Herramientas de salud digital para superar la brecha de atención en epilepsia antes, durante y después de la pandemia de COVID-19 / E-health tools to overcome the gap in epilepsy care before, during and after COVID-19 pandemics

INTRODUCCIÓN: La epilepsia es un trastorno neurológico crónico común que afecta a alrededor de 50 millones de personas en el mundo y abunda la bibliografía sobre la brecha de atención en salud a este sector de la población. Dicha brecha aumentará con la pandemia actual de COVID-19. OBJETIVO: Evaluar la disponibilidad actual de herramientas de salud digital para la atención a personas con epilepsia según la literatura médica mundial y su uso durante dicha pandemia. Desarrollo. Se hizo una revisión de las publicaciones en revistas científicas en la última década que tuvieran como tema principal el uso de herramientas de salud digital o telemedicina enfocada a la atención de los pacientes con epilepsia, incluyendo cuatro meses después de las cuarentenas nacionales por la aparición del virus SARS-CoV2. Se encontraron 17 publicaciones sobre el uso de telemedicina enfocada a la epilepsia. Las herramientas más utilizadas internacionalmente son las plataformas en línea, seguidas de las aplicaciones móviles, videoconferencias, sistemas de captación de crisis epilépticas, listas de verificación, algoritmos de comprensión de datos médicos, llamadas telefónicas, teleelectroencefalografía y mensajes de texto. Ninguna se publicó durante la presente pandemia. CONCLUSIONES: Hay poca bibliografía sobre herramientas de salud digital enfocadas a epilepsia, pero existen varias que pueden emplearse para luchar contra la brecha de atención, especialmente en esta pandemia mundial de COVID-19 que obliga a las personas y comunidades a mantenerse en cuarentena por la emergencia sanitaria. Es necesario eliminar barreras y facilitar el pronto acceso de los pacientes a estas nuevas tecnologías de información

INTRODUCTION: Epilepsy is a common chronic neurological disorder that affects around 50 million worldwide and there is an abundance of literature on the health care gap for this sector of the population. This gap will increase with the current pandemic due to COVID-19. AIM: To evaluate the current availability of digital health tools for the care of people with epilepsy according to the world medical literature and their use during said pandemic. Development. We reviewed the publications in scientific journals in the last decade that had as their main topic the use of digital health tools or telemedicine focused on the care of patients with epilepsy, including 4 months after the national quarantines due to the appearance of the virus SARS-CoV2. Seventeen publications were found on the use of telemedicine focused on epilepsy. The most widely used tools internationally are online platforms, followed by mobile applications, videoconferences, epileptic seizure capture systems, checklists, algorithms for understanding medical data, phone calls, tele-encephalography and text messages. None was published during the COVID-19 current pandemic. CONCLUSIONS: Although there is little literature on the use of digital health tools focused on epilepsy, there are several that can be used to fight the attention gap, especially in this global pandemic by COVID-19 that forces quarantines of people and communities for long periods. It is necessary to remove barriers and facilitate patient access to these new information technologies

Epigenetics in Multiple Sclerosis: Molecular Mechanisms and Dietary Intervention.

INTRODUCTION: Multiple Sclerosis (MS) is a chronic, inflammatory, neurodegenerative demyelinating disease of the central nervous system (CNS). Unfortunately, MS causes important disability in young adults and its prevalence is increasing. While the etiology of MS etiology is not completely understood, it seems to be a multifactorial entity that is influenced by both genetic and epigenetic modifications. Epigenetic mechanisms add or remove different chemical groups for the activation or inhibition of gene expression to block the production of proinflammatory proteins. It is truly important to identify the factors that can trigger epigenetic changes in MS to complement the therapeutic approach, prevent disability and improve patients quality of life. Here, we have conducted a review of external factors that influence in MS and their epigenetic mechanisms. For example, hypomethylation can promote changes in the myelin and subsequent autoimmune reactions. Therapeutic tools can be used, including the histone deacetylase inhibitor Trichostatin A, which ameliorates demyelinating diseases in rodents. However, drugs are not only the therapeutic option: recent studies have also evaluated the therapeutic potential of several bioactive dietary components in neurodegeneration and axonal dysfunction. Numerous food-derived molecules exert important metabolic actions. These molecules include plant polyphenols such as catechins and isoflavones, Ω-3 and Ω-6 polyunsaturated fatty acids, short-chain fatty acids, sulfur-containing compounds such as dally sulfide and other compounds. Antioxidant and anti-inflammatory components in the diet involve transcription factors as well. However, many external factors have shown to influence MS, although no specific epigenetic mechanisms are known. CONCLUSION: In this review, we gather both established and new evidences about the genetic, epigenetic and environmental factors influencing MS and the dietary components that could modulate MS relapse and progression.

Vitamin D and disability in relapsing-remitting multiple sclerosis in patients with a Mexican background.

Previous studies of multiple sclerosis (MS) patients have reported an inverse correlation between disability, the number of relapses and vitamin D levels in mostly white patients. It is unclear if this relationship has the same behavior in individuals with Hispanic backgrounds. To determine the relationship between vitamin D serum levels and disability in a sample of Hispanics of a Mexican background with relapsing-remitting multiple sclerosis (RRMS). A cross-sectional study was conducted on 50 RRMS individuals of Mexican background. The Expanded Disability Status Scale (EDSS) score, progression index (PI) and annual relapse rate (ARR) were recorded for each patient. Vitamin D levels were assessed during the summer. Pearson's test was used to evaluate the relationship between vitamin D and EDSS, PI, ARR, and duration of disease evolution. Most patients were females (n = 29, 58%). The mean vitamin D level was 22.3 (± 6.4) ng/ml; the mean EDSS score was 2.2 (± 0.7), ARR 1.3 (± 0.5) and PI1.08 (± 0.6). No correlation was found between vitamin D levels and EDSS scores, ARR, PI or duration of disease. Moderate negative association between vitamin D levels and EDSS was found just in females (<0.0001). No correlation between vitamin D levels and disability was found in this sample of RRMS Mexicans. Longitudinal studies are needed to better understand the impact of Vitamin D in disability and multiple time points.

Presence of the HLADR13 allele among Mexican Mestizos suggests a protective factor against relapsing-remitting multiple sclerosis (RRMS).

BACKGROUND AND OBJECTIVE: Multiple sclerosis (MS) is a chronic demyelinating disease that affects the central nervous system. Researchers have looked for an association between relapsing-remitting MS (RRMS) and human leukocyte antigen (HLA) as risk or protective factor associated to ethnicity, which may add a partial explanation to disease heterogeneity and geographical variations. We described the frequency of the HLA-DR alleles in Mexican Mestizo (RRMS) patients. PATIENTS AND METHODS: We included 143 RRMS patients and 377 healthy controls, both Mexican Mestizos. Previous signing informed consent, we record demographic and clinical characteristics of the participants. Genetic profile was made, and HLA frequencies in both groups were compared. RESULTS: RRMS patients were 39.8% male and 60.2% female, mean age was 35 years. While, controls were 48%male and 52% women, mean age was 38 years. The most frequent allele found in subjects with RRMS was DR 15 (p=0.006, OR=2.2, 95% CI: 1.3-3.6). DR 13 allele was more frequent among healthy subjects than RRMS patients (p=0.050) with a protective OR 2.6, (95% CI: 1.3-5.2, p=0.050). CONCLUSION: In our study we found HLA DR 13 was more frequent in healthy controls than in RRMS patients, suggesting a protective factor among Mexican Mestizo population.