Paradoxical manifestations during tuberculous meningitis treatment among HIV-negative patients: a retrospective descriptive study and literature review.

BACKGROUND: Tuberculous meningitis (TBM) is the most frequent, severe, and disabling form of central nervous system (CNS) tuberculosis (TB). TBM paradoxical manifestations are characterized by clinical or paraclinical worsening after 1 month of effective anti-TB treatment in patients who initially responded to treatment despite the use of adjunctive corticosteroids. METHODS: Retrospective descriptive study of consecutive HIV-negative adult patients (≥ 18 years) with definitive TBM who developed a paradoxical manifestation following anti-TB in a tertiary-care hospital in Mexico from 2009 to 2019; we also conducted a literature review of published cases/series of paradoxical manifestations in HIV-negative patients from 1980 to 2020. RESULTS: We detected 84 cases of definitive TBM; 55 (68.7%) HIV-negative patients and 29 (36.3%) HIV-infected patients. Among HIV-negative patients, four (7.3%), three female and one male (19-49 years old), developed a paradoxical manifestation within 4-14 weeks following treatment initiation despite receiving adequate corticosteroid doses; Mycobacterium bovis was isolated from the cerebrospinal fluid of three cases and Mycobacterium tuberculosis in one more. Two patients developed vasculopathy-related cerebral infarctions, one severe basilar meningitis, and hydrocephalus, one more a tuberculoma. Two were treated with intravenous cyclophosphamide, and two with steroids. One of the patients treated with steroids died; patients who received cyclophosphamide had a good clinical response. CONCLUSIONS: This case series illustrates the diverse clinical/radiologic paradoxical manifestations of TBM in HIV-negative patients. Cyclophosphamide may be safe and effective in treating TBM-associated paradoxical manifestations. Specific diagnostic and care protocols for these patients are needed.

Headache related to personal protective equipment in healthcare workers during COVID-19 pandemic in Mexico: baseline and 6-month follow-up.

BACKGROUND AND AIM: Headaches related to the use of personal protective equipment (PPE) could affect performance at work in healthcare personnel. Our aim was to describe the prevalence and risk factors for headaches related to PPE, in the personnel of a specialized coronavirus disease 2019 (COVID-19) tertiary hospital. METHODS: In this cross-sectional survey study, we invited healthcare workers from COVID-19 referral center in Mexico (May 22-June 19, 2020) to answer a standardized structure questionnaire on characteristics of new-onset PPE-related headache or exacerbation of primary headache disorder. Participants were invited regardless of whether they had a current headache to avoid selection bias. This is the primary analysis of these data. RESULTS: Two hundred and sixty-eight subjects were analyzed, 181/268 (67.5%) women, 177/268 (66%) nurses, mean age 28 years. The prevalence of PPE-related headache was 210/268 (78.4%). Independent risk factors were occupation other than physician (OR 1.59, 95% CI 1.20-2.10), age > 30 years (OR 2.54, 95% CI 1.25-5.14), and female sex (OR 3.58, 95% CI 1.86-6.87). In the 6-month follow-up, 13.1% of subjects evolve to chronic headache, with stress as predictive risk factor. CONCLUSION: The frequency of PPE-associated headache is high, and a subgroup could evolve to chronic headache. More studies are necessary to improve the knowledge about this condition.

Prediction of acute neurovascular syndromes with prehospital clinical features witnessed by bystanders.

BACKGROUND: The prompt recognition of an acute neurovascular syndrome by the patient or a bystander witnessing the event can directly influence outcome. We aimed to study the predictive value of the medical history and clinical features recognized by the patients' bystanders to preclassify acute stroke syndromes in prehospital settings. METHODS: We analyzed 369 patients: 209 (56.6%) with acute ischemic stroke (AIS), 107 (29.0%) with intracerebral hemorrhage (ICH), and 53 (14.4%) with subarachnoid hemorrhage (SAH). All patients had neuroimaging as diagnostic gold standard. We constructed clinical prediction rules (CPRs) with features recognized by the bystanders witnessing the stroke onset to classify the acute neurovascular syndromes before final arrival to the emergency room (ER). RESULTS: In all, 83.2% cases were referred from other centers, and only 16.8% (17.2% in AIS, 15% in ICH, and 18.9% in SAH) had direct ER arrival. The time to first assessment in ≤ 3 h occurred in 72.4% (73.7%, 73.8%, and 64.2%, respectively), and final ER arrival in ≤ 3 h occurred in 26.8% (32.1%, 15.9%, and 28.3%, respectively). Clinical features referred by witnesses had low positive predictive values (PPVs) for stroke type prediction. Language or speech disorder + focal motor deficit showed 63.3% PPV, and 77.0% negative predictive value (NPV) for predicting AIS. Focal motor deficit + history of hypertension had 35.9% PPV and 78.8% NPV for ICH. Headache alone had 27.9% PPV and 95.3% NPV for SAH. In multivariate analyses, seizures, focal motor deficit, and hypertension increased the probability of a time to first assessment in ≤ 3 h, while obesity was inversely associated. Final ER arrival was determined by age and a direct ER arrival without previous referrals. CONCLUSION: CPRs constructed with the witnesses' narrative had only adequate NPVs in the prehospital classification of acute neurovascular syndromes, before neuroimaging confirmation.

[Myasthenia gravis in adults of institutions pertaining to the Mexican public health system: an analysis of hospital discharges during 2010]. / Miastenia gravis (MG) en adultos de instituciones pertenecientes al sistema público sanitario mexicano: un análisis de egresos hospitalarios durante el año 2010.

INTRODUCTION: Epidemiological studies on myasthenia gravis (MG) in Mexico is mainly derived from experiences in referral centers. OBJECTIVE: To describe the epidemiological characteristics of hospital discharges during 2010 with the diagnosis of MG in adults hospitalized in the Mexican public health system. METHODS: We consulted the database of hospital discharges during 2010 of the National Health Information System (Ministry of Health, IMSS, IMSS oportunidades, ISSSTE, PEMEX, and the Ministry of Defense). The MG records were identified by the code G70.0 of the International Classification of Diseases 10th revision. RESULTS: During 2010 there were 5,314,132 hospital discharges (4,254,312 adults). Among them, 587 (0.01%) were adults with MG (median age: 47 years, 60% women). Women with MG were significantly younger than men (median age: 37 vs. 54 years, respectively; p < 0.001). The median hospital stay was six days. The case fatality rate was 3.4%, without gender differences. Age was associated with the probability of death. CONCLUSIONS: We confirmed the bimodal age-gender distribution in MG. The in-hospital case fatality rate in Mexico is consistent with recent reports around the world.

One-Year and Five-Year Outcomes in Medication Overuse Headache: A Real-World Study.

BACKGROUND: Medication overuse headache (MOH) is one of the global health-related problems that imposes significant morbidity. Effective management requires the abrupt cessation of the overused medications, transition therapy in the initial days, and initiation of preventive treatment. The objective of this study is to provide one-year and five-year follow-ups of study participants diagnosed with chronic migraine and MOH. The study will examine the efficacy of withdrawal therapy, the use of conventional preventive medication, and the use of anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies. METHODOLOGY: We conducted a single-center, prospective, and descriptive study at a tertiary center in Brazil. The population was included by convenience sampling of consecutive subjects diagnosed with chronic migraine and MOH. Demographics and clinical data at baseline and one-year and five-year follow-ups were collected in the clinical records. RESULTS: Among 142 subjects, 116 were females and 26 were males, with a mean age of 42.1±14.3. They were followed for five years. The diagnosis was performed at the mean age of 24.9±14.7 years after the headache onset, and the time with headache ≥15 days per month was 6.3±7.6 years. On baseline, the average number of headache days per month (HDM) was 25.2±5.9. There was a reduction in HDM. At one-year and five-year follow-ups, a ≥75% reduction in HDM was observed, respectively, in 51.4% and 70.4% of the sample. CONCLUSIONS: The five-year follow-up of chronic migraine and MOH treated with the discontinuation of excessive medication, the use of preventative pharmacological agents, and the optional inclusion of anti-CGRP pathway monoclonal antibody led to a significant decrease in the initial occurrence of HDM.

[Amniotic band syndrome: report of a case]. / Sindrome de bridas amnióticas: a propósito de un caso clínico.

BACKGROUND: Amniotic band syndrome was first described in 1832 by Montgomery, and is characterized by constriction bands that can reach limb amputation. CASE REPORT: We report the case of a male neonate born from 17 years old mother, first pregnancy with premature rupture of membranes and eight days of evolution. He was born premature and required resuscitation, with good response. During physical examination injuries by amniotic band in right lower limb and minimal alterations in the left were observed. The most severe injury was amputated and the outcome was favorable so the patient was discharged from the hospital. DISCUSSION: The frequency of this syndrome is relatively low and, apparently, is caused by extrinsic factors such as rupture of membranes. Prenatal diagnosis is possible by prenatal ultrasound and treatment depends on the severity of the injury and tissue viability postbrida. Adequate prenatal control is recommended to pregnant patients, especially those with risk factors coupled with ultrasonic control. Treatment of such patients should be multidisciplinary.

Calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide in migraine treatment.

PURPOSE OF REVIEW: To review the latest advances in migraine management with a focus on medications specifically developed for the treatment of migraine. RECENT FINDINGS: Randomized clinical trials demonstrated the efficacy of calcitonin gene-related peptide (CGRP) mAbs for the preventive treatment of migraine and the small molecule CGRP receptor antagonist gepants for acute abortion and prevention of migraine attacks. Pituitary adenylate cyclase-activating polypeptide (PACAP) is another signaling molecule of interest and represents a potential new drug class of mechanism-based migraine medications. Drugs targeting PACAP are currently undergoing clinical trials, and the coming years will reveal whether this class of drugs will expand our therapeutic armamentarium. SUMMARY: Here, we summarize the role of CGRP and PACAP in migraine pathophysiology and discuss novel therapies targeting the CGRP and PACAP signaling pathways.

Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients.

BACKGROUND: An intriguing feature recently unveiled in some COVID-19 patients is the "silent hypoxemia" phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea. OBJECTIVE: To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients. METHODS: We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia). RESULTS: We studied 470 cases (64.4% men; median age 55 years, interquartile range 46-64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO2 in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101-7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024-9.89; P = 0.045). CONCLUSIONS: Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity.

Neurologic manifestations in hospitalized patients with COVID-19 in Mexico City.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies neurologic features at presentation and complications during the disease course. We aimed to describe the characteristics and predictors for developing in-hospital neurologic manifestations in a large cohort of hospitalized patients with COVID-19 in Mexico City. METHODS: We analyzed records from consecutive adult patients hospitalized from March 15 to June 30, 2020, with moderate to severe COVID-19 confirmed by reverse transcription real-time polymerase chain reaction (rtRT-PCR) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurologic syndromes were actively searched by a standardized structured questionnaire and physical examination, confirmed by neuroimaging, neurophysiology of laboratory analyses, as applicable. RESULTS: We studied 1,072 cases (65% men, mean age 53.2±13 years), 71 patients had pre-existing neurologic diseases (diabetic neuropathy: 17, epilepsy: 15, history of ischemic stroke: eight, migraine: six, multiple sclerosis: one, Parkinson disease: one), and 163 (15.2%) developed a new neurologic complication. Headache (41.7%), myalgia (38.5%), dysgeusia (8%), and anosmia (7%) were the most common neurologic symptoms at hospital presentation. Delirium (13.1%), objective limb weakness (5.1%), and delayed recovery of mental status after sedation withdrawal (2.5%), were the most common new neurologic syndromes. Age, headache at presentation, preexisting neurologic disease, invasive mechanical ventilation, and neutrophil/lymphocyte ratio ≥9 were independent predictors of new in-hospital neurologic complications. CONCLUSIONS: Even after excluding initial clinical features and pre-existing comorbidities, new neurologic complications in hospitalized patients with COVID-19 are frequent and can be predicted from clinical information at hospital admission.

[Moyamoya's disease. A case report]. / Enfermedad de moyamoya. Presentación de un caso.

BACKGROUND: Moyamoya disease is a rare idiopathic non-atherosclerotic, non-inflammatory and non-amyloid cerebrovascular disease characterized by stenosis and progressive occlusion of the internal carotid artery and its branches. Upon panangiography, this abnormality is typically visualized as a cigarette smoke-like pattern due to formation of new collateral vessels. The highest incidence occurs in Asia, principally affecting women. This case report describes the characteristics of these patients and the way to diagnose and treat them. CLINICAL CASE: A 43-year-old man with a history of chronic headache, subarachnoid hemorrhage and tonic clonic seizures; because of his age he was programmed to the young patient study protocol and so he underwent some studies like angiography, angiographic resonance and transcranial Doppler, these exams revealed a bilateral stenosis of the internal carotid arteries and its branches. DISCUSSION: The prognosis of these patients is unfavorable when the disease begins in childhood. Since conservative treatment may not be long-term useful, surgery should be considered in patients with Moyamoya disease. The use of transcranial Doppler is recommended in patients with these clinical features as an initial diagnostic exam.

Nuevos tratamientos contra la migraña / New treatments against migraine

Resumen: La migraña es una enfermedad con alta prevalencia y discapacitante que afecta a población económicamente activa, por lo que representa un problema de salud pública. En la actualidad la gran mayoría de pacientes aptos para recibir tratamiento preventivo no lo reciben, ya sea por desconocimiento del médico o por la complejidad o efectos adversos de los tratamientos disponibles. Existen nuevos fármacos que actúan en la vía del péptido relacionado con el gen de la calcitonina (gepantes y anticuerpos monoclonales) y en el agonismo selectivo del receptor 1F de serotonina, que han mostrado efectividad clínica con pocos efectos adversos. Su eficacia, sin embargo, pudiera no ser mayor a la de los fármacos ya conocidos. Al momento se han aprobado tres anticuerpos monoclonales (erenumab, galcanezumab y fremanezumab) y se cuenta con estudios de fase III de otros grupos farmacológicos, por lo anterior, es importante actualizar los conocimientos de estos nuevos focos terapéuticos y del mecanismo de acción de estos nuevos tratamientos que pronto estarán disponibles.

Abstract: Migraine is a disease with high prevalence and disability that affects the economically active population, so it represents a public health problem. Nowadays, the vast majority of patients who are candidates for preventive treatment do not receive it, either due to lack of knowledge of the physician or because of the complexity and/or adverse effects of the available treatments. There are new drugs that act in the calcitonin generelated peptide pathway (gepants and monoclonal antibodies) and in the selective agonism of the serotonin 1F receptor, which have shown clinical effectiveness with few adverse effects. Its efficacy, however, may not be greater than that of the drugs already known. At the moment three monoclonal antibodies have been approved (erenumab, galcanezumab and fremanezumab) and there are studies of phase III of other pharmacological groups. Therefore, it is important to update the knowledge associated with these new therapeutic focuses and the mechanism of action of these new treatments that will be available soon.

Trombosis venosa cerebral: lo que hay que saber / Venous cerebral thrombosis: What you need to know

Resumen La trombosis venosa cerebral representa 0.5% del evento vascular cerebral en el mundo. Sin embargo, la expresión fenotípica de la enfermedad en los países en desarrollo como México muchas veces es subestimada por múltiples factores, entre ellos la falta de sospecha de la enfermedad, la carencia de estudios diagnósticos y el patrón subclínico de la enfermedad. Desde hace más de 30 años se ha considerado a la población mexicana con un factor de riesgo de la aparición de fenómenos protrombóticos en sitios tradicionales; sin embargo, en la última década la prevalencia de trombosis venosa en sitios atípicos, como el sistema venoso cerebral, se ha incrementado. Por lo anterior, es importante para el médico no neurólogo el conocimiento de esta enfermedad, aparentemente no común, en nuestra población.

Abstract Cerebral venous thrombosis represents 0.5% of all strokes in the world. However, the phenotypic expression of the disease in developing countries such as Mexico is often underestimated by multiple factors, including low suspicion of the disease, lack of diagnostic studies and subclinical pattern of the disease. Since more than 30 years, Mexican population has been considered with a risk factor for the development of prothrombotic phenomena in traditional sites; however, in the last decade prevalence of venous thrombosis in atypical sites, such as the cerebral venous system, has increased dramatically, thus, it is mandatory for the non-neurologist physician to know about the disease, apparently uncommon in our population.

[Characterisation of factors associated with carotid stenosis in a population at high risk]. / Caracterizacion de factores asociados con estenosis carotidea en una poblacion de alto riesgo.

INTRODUCTION: Moderate to severe stenosis is the less prevalent among the forms of carotid atherosclerotic disease), but it carries a high risk of ischaemic stroke. AIM: To characterise factors associated with moderate to severe carotid stenosis in a high-risk population. PATIENTS AND METHODS: We performed an analysis on traditional risk factors associated with carotid stenosis ≥50% in 533 patients who received Doppler ultrasound due to a history of stroke (34%) or who had = 2 of the risk factors: age ≥55 years (86%), hypertension (65%), dyslipidemia (52%), obesity (42%), diabetes (40%) or smoking (40%). RESULTS: The prevalence of carotid stenosis ≥50% was 7.1%, symptomatic (associated with stroke in congruent territory) in 5.6%, bilateral in 2.1% and bilateral symptomatic in 1.5%. A 36.8% of patients had moderate to severe load (≥4) of atherosclerotic plaques (25.9% moderate: 4-6 plaques, and 10.9% severe: ≥7 plaques). By multivariate analysis we identified the age ≥75 years, dyslipidemia, and smoking as factors independently associated with carotid stenosis ≥50%, and hypertension and smoking with symptomatic stenosis. The number of risk factors was strongly associated with the prevalence of carotid stenosis. Notably, neither diabetes nor obesity explained the degree of moderate to severe carotid stenosis. CONCLUSIONS: As forms of carotid atherosclerotic disease, moderate to severe stenosis is less frequent than a high burden of atherosclerotic plaques. Advanced age, smoking, dyslipidemia and hypertension are the main traditional risk factors associated with the degree of carotid stenosis.

TITLE: Caracterizacion de factores asociados con estenosis carotidea en una poblacion de alto riesgo.Introduccion. La estenosis moderada a grave es la forma de enfermedad carotidea aterosclerosa menos prevalente, pero que implica un alto riesgo de ictus isquemico. Objetivo. Caracterizar los factores asociados con la estenosis carotidea moderada a grave en una poblacion de alto riesgo. Pacientes y metodos. Realizamos un analisis de los factores de riesgo tradicionales asociados a estenosis carotidea >= 50% en 533 pacientes que recibieron evaluacion mediante ultrasonograma Doppler por historia de ictus (34%), o que contaban con al menos dos de los factores de riesgo: edad >= 55 años (86%), hipertension (65%), dislipidemia (52%), obesidad (42%), diabetes (40%) o tabaquismo (40%). Resultados. La prevalencia de estenosis carotidea >= 50% fue del 7,1%, sintomatica (asociada a ictus en territorio congruente) en el 5,6%, bilateral en el 2,1% y sintomatica bilateral en el 1,5%. Un 36,8% de los pacientes presento carga moderada a grave (>= 4) de placas de ateroma (25,9%, moderada: 4-6 placas; y 10,9%, grave: >= 7 placas). Mediante analisis multivariable se identifico la edad >= 75 años, la dislipidemia y el tabaquismo como factores asociados con estenosis >= 50%, y la hipertension arterial y el tabaquismo con estenosis sintomatica. El numero de factores de riesgo se asocio fuertemente con la prevalencia de estenosis carotidea. Notablemente, ni la diabetes ni la obesidad explicaron el grado de estenosis moderada a grave. Conclusiones. Como formas de enfermedad carotidea aterosclerosa, la frecuencia de estenosis moderada a grave es menor que una carga alta de placas de ateroma. La edad avanzada, el tabaquismo, la dislipidemia y la hipertension son los principales factores tradicionales que se asocian con el grado de estenosis carotidea.

[Mortality associated with a diagnosis of Guillain-Barré syndrome in adults of Mexican health institutions]. / Mortalidad asociada al diagnóstico de síndrome de Guillain-Barré en adultos ingresados en instituciones del sistema sanitario Mexicano.

INTRODUCTION: Guillain-Barré syndrome (GBS) is a neurological emergency representing the main cause of flaccid paralysis around the world, affecting all age groups. Little is known about the essential epidemiology of GBS in most Latin American countries. AIM: To determine the mortality associated with the diagnosis of GBS in hospital discharges during 2010 in hospitals of the Ministry of Health, Mexico. PATIENTS AND METHODS: We analyzed the database of hospital discharges of institutions pertaining to the Ministry of Health. Study cases were identified by the code G61.0 of the International Classification of Diseases, 10th revision (ICD-10). We excluded records of patients younger than 18 years and patients without complete demographic information. RESULTS: During the year 2010 there were 2,634,339 discharges from hospitals of the Ministry of Health. We identified a total of 467 hospitalizations due to GBS in adults (median age: 41 years; 62.1% male) from 121 health institutions of the 32 Republic States. The highest frequency of GBS hospitalizations occurred during summer and fall. The median hospital stay was 8 days. The hospital mortality rate was 10.5%. The probability of death was directly associated with age, without a particular trend regarding gender, hospital care or state. CONCLUSIONS: In 2010 GBS hospital mortality in this part of the Mexican health system was higher than that reported in contemporary studies. A seasonal association was observed regarding the frequency of hospitalizations for GBS.

TITLE: Mortalidad asociada al diagnostico de sindrome de Guillain-Barre en adultos ingresados en instituciones del sistema sanitario mexicano.Introduccion. El sindrome de Guillain-Barre (SGB) es una urgencia neurologica que constituye la principal causa de paralisis flacida en el mundo, y que afecta a todos los grupos etarios. Se desconocen notablemente las caracteristicas epidemiologicas esenciales del SGB en la mayor parte de los paises de America Latina. Objetivo. Determinar la mortalidad asociada con el diagnostico de SGB en altas hospitalarias efectuadas durante el año 2010 en instituciones de la Secretaria de Salud, Mexico. Pacientes y metodos. Se analizo la base de datos de altas hospitalarias de instituciones que pertenecen a la Secretaria de Salud. Se identificaron los casos de SGB mediante el codigo G61.0 de la Clasificacion Internacional de Enfermedades, 10.ª revision (CIE-10). Se excluyeron los registros de pacientes menores de 18 años y los casos sin informacion demografica completa. Resultados. Durante el año 2010 se registraron 2.634.339 altas de hospitales que pertenecen a la Secretaria de Salud. Se identifico un total de 467 hospitalizaciones por SGB en adultos (mediana de edad: 41 años; 62,1% hombres) de 121 instituciones sanitarias de los 32 estados federados de Mexico. Durante el verano y otoño se registro la mayor frecuencia de hospitalizaciones por SGB. La mediana de la estancia hospitalaria fue de 8 dias y la tasa de mortalidad hospitalaria, del 10,5%. La probabilidad de muerte se asocio directamente con la edad, sin una tendencia particular respecto al sexo, hospital de atencion o entidad federativa. Conclusiones. En 2010, la mortalidad hospitalaria por SGB en esta parte del sistema sanitario mexicano fue mas alta de la que se informa en estudios contemporaneos. Se observo una asociacion estacional con la frecuencia de hospitalizaciones por SGB.

[Visceral leishmaniasis in an HIV positive patient]. / Leishmaniasis visceral en un paciente VIH positivo.

BACKGROUND: visceral leishmaniasis is the most serious clinical picture of leishmaniasis or kala azar. In Mexico it is a rare disease, which is a reason why it is diagnosed late concluding with patient's death most of the time. We present a clinical case of an HIV-positive male patient who developed visceral leishmaniasis, with the objective of showing the pathophysiological characteristics as well as the diagnostic approach and treatment. CLINICAL CASE: a 45-year-old male, a water utility company worker, presented to the hospital as having chronic bloody diarrhea, abdominal distension, cramping pain, weight loss and fever. On physical examination, he was febrile, with pain localized to the right lower quadrant and hepatosplenomegaly. The ELISA test for HIV was positive and the ultrasound showed a cecal tumor. A tumor biopsy was performed and the pathology report described leishmaniasis. CONCLUSIONS: in patients with leishmaniasis and HIV the response to treatment is poor and the mortality rate is high due to lower immune response from the host. Current studies suggest treating these patients with HIV and leishmaniasis with pertinent drugs in combination with miltefosine and liposomal amphotericin B.

Introducción: la leishmaniasis visceral o kala azar es la presentación clínica más grave. En México, es una enfermedad rara por lo que su diagnóstico es tardío y generalmente culmina en la muerte del paciente. Se describe a un paciente VIH positivo que desarrolló leishmaniasis visceral. El objetivo es explicar sus características fisiopatológicas y de su tratamiento. Caso clínico: hombre de 45 años de edad, quien ingresó al hospital por cuadro crónico de diarrea sanguinolenta, distensión abdominal, dolor tipo cólico, pérdida de peso y fiebre. A la exploración física se identificó paciente febril con dolor en fosa iliaca derecha y hepatoesplenomegalia. La prueba ELISA para VIH resultó positiva y el ultrasonido hizo evidente una tumoración en ciego, por lo que se realizó biopsia. El informe histopatológico indicó que se trataba de leishmaniasis. Conclusiones: en los pacientes con leishmaniasis e infección por VIH existe pobre respuesta al tratamiento y la mortalidad es alta, causada por la menor respuesta inmune del huésped. En la literatura especializada se sugiere el tratamiento establecido para la infección por VIH combinado con miltefosine y anfotericina B liposomal para la leishmaniasis.

[Metabolic syndrome prevalence and clinical features in blood donors]. / Prevalencia de síndrome metabólico y características clínicas en donadores de sangre.

BACKGROUND: Metabolic syndrome (MS) including obesity, diabetes mellitus, hypertension, dyslipidemia, etc.. is a major cause of morbidity and mortality worldwide. It was reported that 15.9% of blood donors showed changes in fasting plasma glucose. OBJECTIVE: To determine the prevalence of MS in a population of healthy donors in a secondary hospital. MATERIAL AND METHODS: A cross-sectional study, included 726 healthy donors who attended the blood bank HGZ36. The SM was identified with at least 3 of 5 criteria of the NCEP ATPIII, we applied a structured questionnaire. We determined HDL cholesterol, triglycerides, glucose Abnormal Fasting (GAA), hypertension (SAH), body mass index (BMI), waist circumference (WC), hip circumference (NCC). Plan Analysis: prevalence, t student, Chi2. RESULTS: Of the 726 donors, 85.1% were male, according to the ATPIII criteria, 54.8% (398) had a GAA, 63.2% (458) had hypertriglyceridemia, almost 17% (121) presented HDL hypocholesterolemia, 44.1% (320) were overweight by BMI, the prevalence of metabolic syndrome was 54.4%, in comparison by gender, men had a statistically significant difference compared to women, showing an OR = 2.27 (p = 0.0001, 95% CI 1.44-3.60). CONCLUSIONS: MS is highly prevalent in this population, which involves implementing preventive measures, changes in lifestyles and identify risk factors to be free from diseases like diabetes, hypertension, obesity and MS itself.

Esclerosis múltiple: revisión de la literatura médica / Multiple Sclerosis, a review of the literature

La esclerosis múltiple es la enfermedad autoinmune que afecta al sistema nervioso central más frecuente en sujetos de entre 20-50 años, y es la principal causa de discapacidad en este grupo. Su cuadro clínico suele ser de cuadros agudos neurológicos con remisiones posteriores y en algunos casos suelen ser progresivos hasta la muerte. El diagnóstico se basa en el cuadro clínico y se apoya en la evidencia de lesiones en resonancia magnética diseminadas en tiempo y espacio, los múltiples tratamientos en la actualidad no curan la enfermedad pero logran suprimir en gran numero la cantidad de brotes. Realizamos esta revisión con el objetivo de mostrar el espectro general de esta amplia enfermedad con la idea de que sea de ayuda a médicos y estudiantes que no estén familiarizados con esta patología que es cada vez más frecuente en nuestro país.

Multiple sclerosis is an autoimmune disease that affects the central nervous system, most common in young people aged 20-50 years. It is the leading cause of disability in this group. The clinical course is usually characterized by severe neurological afflictions followed by remissions and in some cases tend to be progressive to death. The diagnosis is based on clinical symptoms and is supported by the evidence of MRI lesions disseminated in time and space, multiple treatments are currently incapable of curing the disease but they are able to suppress outbreaks in great measure. This review was made with the mere objective to demonstrate the general spectrum of this wide illness with the idea that it is helpful to physicians and students who are not familiar with the disease that is becoming increasingly common in our country.