Caracterización clínica e imagenológica de una serie de pacientes con disección de arterias cervicales e intracraneales / Cervicocranial arterial dissection: experience in 57 patients

Background: Cervicocranial arterial dissection (CIAD) is an important cause of stroke. Aim: To describe the clinical and imaging characteristics of patients with CIAD. Material and Methods: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). Results: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. Conclusions: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.

[Cervicocranial arterial dissection. Experience in 57 patients]. / Caracterización clínica e imagenológica de una serie de pacientes con disección de arterias cervicales e intracraneales.

BACKGROUND: Cervicocranial arterial dissection (CIAD) is an important cause of stroke. AIM: To describe the clinical and imaging characteristics of patients with CIAD. MATERIAL AND METHODS: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). RESULTS: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. CONCLUSIONS: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.

Neuropeptides and oligopeptidases in schizophrenia.

Schizophrenia (SCZ) is a complex psychiatric disorder with severe impact on patient's livelihood. In the last years, the importance of neuropeptides in SCZ and other CNS disorders has been recognized, mainly due to their ability to modulate the signaling of classical monoaminergic neurotransmitters as dopamine. In addition, a class of enzymes coined as oligopeptidases are able to cleave several of these neuropeptides, and their potential implication in SCZ was also demonstrated. Interestingly, these enzymes are able to play roles as modulators of neuropeptidergic systems, and they were also implicated in neurogenesis, neurite outgrowth, neuron migration, and therefore, in neurodevelopment and brain formation. Altered activity of oligopeptidases in SCZ was described only more recently, suggesting their possible utility as biomarkers for mental disorders diagnosis or treatment response. We provide here an updated and comprehensive review on neuropeptides and oligopeptidases involved in mental disorders, aiming to attract the attention of physicians to the potential of targeting this system for improving the therapy and for understanding the neurobiology underlying mental disorders as SCZ.

Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia in Guatemala: Patient outcomes and economic analysis from a low-middle-income country.

BACKGROUND: Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms supraventricular tachycardia (SVT). Currently no studies exist on the cost-effectiveness of RFA compared to medical treatment (MT) in adult Latin American population. METHODS: Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (UNICAR) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Costs were obtained from UNICAR's administration. A cost-effectiveness analysis was conducted which evaluated costs and quality adjusted life years (QALYs) to compare interventions in terms of their incremental cost-effectiveness ratios (ICERs). RESULTS: The first RFA had 83% success and cumulative 94% success was achieved with a second one. The cost of the RFA procedure itself was $5,411. RFA gains 1.46 QALYs and saves $ 7,993 compared to of MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that the RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates and quality of life. CONCLUSIONS: RFA dominates MT by improving quality of life and reducing expenditures when used to treat severely symptomatic patients with SVT in Guatemala. The robustness of these finding to variations in parameter assumptions, suggests these findings may hold in other similar settings.

Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia in Guatemala: Patient Outcomes and Economic Analysis from a Low- to Middle-Income Country.

BACKGROUND: Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms of supraventricular tachycardia (SVT). Currently, no studies exist on the cost-effectiveness of RFA compared with that of medical treatment (MT) in adult Latin American population. METHODS: Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (Unidad Nacional de Cirugía Cardiovascular [UNICAR]) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Cost data were obtained from UNICAR's administration. A cost-effectiveness analysis that evaluated costs and quality-adjusted life-years to compare interventions in terms of their incremental cost-effectiveness ratios was conducted. RESULTS: The first RFA had an 83% success rate, and a cumulative success rate of 94% was achieved with a second. The cost of the RFA procedure itself was $5411. RFA gained 1.46 quality-adjusted life-years and saved $7993 compared with MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates, and quality of life. CONCLUSIONS: RFA dominates MT by improving quality of life and reducing expenditures when used to treat patients with severe symptoms of SVT in Guatemala. The robustness of these finding to variations in parameter assumptions suggests that these findings may hold in other similar settings.

Evaluación de funcionalidad, discapacidad y salud para la rehabilitación psicosocial de pacientes asilados por trastornos mentales graves / Evaluation of functioning, disability, and health status for psychosocial rehabilitation among institutionalized patients with severe mental disorders

Introduction The World Health Organization (WHO) made a major shift on the outcomes of illness, diseases, and interventions from clinical indicators to those related with levels of functioning and disability, as well as the possibility to determine areas of improvement on a case-by-case basis. Along with this theoretical approach, a new instrument was proposed to WHO members: the International Classification of Functioning, Disability and Health (ICF). The instrument is flexible, easy to apply in different clinical scenarios (it is not attached to a cluster of diseases), culturally adapted in several languages, and complementary to clinical and para-clinical information. In psychiatry, the use of the ICF may be highly valuable to establish the preserved areas of functioning as well as the most salient disabilities to formulate a proper case management, and then, to plan adequate public policies. This report includes the results of an evaluation of functioning, disability and heath dimensions, along with the psychometric properties of the ICF checklist, among people with severe and persistent mental disorders that have been institutionalized in a psychiatric hospital in the State of Jalisco, Mexico. Method Subjects: Inmates of a 50 year old psychiatric facility, dependent from the Mental Health Institute of Jalisco (SALME), within the frame of the Ministry of Health of the State of Jalisco in Mexico. This facility is divided in acute wards, were patients are hospitalized in acute phases of severe and persistent mental disorders, and <> wards which have existed since the origins of the hospital and became a place where people were abandoned and finally stayed institutionalized under the State's support and supervision. The later population was included in this evaluation. Measures: A psychiatrist (AM), previously trained on the administration of the ICF, supervised the evaluation of: 1) the <> domains of the Short list of ICF proposed by WHO (AP-ICF); 2) The American Psychiatric Association's Global Assessment of Functionality Scale (GAF); and 3) The Life Skills Profile(LKP). Results A total sample of 205 subjects was included; they were 64.9% males, with a mean age of 40.28±14.39 years old. The mean hospitalization time was 18.04±10.29 years. Psychiatric diagnosis distribution was: severe mental retardation (MR) (29.8%); moderate MR (15.6%), residual or undifferentiated schizophrenia (8.3%), and paranoid schizophrenia (7.8%). A concurrent physical illness was identified in 48.8% (n=112) of the subjects. Salient health problems were: epilepsy (n=47, 22.9%), chronic obstructive pulmonary disease (n=6, 2.9%), diabetes (n=5, 2.4%), and systemic arterial hypertension (n= 4, 2%). AP-ICF validity and reliability: Correlations between AP-ICF domains and GAF were all moderate (between -.51 to -.71), negative and statistically significant. Cronbach's alphas were as follows: a) Learning and applying knowledge: .85 for the first qualifier, and .89 for the second; b) General tasks and demands: .90 and .92; c) Communication: .93 for both qualifiers; d) Movement: .78 for the first qualifier, and .89 for second qualifier; e) Self Care: .94 and .96; f) Domestic Life Areas: .91 and .95; g) Interpersonal Interactions: .79 and .91; h) Major Life Areas: .59 and .70; i) Community, Social and Civic Life: .75 and .72. Functionality and disability among institutionalized patients: In the Global Assessment of Functioning measure, subjects distribution belonging to punctuations ranges were: 31-40 points(n=54, 26.3%); 11-20 points (22.9%,n=47); 21-30 points (21%,n=43); 41-50 points (14.6%,n=30); 51-60 points (11.2%, n=23); 61-70 points (2.9%, n=6), and 1% felled in the <> range. On the Life Skills Profile (LSP), means and standard deviations were as follows: a) Self Care: row score= 19.85 ± 3.42, percentage transformation= 49.64% ± 8.56; b) Social Communication: row score= 16.70±3.42, percentage transformation= 41.76% ± 9.39; c) Communication with contact: row score= 14.00 ± 2.60, percentage transformation= 58.35% ± 10.85; d) Communication without contact: row score= 9.39 ± 2.47, percentage transformation= 39.12% ± 10.30; e) Autonomy Life: row score= 11.87 ±1.89, percentage transformation= 42.40% ± 6.76. Major <> (ICF) dysfunction domains were as follows: Community, social and civic life, Domestic life areas, Interpersonal interactions, and Major life areas. For the first qualifier, mean row scores and percentage transformations for all activities and participation domains were: a) Learning & applying knowledge: 14.66 ± 5.40, 61.09% ± 22.5; b) General Tasks and demands: 4.78 ± 2.6, 59.75% ± 33.22; c) Communication: 8.88 ± 6.4, 44.43% ± 32.35; d) Movement: 2.63 ± 3.8, 10.99% ± 15.89; e) Self Care: 9.21 ± 8.5, 28.79% ± 26.73; f) Interpersonal Life Interactions: 20.06 ± 5.7, 71.67% ± 20.41; g) Major Life Areas: 15.15 ± 6.5, 63.15% ± 27.08; h) Community, Social & Civic Life: 17.42 ± 2.7, 87.10% ± 13.86. For the second qualifier, mean row scores and percentage transformations for all activities and participation domains were: a) Learning & applying knowledge:12.34 ± 5.8, 51.44% ± 24.33; b) General Tasks and demands: 3.91 ± 2.63, 48.90% ± 32.96; c) Communication: 7.36 ± 6.21, 36.82% ± 31.07; d) Movement: 2.24 ± 3.58, 9.34% ± 14.93; e) Self Care: 5.80 ± 7.15, 18.12% ± 22.37; f) Interpersonal Life Interactions: 16.88 ± 7.49, 52.77% ± 23.40; g) Major Life Areas: 13.5 ± 7.18, 56.25% ± 29.92; h) Community, Social & Civic Life: 14.29 ± 5.11, 71.48% ± 25.58. Conclusions In this study we identified three mayor groups of institutionalized patients, with different needs of attention. First, a group of people with severe disability, that do not require a permanent psychiatric hospitalization supervision and could benefit from treatment and increase quality of life in other kind community care facilities. A major second group (around 70% of patients) that are theoretically candidates for community rehabilitation and social reinsertion, in whom there is no scientific argument to justify their institutionalization in a psychiatric hospital. Reasons for this reality are to be explored in further social and service history implementation. A third subgroup of patients had been hospitalized many years, and for them, given the need of constant supervision is necessary and an alternative permanent assistance may be granted, but the psychiatric hospital is not the facility designated for them. Functioning and disability evaluation of persons with severe and persistent mental disorders that are institutionalized in the Mental Health Institute of Jalisco, Mexico, was useful to motivate and develop local communitarian psychiatric rehabilitation facilities and programs. Finally, we suggest that <> domains of ICF checklist are a valid and reliable tool to evaluate Mexican psychiatric patients.

Introducción En este reporte se presentan los resultados de la evaluación de funcionalidad, discapacidad y estado de salud de las personas con trastornos mentales graves y persistentes que se encuentran asiladas en el Centro de Atención Integral en Salud Mental de Estancia Prolongada (CAISAME-EP) del Instituto Jalisciense de Salud Mental (SALME), la instancia de la Secretaría de Salud del Estado de Jalisco que se encarga de la atención psiquiátrica de la entidad. El estudio se llevó a cabo para impulsar el desarrollo de políticas y programas de atención en salud mental locales que puedan elevar el estatus funcional y el bienestar vital de estos individuos. Adicionalmente se proporcionan los primeros datos de validez y confiabilidad, en población mexicana con trastornos mentales graves y persistentes, de la versión en español del apartado de <> de la lista corta de cotejo de la CIF. Método Los pacientes hospitalizados en los pabellones de la institución denominados <> fueron evaluados con base en: 1. el apartado de <> de la lista corta de cotejo de la CIF (AP-LC-CIF); 2. la Escala de Evaluación de la Actividad Global (EEAG) y 3. el Perfil de Habilidades de la Vida Cotidiana (PHVC). Resultados De un total de 205 usuarios, el 64.9% eran de sexo masculino. Tenían una edad promedio de 40.28±14.39 años y se encontraban hospitalizados hacía 18.04±10.29 años. El diagnóstico más frecuente fue el retraso mental severo (29.8%), le siguió el moderado (15.6%), la esquizofrenia residual e indiferenciada (8.3%), y la esquizofrenia paranoide (7.8%). El 48.8% de la muestra presentó alguna otra enfermedad física (n=102). La mayoría de los usuarios tuvieron entre 31 y 40 de puntuación en la EEAG (n=54, 26.3%); el área de mayor deterioro en actividades de la vida cotidiana (PHVC) fue la relativa al contacto social interpersonal, seguida de la de autocuidado; y los dominios del AP-LC-CIF con mayor disfunción fueron: vida comunitaria, social y cívica; vida doméstica; interacciones y relaciones interpersonales, y áreas principales de la vida. Conclusiones Se identificaron tres grandes grupos de pacientes con enfermedades mentales graves y persistentes asilados en el Estado de Jalisco, México; con necesidades de atención diferentes entre sí. Por una parte, existe un alto porcentaje de usuarios con retraso mental pronunciado que no requiere de atención psiquiátrica continua bajo una norma hospitalaria costosa, sino cuidados en un ambiente protegido que no sea un hospital psiquiátrico. Por otro lado, prácticamente un 70% de los pacientes asilados en la institución es teóricamente susceptible de rehabilitación comunitaria y no hay razón que justifique que vivan en un hospital psiquiátrico. Sin embargo, un tercer grupo de pacientes, que constituye además un altísimo porcentaje, ha estado asilado ahí durante muchos años lo que implica sumar a las tareas para implementar un sistema de rehabilitación comunitaria, un proceso de desinstitucionalización psiquiátrica. La presente evaluación de la discapacidad y la funcionalidad de la población asilada en la institución fue de utilidad para al menos dos asuntos. En primer lugar, para demostrar la adecuación del apartado de actividades y participación la CIF para evaluar a la población psiquiátrica con trastornos mentales graves. Y en segundo lugar, para impulsar la planeación y desarrollo de instancias y programas de rehabilitación psiquiátrica comunitaria en la entidad. Idealmente, éstos deberán implementarse resolviendo las necesidades de capacitación específica del personal, así como el estigma y discriminación que asecha a estos pacientes y sus familias.

A new tetranortriterpenoid from Trichilia havanensis.

A new triterpenoid, 1beta,2beta;21,23-diepoxy-7alpha-hydroxy-24,25,26,27-tetranor-apotirucalla-14,20,22-trien-3-one (1), has been isolated from an acetone extract of seeds of Trichilia havanensis, along with other known limonoids. The structure of 1 was established by spectroscopic methods, particularly by 1D and 2D NMR studies. Compound 1 was tested as an antifeedant agent against Leptinotarsa decemlineata larvae, showing a significant antifeedant activity at 300 ppm.

La transferencia de embriones. Una técnica de mejoramiento animal en ganado de lidia / Embryo transfer. A technique of animal improvement in fighting livestock

Dos explotaciones del estado de Tlaxcala (uno productor de ganado de lidia y otro productor de leche), se utilizaron para evaluar dos tipos de hormonas, la gonadotropina de suero de yegua gestante (PMSG) y la hormona folículo estimulante (FSH), en relación con la cantidad y calidad de embriones que se obtuvieron por superovulación en el programa de transferencia de embriones. Para la superovulación, se formaron dos grupos de cinco hembras de lidia; administrando al primero, FSH en dosis descendentes de 100 U.I. a 37.5 U.I. durante cuatro días consecutivos, y al segundo grupo con la administración de PMSG, en una sola dosis de 2,000 U.I. Se obtuvieron con FSH, 25 embriones transferibles, 20 degenerados o inmaduros y 15 ovocitos no fertilizados, sin embargo con PMSG, se obtuvieron cinco embriones transferibles, cinco degenerados o inmaduros y cinco ovocitos no fertilizados, lo que indica que el tratamiento con FSH, es más efectivo que el de PMSG para superovular a hembras de lidia con una probabilidad estadísticamente significativa (P < 0.05).Los 30 embriones que se obtuvieron para ser transferidos, fueron transportados a la explotación de leche, donde se llevó a cabo la transferencia de los mismos a 30 vaquillas respectivamente, mismas que fueron consideradas como receptoras. Del total de las transferencias, sólo cinco vaquillas se diagnosticaron como gestantes (16.6 por ciento), coincidiendo con embriones obtenidos de hembras superovuladas con FSH; cinco (16.6 por ciento) repitieron el estro a los 21 días de ciclo; otras cinco vaquillas (16.6 por ciento) repitieron el estro hasta los 37 días de ciclo; diez (33.3 por ciento) sólo presentaron un cuerpo lúteo en el ovario derecho y las cinco restantes (16.6 por ciento) además de presentar también un cuerpo lúteo en el ovario derecho, presentaban infección uterina. Esto se corroboró estadísticamente con una probabilidad estadística (P < 0.05).

Hallazgos endoscópicos en 494 estudios del colon realizados en Angola durante 1991a 1993 / Endoscopic findings in 949 studies of the colon performed in Angola during 1991-1993

Se presentan 494 pacientes con estudios endoscópicos de colon y recto; del total se efectuaron 428 rectosigmoidoscopia y 66 colonoscopia. La enfermedad más frecuente fue la hemorroides con 292 (36 pacientes presentaban fístula perianal y 20 fisuras anales). Las colitis ocuparon el 2do. lugar, y se destacan las parasitarias por Ameba histolytica y Shistosoma mansoni. Se verificaron 8 neoplasias de colon y 12 pacientes presentaban prueba de Elisa positiva, y se hallaron en estos casos signos de colitis inespecífica, fístula y abscesos perianales (AU)

Hallazgos endoscopicos en 494 estudios del colon realizados en Angola durante 1991a 1993 / Endoscopic findings in 949 studies of the colon performed in Angola during 1991-1993

Se presentan 494 pacientes con estudios endoscopicos de colon y recto; del total se efectuaron 428 rectosigmoidoscopia y 66 colonoscopia. La enfermedad mas frecuente fue la hemorroides con 292 (36 pacientes presentaban fistula perianal y 20 fisuras anales). Las colitis ocuparon el 2do. lugar, y se destacan las parasitarias por Ameba histolytica y Shistosoma mansoni. Se verificaron 8 neoplasias de colon y 12 pacientes presentaban prueba de Elisa positiva, y se hallaron en estos casos signos de colitis inespecifica, fistula y abscesos perianales

Situacion de la atencion prenatal en una poblacion de mujeres embarazadas / State of prenatal care in a pregnancy women population

Mediante un estudio descriptivo de corte transversal, se realizo una investigacion en 155 mujeres embarazadas en la zona rural como urbana del municipio de Padre las Casas en el ano 1990 con el proposito de determinar la situacion de la atencion prenatal. Los Resultados son: las embarazadas eran basicamente jovenes (menos de 20 ano) (58.7 por ciento ). Estas se habian chequeado en un gran porcentaje (41.4 por ciento ), menos de 3 veces y el 39.5 por ciento nunca habia visitado un medico en el curso de su embarazo. El 64.6 por ciento , en ningun momentose habia administrado dosis alguna de toxoide tetanica. El 29.1 por ciento de este grupo prioritario de salud presento uno o varios signos y/o sintomas de patologias propias del embarazo

Métodos de planificación familiar usados por mujeres en edad fertil / Family planning methods used for women in fertil age

Mediante estudio descriptivo de corte transversal, se realizo una investigacion en 1,318 mujeres en edad fertil (15-45 años) tanto en la zona rural como urbana del municipio de Padre las Casas en el año 1990, con la finalidad de determinar la situacion de la planificacion familiar en dicha comunidad. Los resultados de esta investigacion son: La poblacion en edad fertil es basicamente joven (menos de 30 años) 65.9 por ciento . Existe la tendencia a tener menos de 4 hijos (40.5 por ciento ). La mayoria de las mujeres no estan planificadas (69 por ciento ). Entre los metodos usados predomina la cirugia como metodo definitivo de planificacion familiar (62 por ciento )

Tratamiento quirúrgico de la diverticulitis complicada del colon sigmoide / Surgical treatment of complicated diverticulitis of the sigmoid colon

Se ralizó un estudio de 174 historias clínicas de pacientes diagnosticados como que presentaban diverticulitis del colon de los que necesitaron tratamiento quirúrgico de urgencia 22 (12,6

). El síntoma principal fue el dolor (72,7

) el tacto rectal fue útil en 12 enfermos (54,5

). El diagnóstico preoperatorio fue correcto en el 40,9

. Las complicaciones quirúrgicas más frecuentes fueron sepsis de la herida en 9 pacientes y trastornos de la colostomía en 5. La mejor evolución posoperatoria fue con la operación de Hartman en las intervenciones de urgencia y la hemocolestomía izquierda en las electivas. La mortalidad global fue del 18,1

con un índice de recidiva de 11,7

que coincidió con las sigmoidectomías realizadas