Motor assessment of patients with multiple system atrophy: underuse of the Unified Multiple System Atrophy Rating Scale (UMSARS).

PURPOSE: Despite the availability of the Unified Multiple System Atrophy (MSA) Rating Scale (UMSARS) for almost two decades, studies still use scales developed for Parkinson's disease (PD) or ataxia (ATX). Our aim was to evaluate the use of UMSARS (part II, motor) compared to other motor rating scales in patients with MSA. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant literature search was conducted concerning studies of patients with MSA, reporting motor assessment with clinical rating scales, and focusing on the frequency of UMSARS use. RESULTS: We included 261 articles, of which 42.9% did not use UMSARS, but rather scales for PD (59.8%), ATX (24.1%), or both (14.3%). Although UMSARS use increased with time, misuse of PD and ATX scales persists, with no evidence of a decremental trend. CONCLUSIONS: Although higher in observational studies, the misuse of PD and ATX-related scales in MSA patients persists in prospective (planned) trials. Reasons for that must be addressed.

Effects of Plyometric Training with Agility Ladder on Physical Fitness in Youth Soccer Players.

The aim of this study was to assess the effects of plyometric training with an agility ladder on components of physical fitness in youth soccer players. A total of twenty male under-13 soccer players were randomly assigned to a plyometric training group with an agility ladder (n=10) or a control group (n=10). Before and after training intervention linear sprint test (5 m, 10 m, 20 m), vertical jump ability (squat jump, countermovement jump and countermovement jump with arms), agility test, and slalom dribble test were assessed. The plyometric training with agility ladder was applied two times per week over six weeks. Data were analyzed using linear mixed model. The plyometric training group showed significant improvements (p<0.001) from pre-test to post-test in countermovement jump, countermovement jump with arms, and slalom dribble test. In the control group, no significant enhancements were obtained in all performance tests (p>0.05). The between-group analysis showed significant differences in countermovement jump with arms (p=0.03), but no significant differences (p>0.05) were found in squat jump, countermovement jump, sprint, agility test, and slalom dribble test. In conclusion, the short-term plyometric training with agility ladder seems to be ineffective and not time-efficient to improve physical fitness in youth soccer players. However, the interpretation of these results must be understood within the sample size limitations.

The influence of initial selection age, relative age effect and country long-term performance on the re-selection process in European basketball youth national teams.

The aims of the study were to: (a) analyse the re-selection patterns in European youth basketball national teams, and (b) investigate how the chance of re-selection is influenced by the initial selection age and relative age of the players, as well as the long-term performance of the country at the youth level. The sample consisted of 8362 basketball players (5038 men, 3324 women) born 1988-1997 who have participated in at least one U16, U18 or U20 European youth basketball championship between 2004 and 2017. The results from the survival analysis showed that around 75% of male and 80% of female players participating in a championship were re-selected the following year. Also, initial selection age, relative age effect, and the country long-term performance influenced the re-selection rates, with relationships being different between men and women. To conclude, the results of the present study show that the re-selection process by which players progress in European youth national basketball teams is complex and influenced by several different factors.

Effects of age on physical and technical performance in National Basketball Association (NBA) players.

This study evaluated the effects of age on physical and technical game performance for different positions in professional basketball players. In this cross-sectional study, a total of 25,523 individual match observations were undertaken on players from the 2018-19 NBA season. The players were classified into four age groups (19-22 years, 23-25 years, 26-29 years, and 30-42 years). Differences in physical and technical match performance were analysed for the following variables: distance covered, average speed, minutes played, points scored and playing efficiency. The results showed that players older than 30 covered shorter distance and had lower average speed than younger players, that guards and forwards older than 26 played more minutes per game than younger ones, and that guards older than 26 scored more points and were more efficient than younger one, while centres age 23-25 scored more points per games than centres older than 30. In conclusion, physical performance declined with age, and while playing time and technical performance generally remained stable or increased, especially for guards. However, there was some evidence of decline for centres.

Acute effects of training load on contractile properties during a competitive microcycle in elite soccer players.

The aim of this study was to examine changes in muscle contractile properties across a microcycle of training in professional soccer players during the in-season period. Nineteen professional soccer players were assessed with tensiomyography (TMG) on the biceps femoris and rectus femoris before and after 5 training sessions of an in-season microcycle. Training load was quantified during each training session. Significant differences were observed in training load variables across different training sessions, with the last training session prior to match day showing the lowest values for all training load variables. Significant pre- to post-session increases were observed in muscle stiffness of the rectus femoris and biceps femoris during the first four training sessions (effect size range, 0.5 to 0.9). However, no significant differences were observed in muscle contraction time and contraction velocity from pre- to post-session. In addition, repeated measures correlation analysis revealed significant relationships between absolute change in muscle stiffness of the rectus femoris and training duration, high-speed distance covered during training, and training average distance. The current study shows that players are physically taxed on their muscular stiffness by the training load. Post-session muscular stiffness assessment should be recommended to determine neuromuscular status and readiness in professional soccer players during the competitive season.

How can lifeguards recover better? A cross-over study comparing resting, running, and foam rolling.

PURPOSE: The aim of this study is to compare the effectiveness of active recovery in form of running or foam rolling on clearing blood lactate compared to remain sitting after a water rescue. METHOD: A quasi experimental cross-over design was used to test the effectiveness of two active recovery methods: foam rolling (FR) and running (RR), compared with passive recovery (PR) on the blood lactate clearance after performing a water rescue. Twelve lifeguards from Marín (Pontevedra) completed the study. The participants performed a 100-meter water rescue and a 25-minute recovery protocol. RESULTS: The post recovery lactate levels were significantly lower for foam rolling (4.4±1.5mmol/l, P=0.005, d=0.94) and running (4.9±2.3mmol/l, P=0.027, d=1.21) compared with resting (7.2±2.5mmol/l); there was no significant difference between foam rolling and running (P=1.000). CONCLUSIONS: We found that surf lifesavers clear out blood lactate more efficient when performing an active recovery protocol. Foam rolling is an effective method of increasing the rate of blood lactate clearance. These two recovery methods are also adequate for surf lifeguards as they do not interfere with the surveillance aspect of their job.

Cannabis and pain: a scoping review.

For centuries, cannabis has been used with many different purposes, including medicinal use, usually bypassing any formal approval process. However, during the last decade, interest in cannabis in medicine has been increasing, and several countries, including the United States and Canada, have produced their own legislation about marihuana and cannabis-based medicines. Because of this, interest in research has been increasing and evidence about its medical effects is becoming necessary. We conducted a review examining the evidence of cannabis in pain. Cannabis had been shown to be useful in acute and chronic pain, however recently, these results have been controverted. Within the different types of chronic pain, it has a weak evidence for neuropathic, rheumatic pain, and headache, modest evidence for multiple sclerosis related pain, and as adjuvant therapy in cancer pain. There is no strong evidence to recommend cannabis in order to decrease opioids in patients with chronic use. Even though cannabis-based medications appear to be mostly safe, mild adverse effects are common; somnolence, sedation, amnesia, euphoric mood, hyperhidrosis, paranoia, and confusion may limit the use of cannabis in clinical practice. Risks have not been systematically analyzed. Special concern arises on how adverse effect might affect vulnerable population such as elderly patients. More research is needed in order to evaluate benefits and risks, as well as the ideal administration route and dosages. As cannabis use increases in several countries, answers to these questions might be coming soon.

Does Vibration Foam Roller Influence Performance and Recovery? A Systematic Review and Meta-analysis.

BACKGROUND: Foam rolling has been extensively investigated, showing benefits in performance and recovery. Recently, vibration has been added to foam rollers, with hypothesized advantages over conventional foam rollers. However, there is no systematic evidence in this regard. OBJECTIVE: To carry out a systematic review and meta-analysis about the effects of vibration foam roller (VFR) on performance and recovery. METHODS: A systematic search was conducted in PubMed/MEDLINE, Web of Science and SportDiscus according to the PRISMA guidelines. The outcomes included performance (jump, agility and strength) and recovery variables (blood flow, pain and fatigue) measured after an intervention with VFR. The methodological quality was assessed with the PEDro scale. A random-effects model was used to perform the meta-analysis. RESULTS: Initially, 556 studies were found and after the eligibility criteria 10 studies were included in the systematic review and 9 in the meta-analysis. There was no significant effects on jump performance (SMD = 0.14 [95% CI - 0.022 to 0.307]; p = 0.101; I2 = 1.08%) and no significant beneficial effects were reported on isokinetic strength (SMD = 0.16 [95% CI - 0.041 to 0.367]; p = 0.117; I2 = 9.7%). Recovery appears to be enhanced after VFR interventions, but agility does not seem to increase after VFR interventions. CONCLUSION: This systematic review and meta-analysis suggest that VFR could have great potential for increasing jump performance, agility, strength and enhancing recovery. Further research is needed to confirm the effects of VFR on performance and recovery. Trial Registration This investigation was registered in PROSPERO with the code CRD42021238104.

Why Percussive Massage Therapy Does Not Improve Recovery after a Water Rescue? A Preliminary Study with Lifeguards.

The aim of this study was to analyze the effects of percussive massage therapy (PMT) on lifeguards' recovery after a water rescue, in comparison with passive recovery. Methods: A quasi-experimental crossover design was conducted to compare passive recovery (PR) and a PMT protocol. A total of 14 volunteer lifeguards performed a simulated 100 m water rescue and perceived fatigue and blood lactate were measured as recovery variables after the rescue and after the 8-min recovery process. Results: There were no differences between PMT and PR in lactate clearance (p > 0.05), finding in both modalities a small but not significant decrease in blood lactate. In perceived fatigue, both methods decreased this variable significantly (p < 0.001), with no significant differences between them (p > 0.05). Conclusions: PMT does not enhance recovery after a water rescue, in comparison with staying passive. Despite PMT appearing to be adequate for recovery in other efforts, it is not recommended for lifeguards' recovery after a water rescue.

Progression of metabolic syndrome and associated cardiometabolic risk factors from prepuberty to puberty in children: The PUBMEP study.

Introduction: Metabolic syndrome (MetS) is a cluster of clinical and metabolic alterations related to the risk of cardiovascular diseases (CVD). Metabolic changes occurring during puberty, especially in children with overweight and obesity, can influence the risk of developing chronic diseases, especially CVD. Methods: Longitudinal study based on the follow-up until puberty of a cohort of 191 prepubertal Spanish boys and girls without congenital, chronic, or inflammatory diseases: undernutrition: or intake of any drug that could alter blood glucose, blood pressure, or lipid metabolism. The following parameters were used to determine the presence of MetS: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low HDL-c. Results: A total of 75·5% of participants stayed in the same BMI category from prepuberty to puberty, whereas 6·3% increased by at least one category. The prevalence of MetS was 9·1% (prepubertal stage) and 11·9% (pubertal stage). The risk of presenting alterations in puberty for systolic blood pressure (SBP), plasma triacylglycerols, HDL cholesterol (HDL-c), and HOMA-IR was significantly higher in those participants who had the same alterations in prepuberty. MetS prevalence in puberty was predicted by sex and levels of HOMA-IR, BMI-z, and waist circumference in the prepubertal stage, in the whole sample: in puberty, the predictors were levels of HOMA-IR, BMI-z, and diastolic blood pressure in participants with obesity. Two fast-and-frugal decision trees were built to predict the risk of MetS in puberty based on prepuberty HOMA-IR (cutoff 2·5), SBP (cutoff 106 mm of Hg), and TAG (cutoff 53 mg/dl). Discussion: Controlling obesity and cardiometabolic risk factors, especially HOMA-IR and blood pressure, in children during the prepubertal stage appears critical to preventing pubertal MetS effectively.

Baby-Led Weaning: What Role Does It Play in Obesity Risk during the First Years? A Systematic Review.

Childhood is a window of opportunity for the prevention of the obesity pandemic. Since "the first 1000 days of life" is a period in which healthy eating habits must be acquired, it should be the target for preventive strategies. Baby-led weaning (BLW) is an emergent way of weaning that could influence children's health. The nutrition committees of the main pediatric societies affirm there is not enough evidence to support which is the best method of weaning. The aim was to determinate the influence of BLW on the infant's weight gain compared to the traditional spoon-feeding, and to assess if it could decrease the risk of obesity in children. A systematic review was conducted, following the PRISMA method. Pubmed, Web of Science, Embase, and Cochrane Library were searched. Out of 747 articles, eight studies (2875 total infants) were included (two randomized control trials, 6 observational studies). Results were indecisive, while some studies seem to demonstrate lower weight gain in infants that apply BLW, others show inconclusive results. The risk of bias in all included studies was moderate or high. In conclusion, more clinical trials and prospective studies should be done prior to providing a general recommendation about the best method of weaning to reduce the risk of obesity.

Talent Selection Strategies and Relationship With Success in European Basketball National Team Programs.

There is limited knowledge of the talent selection strategies used by national sporting organizations to identify and develop talented players in basketball. Therefore, we aimed to explore differences in selection strategies between European youth basketball national team (NT) programs, and how they relate to the program's success. Specifically, we examined differences in the number of youth NT players and within-country variance in the 1988-1999 generations between 38 countries (n men = 38, women = 32). Further, we tested if the number of youth NT players and within-country variance was related to the NTs senior ranking, youth ranking, and youth-to-senior player promotion, using generalized Bayesian multilevel models. We further checked the moderating effect of the amount of licensed basketball players in each country. On average, 15.6 ± 2.0 male and 12.4 ± 1.8 female players were selected per generation. Over a third of the NTs consistently selected a higher or lower number of players than the average, with a difference of 8.1 players (95% CI [5.8, 10.8]) for men and 7.6 players (95% CI [5.4, 10.0]) for women between the countries with the highest and lowest average. When licensed players were used as moderator, the differences decreased but did not disappear, in both genders. There was an above 99.3% probability that a higher number of players was positively related to higher men's senior and youth rankings, and women's youth ranking. Within countries, generations with a higher number of youth players generated more senior players, with a probability of 98.4% on the men's, and 97.3% on the women's side. When licensed players were used as moderator, the probabilities for these relationships remained largely unaffected, apart from women's youth ranking, which sank to 80.5%. In conclusion, the selection strategy in basketball NT programs varies between European countries and selecting a higher number of players possibly relates to better long-term performance and more players promoted to the senior NTs. These findings show that talent development programs should make conscious decisions about their selection strategies as it can affect their success.

The role of domain-specific and domain-general cognitive functions and skills in sports performance: A meta-analysis.

Cognition plays a key role in sports performance. This meta-analytic review synthesizes research that examined the relationship between cognitive functions, skills, and sports performance. We identified literature by searching Cochrane Library, APA PsycINFO, PubMed, and Web of Science. We included studies conducted on competitive athletes, assessed cognitive prerequisites, and included performance measures related to the sport. Of the 9,433 screened records, 136 reports were included, containing 142 studies, 1,227 effect sizes, and 8,860 participants. Only 11 studies used a prospective study design. The risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies. The multilevel meta-analysis showed a medium effect size for the overall difference in cognitive functions and skills, with higher skilled athletes scoring better than lower skilled athletes (Hedges' g = 0.59, 95% CI [0.49, 0.69]). The moderator analysis showed larger effect size for tests of cognitive decision-making skills (g = 0.77, 95% CI [0.6, 0.94]) compared to basic (g = 0.39, 95% CI [0.21, 0.56]) and higher cognitive functions (g = 0.44, 95% CI [0.26, 0.62]), as well as larger effect for sport-specific task stimuli compared to general ones. We report that higher skilled athletes perform better on cognitive function tests than lower skilled athletes. There was insufficient evidence to determine whether cognitive functions and skills can predict future sport performance. We found no evidence to support claims that tests of general cognitive functions, such as executive functioning, should be used by practitioners for talent identification or player selection. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Vitamin D Decrease in Children with Obesity Is Associated with the Development of Insulin Resistance during Puberty: The PUBMEP Study.

Obesity and cardiometabolic risk have been associated with vitamin D levels even in children. The objective of the present study was to evaluate the association between insulin resistance (IR), cardiometabolic risk factors, and vitamin D in children from prepubertal to pubertal stages. A total of 76 children from the PUBMEP study, aged 4-12 years at baseline, were included. Children were evaluated in prepubertal and pubertal stages. Anthropometric measurements and selected cardiometabolic risk biomarkers, such as plasma glucose, blood lipids, insulin, adiponectin, leptin, and blood pressure, and serum 25-hydroxyvitamin D (25(OH)D) were determined. Children were categorized by obesity degree and IR status combined before and after puberty. Paired t-test and multivariate linear regression analyses were conducted. During puberty, the increase in triacylglycerols, insulin, and HOMA-IR and the decrease in QUICKI were significantly associated with the reduction in 25(OH)D (B = -0.274, p = 0.032; B = -0.219, p = 0.019; B = -0.250, p = 0.013; B = 1.574, p = 0.013, respectively) after adjustment by BMI-z, sex, and pubertal stage. Otherwise, prepubertal non-IR children with overweight/obesity that became IR during puberty showed a significant decrease in 25(OH)D and HDL-c, and an increase in waist circumference and triacylglycerol concentrations (p < 0.05 for all) over time. These results suggest that changes in IR seem to be associated with an effect on 25(OH)D levels during puberty, especially in children with overweight.

Association of Diet, Physical Activity Guidelines and Cardiometabolic Risk Markers in Children.

The aim was to identify different dietary and physical activity (PA) patterns in 5- to 14-year-old children with a high prevalence of overweight and obesity using cluster analysis based on their adherence to the Spanish Society of Community Nutrition dietary guidelines and levels of PA, and to determine their associations with age, sex, body composition, and cardiometabolic risk markers. In 549 children, hierarchical cluster analysis was used to identify subgroups with similar adherence to dietary recommendations and level of PA. Three clusters were identified: Cluster 1, with the lowest level of vigorous PA and adherence to dietary recommendations; Cluster 2, with the lowest levels of moderate and vigorous PA and the highest adherence to dietary recommendations; and Cluster 3, with the highest level of PA, especially vigorous PA and a medium level adherence to dietary recommendations. Cluster 3 had lower total body fat and higher lean body mass percentages than Cluster 2. Cluster 2 had lower high-density lipoprotein cholesterol and higher low-density lipoprotein cholesterol levels than Cluster 1. The results from our study suggest that it is important to consider adherence to PA recommendations together with adherence to dietary guidelines to understand patterns of obesogenic habits in pediatric populations with high prevalence of overweight and obesity.

Test-Retest Reliability of Skill Tests in the F-MARC Battery for Youth Soccer Players.

This study aimed to evaluate the test-retest reliability of soccer skill tests belonging to the F-MARC test battery. To avoid bias during talent identification and development, coaches and scouts should be using reliable tests for assessing soccer-specific skills in young male players. Fifty-two U-14 outfield male soccer players performed F-MARC soccer skill tests on two occasions, separated by 7 days. After familiarization, we administered two trial sessions of five skill tests: speed dribbling, juggling, shooting, passing, and heading. We assessed absolute reliability by expressing the standard error of measurement as a coefficient of variation with 95% limits of agreement, and we assessed relative reliability with the intraclass correlation coefficient and with Pearson's correlation (r). The results demonstrated satisfactory relative and absolute reliability for speed dribbling, right foot juggling, short passing, shooting a dead ball right, shooting from a pass, heading in front, and heading right. However, reliability values for left foot juggling, chest-head-foot juggling, head-left-foot-right foot-chest-head juggling, long pass, and shooting a dead ball left tests were not strong enough to suggest their usage by coaches in training or sport scientists in research.

Reliability of Teams' Game-Related Statistics in Basketball: Number of Games Required and Minimal Detectable Change.

In basketball, game-related statistics are the most common measure of performance. However, the literature assessing their reliability is scarce. Purpose: Analyze the number of games required to obtain a good relative and absolute reliability of teams' game-related statistics. Method: A total of 884 games from the 2015-2016 to 2017-2018 seasons of the Spanish men's professional league were analyzed using all games and clustered by scoring difference. Intra-class correlation coefficient (ICC) was calculated for each variable. The number of games required to detect a change and to achieve good relative reliability was calculated using minimal detectable change and Spearman-Brown prophecy formula respectively. Results: Using all games, the results showed that the minimal number of games required in each group was 30 to detect a medium change (d > .5), 187 for a small change (d > .2), and 100 for good relative reliability (ICC ≥ .75). Using balanced and unbalanced games, the minimal number of games required in each group was respectively 31 and 30 to detect a medium change (d > .5), 190 and 188 for a small change (d > .2), and 191 and 121 for good relative reliability (ICC ≥ .75). Conclusions: The sample needs to consist of at least 30 games in each group to detect a medium size change, and at least 190 games to detect a small size change. To be able to rank teams with good reliability, at least 100 games are required when including both balanced and unbalanced games.

Longitudinal Study of Individual Exercises in Elite Rhythmic Gymnastics.

The performance evolution in rhythmic gymnastics depends on changes in code of points. At the beginning of each Olympic cycle the code of points changes and therefore, the content of the competition exercises, as well. This study aimed to analyze - for each apparatus - the evolution of number of technical elements and final score over the last two decades (last 13 world championships), how they have been affected by changed code of points, and how the final score relates to the number of technical elements performed. The sample consisted of 416 exercises in five apparatus: ball (96), rope (40), hoop (96), ribbon (88), and clubs (96). The following variables were gathered: code of points, apparatus, technical group, total number of elements, final classification, and final score. Linear mixed-effects models were used to examine the effects on the number of elements and final score in each apparatus. The number of technical elements increased in all apparatus, between 7.4 and 20% over a 10-year period. There were mixed evolutions of final score between the different apparatus, between -6.3 and 14% over a 10-year period. There is small increase in number of elements in hoop and a small decrease in rope after a code change. There was a small decrease in final score in championships after a code change in hoop, moderate in clubs and ribbon, and large in rope. There was a negative relationship between number of elements performed and final score in clubs. In conclusion, the code change generally effects the final score negatively, but there were apparatus specific effects of code change on number of elements and relationship between number of elements and final score.

Learning and Treatment of Anaphylaxis by Laypeople: A Simulation Study Using Pupilar Technology.

An anaphylactic shock is a time-critical emergency situation. The decision-making during emergencies is an important responsibility but difficult to study. Eye-tracking technology allows us to identify visual patterns involved in the decision-making. The aim of this pilot study was to evaluate two training models for the recognition and treatment of anaphylaxis by laypeople, based on expert assessment and eye-tracking technology. A cross-sectional quasi-experimental simulation study was made to evaluate the identification and treatment of anaphylaxis. 50 subjects were randomly assigned to four groups: three groups watching different training videos with content supervised by sanitary personnel and one control group who received face-to-face training during paediatric practice. To evaluate the learning, a simulation scenario represented by an anaphylaxis' victim was designed. A device capturing eye movement as well as expert valuation was used to evaluate the performance. The subjects that underwent paediatric face-to-face training achieved better and faster recognition of the anaphylaxis. They also used the adrenaline injector with better precision and less mistakes, and they needed a smaller number of visual fixations to recognise the anaphylaxis and to make the decision to inject epinephrine. Analysing the different video formats, mixed results were obtained. Therefore, they should be tested to evaluate their usability before implementation.

Toxoplasmosis en sistema nervioso central: revisión sobre la patología, abordaje diagnóstico y tratamiento / Toxoplasmosis in the central nervous system: Review of the pathology, diagnostic approach and treatment

RESUMEN La toxoplasmosis es una de las infecciones más comunes en humanos. Debido a la prevalência de la coinfección con VIH, conlleva un alto impacto en los sistemas de salud. Los seres humanos pueden infectarse de toxoplasma al consumir carne mal cocinada de cordero o cerdo que contenga los quistes tisulares, o al consumir agua o alimentos contaminados con heces de gatos. Una vez presente en el humano, el T. gondii se multiplica en los enterocitos y se disemina por el torrente sanguíneo o linfático, parasitando las células musculares, de la retina y frecuentemente el sistema nervioso central. La técnica más usada para la detección de IgG o IgM contra toxoplasma es la técnica de Elisa. Los anticuerpos IgG pueden estar elevados sin tener una infección activa, por lo que el diagnóstico con IgM y posteriormente con test de avidez es fundamental. El líquido cefalorraquídeo muestra pleocitosis leve e hiperproteinorraquia. Las neuroimágenes son de alta utilidad, ya que usualmente la punción lumbar puede estar contraindicada por lesiones que producen efecto de masa. Idealmente, los pacientes deben ser valorados con resonancia magnética en la que típicamente se observan lesiones eccéntricas en ganglios basales con realce en anillo, posteriormente a la aplicación de contraste. Se debe considerar el linfoma del sistema nervioso central como diagnóstico diferencial. El tratamiento suele iniciarse de manera empírica con pirimetamina, sulfadiazina y ácido folínico, con evaluación de la mejoría imagenológica a los 10-14 días. Si no se encuentra disponible, es posible el tratamiento con trimetoprin-sulfametoxazol. El inicio temprano del tratamiento antibiótico es fundamental para el buen pronóstico; en cuatro meses se observa recuperación neurológica completa en menos del 20 % de los casos y a los tres años de seguimiento en aproximadamente el 30 % de los pacientes.

SUMMARY Toxoplasmosis is one of the most common infections in humans. Due to the prevalence of coinfection with HIV, it carries a high impact on health systems. Humans can become infected with toxoplasma by consuming undercooked lamb or pork meat that contains tissue cysts, or by consuming water or food contaminated with cat feces. Once present in humans, T. gondii multiplies in enterocytes and spreads through the blood or lymphatic stream, parasitizing muscle cells, the retina, and frequently the Central Nervous System. The most used technique for the detection of IgG or IgM against toxoplasma is the ELISA technique. IgG antibodies can be elevated without having an active infection, so diagnosis with IgM and later with avidity test is essential. Cerebrospinal fluid shows mild pleocytosis and hyperprotein spinal cord. Neuroimaging is highly useful, since lumbar puncture can usually be contraindicated due to lesions that produce a mass effect. Ideally, patients should be evaluated with magnetic resonance imaging, which typically shows eccentric lesions in the basal ganglia with ring enhancement after the application of contrast. Central Nervous System lymphoma should be considered as a differential diagnosis. Treatment is usually started empirically with pyrimethamine, sulfadiazine, and folinic acid, with evaluation of imaging improvement at 10-14 days. If not available, treatment with trimethoprine-sulfamethoxazole is possible. The early initiation of antibiotic treatment is essential for a good prognosis, in 4 months complete neurological recovery is observed in less than 20 % of cases and after 3 years of follow-up in approximately 30 % of patients.