interferon to fingolimod was the most common escalation step. The COVID-19 pandemic affected follow-up aspects of these studies. Conclusion: This is the first study providing data on frequencies and clinical characteristics from 8 countries from the Central American and Caribbean region, addressing MS as an emergent epidemiologic disorder. More studies from these areas are encouraged.
RESUMEN
Huntington's disease (HD) is a rare neurodegenerative disease with a multitude of symptoms, which requires access to specialized multidisciplinary care for adequate management. The aim of this study was to survey the characteristics of care in various HD centers in South America (SA).
A questionnaire was sent to 24 centers involved in the care for HD patients in SA.
Of the total 24 centers, 19 (79.2%) are academic units. The majority of centers (62.5%) are general movement disorders clinics. Multidisciplinary care is available in 19 (79.2%) centers and in 20 (83.3%) care is provided free of charge. Genetic testing and counseling are available in 25 and 66.6% of centers, respectively. The majority of centers (83.3%) have no institutional support for end-stage care.
Although HD centers in SA are committed to providing multidisciplinary care, access to genetic counseling and end-stage care are lacking in most centers.
A doença de Huntington (DH) é uma doença neurodegenerativa rara que requer tratamento multidisciplinar especializado para manejo adequado. O objetivo do presente trabalho foi pesquisar as características da assistência à saúde em centros de DH na América do Sul (AS).
Um questionário foi enviado para 24 centros envolvidos no cuidado de pacientes com DH na AS.
Dos 24 centros, 19 (79,2%) são unidades acadêmicas. A maioria (62,5%) são clínicas de distúrbios dos movimentos. Cuidado multidisciplinar é disponível em 19 (79,2%) dos centros e em 20 (83,3%), o tratamento é gratuito. O teste e o aconselhamento genético estão disponíveis em 25 e 66,6% dos centros, respectivamente. Não há suporte institucional para cuidado terminal em 83,3% dos centros.
Apesar dos centros de DH na AS terem compromisso com o provimento de cuidados multidisciplinares, o acesso a aconselhamento genético e a tratamento na fase terminal são falhos na maioria dos centros.
Asunto(s)
Humanos , Atención Integral de Salud/estadística & datos numéricos , Atención a la Salud/estadística & datos numéricos , Enfermedad de Huntington/terapia , Asesoramiento Genético , Pruebas Genéticas , Atención Dirigida al Paciente/estadística & datos numéricos , América del Sur , Encuestas y CuestionariosRESUMEN
The authors present a historical review of the seminal clinical contribution of Professor Américo Negrette, a Venezuelan neurologist, to the evolution of scientific knowledge about Huntington's disease.
Os autores apresentam uma revisão histórica sobre a magistral contribuição clínica do Professor Américo Negrette, neurologista venezuelano, na evolução do conhecimento científico sobre a doença de Huntington.
Asunto(s)
Historia del Siglo XX , Historia del Siglo XXI , Humanos , Enfermedad de Huntington/historia , Neurología/historia , VenezuelaRESUMEN
Los agonistas dopaminérgicos constituyen un elemento importante en la terapia de la enfermedad de Parkinson. Se revisa con especial énfasis la nueva generación de agonistas.
Asunto(s)
Agonistas de Dopamina/administración & dosificación , Enfermedad de Parkinson/terapiaRESUMEN
Se hizo una revisión retrospectiva de 3.753 historias de Atención Primaria de Salud (APS), correspondiente al trimestre enero-marzo de 1987. A 204 pacientes (5.43%) se les hizo el diagnóstico o venían referidos de otros centros por alguna patología quirúrgica. se agruparon estas entidades según categorias codificadas por la Clasificación Internacional de Enfermedades. Se presentan las patologías quirúrgicas de acuerdo con su frecuencia por aparatos y sistemas, edad, sexo y referencia justificada a un servicio de Cirugia General. los resultados se expresan en porcentajes. Las Consultas del Primer Nivel de Atención Médica del Centro de APS en el A-HUC, constituye una asistencia médica importante, que permite el diagnóstico precoz y la clasificación de los problemas de salud del usuario según estados morborsos, edad y sexo, facilitando la selección de los pacientes que en forma justificada ameriten tratamiento en un segundo o tercer nivel de atención