In Silico Screening of a Bile Acid Micelle Disruption Peptide for Oral Consumptions from Edible Peptide Database.

Recently, many bioactive peptides have been identified using bioinformatics tools. Previously, our group developed a method to screen dual-functional peptides that have direct intestinal delivery with porous silica gel and bile acid micelle disruption. However, newly designed peptides were not found in any storage protein. Therefore, in this study, in silico screening was performed using a 350,000 edible peptide library consisting of 4- to 7-mer independent peptides. As an initial screening, all edible peptides were applied to the random forest model to select predicted positive peptides. For a second screening, the peptides were assessed for the possibility of intestinal delivery using a 3D color map. From this approach, three novel dual-functional peptides, VYVFDE, WEFIDF, and VEEFYC were identified, and all of them were derived from storage proteins (legumin, myosin, and 11S globulin). In particular, VEEFYCS, in which a serine residue (S) is added to VEEFYC, was assumed to be released by thermolysin from the 11S-globulin derived from Ginkgo biloba by LC-MS/MS analysis. VEEFYCS was found to have suitable direct intestinal delivery and bile acid micelle disruption activity.

Parkinson's disease prevalence, age distribution and staging in Colombia.

Parkinson's disease (PD) has the second highest prevalence among neurodege - nerative diseases. In Colombia, PD population dynamics are currently unknown. Health records offer a unique resource to study frequency and multi-morbidity of chronic diseases. The aim of this research is to estimate prevalence and staging using administrative data (AD) provided by Health Maintenance Organizations (HMOs). A cross-sectional study was conducted using 2015 AD from two Colombian HMOs (4.312.928 beneficiaries, 9.01% of the affiliated Colombian population). PD prevalence and severity was estimated by age and sex. Prevalence was adjusted to WHO demographics. Age-adjusted PD prevalence was 205.89 per 100.000 inhabitants. Prevalence increment of 62.13% was found between those aged ≥40 years and those aged ≥50 years. Similarly, each extra decade (50-80+) represented an increment of 83.65%, 80.95%, and 35.10%. Between 40 and 89 years, males exhibited a significantly higher PD prevalence compared to females. Advanced PD was more frequent as age increased from 3.77% in the group between 40 to 49 years to 25.86% in those older than 89 years. More common related comorbidities were arterial hypertension, diabetes, and psychiatric disorders; the first two increased their frequency with age, and the last one maintained its prevalence across all age groups. AD sets are useful to estimate the prevalence and staging of PD. Prevalence of PD in Colombia is higher in men and increases with age, as well as disease severity.

Direct cost of Parkinson's disease in a health system with high judicialization: evidence from Colombia.

Objective: To estimate all-claims-all-conditions expenditures paid for by health plans for patients suffering from Parkinson´s disease (PD). Methods: Using administrative claims data from two health maintenance organizations for 2014 and 2015 in Colombia, we identified 2,917 patients with PD by applying an algorithm that uses International Statistical Classification of Diseases and Related Health Problems and Anatomical Therapeutic Chemical Classification System codes. Descriptive statistics were applied to compute unadjusted all-cause median costs. A generalized linear model was used to estimate adjusted and attributable direct costs of advanced PD. Results: Approximately 30% of the all-cause direct costs were associated with technologies not included in universal health coverage benefit packages. In 2015, the annual median interquartile range per patient all-cause direct costs to insurers was USD1,576 (605-3,617). About 16% of patients had advanced PD. Regression analysis estimated that additional costs attributable to advanced PD was USD3,416 (p = 0.000). Multimorbidity was highly prevalent, and 96% of PD patients had at least one other chronic condition. Conclusions: In the context of high judicialization, patients suffering from PD must increasingly use the judicial system to access treatment. To promote more equitable and efficient access benefit packages, developing countries must consider more thoroughly the needs of these patients.

Case Report: Rapid Eye Movement Sleep Behavior Disorder as the First Manifestation of Multiple Sclerosis: A Case Report and Literature Review.

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by brief recurrent episodes of loss of muscle atonia during rapid eye movement sleep, with enacted dreams that cause sleep disruption. Patients with multiple sclerosis (MS) have an increased risk compared with the general population to be affected by a sleep disturbance, including RBD. Patients affected, however, uncommonly can present RBD as the first clinical manifestation of MS without other neurologic deficits. These clinical presentations have usually been attributed to inflammatory lesions in the pedunculopontine nuclei, located in the dorsal pons. We present a case of RBD in a 38-year-old woman who was later diagnosed as having MS due to imaging findings and development of focal neurologic deficits. MS should be considered among the differential diagnoses in patients who present with symptoms of RBD, particularly if they are young and female.

Actual expense associated with patients with Alzheimer's disease in Colombia.

BACKGROUND: There is paucity in the level of knowledge on the actual insurer expenses associated with patients suffering with dementia in the developing world. Less is known about direct costs by severity and how costs vary because of the presence of other comorbidities. METHODS: Using claims data from an insurer for three years, we identified patients with AD with an algorithm that takes advantage of information on age, primary diagnosis, and services and drugs provided. RESULTS: Distribution by dementia stage was as follows: mild 21%, moderate 53%, severe 17%, and undetermined 9%. Expenses paid for all causes by the insurer were at least double than estimated in the literature and were increasing annually at rates higher than 30%. Also, 92% of patients have at least another chronic condition. CONCLUSIONS: Worldwide costs of dementia estimates maybe underestimating the actual costs to health systems in the developing world.

Costo-utilidad de intervenciones en pacientes con síndrome del túnel carpiano atendidos en un centro de alta complejidad en Cali, Colombia / Cost-Utility of Interventions in Patients with Carpal Tunnel Syndrome Treated at a Tertiary Center in Cali, Colombia / Custo-utilidade de intervenções em pacientes com síndrome do túnel do carpo atendidos em um centro de atendimento terciário em Cali, Colômbia

Introducción: Aunque existen varios tratamientos para el síndrome de túnel carpiano (STC), no se ha evaluado la eficiencia en Colombia. Objetivo: Determinar la razón de costo-utilidad incremental (RCUI) del tratamiento médico y quirúrgico en pacientes con STC. Materiales y métodos: Se realizó un estudio de costo-utilidad desde la perspectiva social con pacientes mayores de 18 años con diagnóstico de STC quienes recibieron tratamiento médico o quirúrgico. Se calcularon años de vida ajustados a calidad (AVAC) mediante el EQ-5D. Los costos fueron obtenidos del manual tarifario del Instituto de Seguros Sociales para el año 2001+30%.Se extrapoló a largo plazo mediante un modelo de Markov con una tasa de descuento de 3,5%. Se realizó un análisis de sensibilidad probabilístico usando la simulación de Monte Carlo. Resultados: Participaron 53 pacientes: mujeres (71,7%); edad promedio de 55,5 años. El 79% de los pacientes recibió tratamiento médico. La conducta médica más frecuente fue la observación (28 pacientes, 66,7%) y AINES (7 pacientes, 16,6%). El tratamiento médico proporcionó 0,33 AVAC (±0,11) y la cirugía 0,37 (±0,10). El costo total medio en pesos colombianos (COP), del tratamiento médico a los 6 meses y 20 años fue COP 132006 (IC 95%: COP 70255 - 425341) y COP 483440 (IC 95%: COP 104310 - 862570), respectivamente. La cirugía tuvo un costo de COP 1972644 (IC 95 %: COP 981204 -8517065) y COP 979585 (IC 95%: COP 684912 - 1274258). La cirugía fue dominada a los 6 meses. La RCUI a los 20 años fue de COP 1033635/AVAC adicional (IC 95%:COP 840179 - 1235323/AVAC adicional) con un 80% de probabilidad de que la cirugía sea costo útil cuando existe una disposición a pagar de COP 5000000. Conclusión: En el corto plazo el tratamiento médico es más costo útil que la cirugía. En el largo plazo, la cirugía tiene mayor probabilidad de ser costo útil.

Introduction: Although there are several treatments for carpal tunnel syndrome -cts-, the efficiency of these has not yet been evaluated in Colombia. Objective: Determine the incremental cost-utility ratio -icur- of medical and surgical treatment in patients with cts. Material and methods: A cost-utility analysis was conducted from the societal perspective with patients older than 18 years diagnosed with cts who received medical or surgical treatment. Quality-adjusted life-years (-qalys- were calculated using the EQ-5d. Costs were obtained from the iss national tariff 2001+30%.The results were extrapolated to long term figures through a Markov model with a discount rate of 3.5%.A probabilistic sensitivity analysis using Monte Carlo simulation was performed. Results: Fifty-three patients participated, women (71.7%); mean age: 55.5 years. 79% of patients received medical treatment.The most frequent treatment was medical observation (66.7%) and nsaids (16.6%). Medical treatment provided 0.33 qalys (± 0.11) and surgery 0.37 (± 0.10). The average total cost of medical treatment at six months and 20 years was COP 132006 (95% CI: COP 70255-425341) and COP 483440 (95% CI: COP 104310-862570) respectively.The cost of surgery was COP 1972644 (95% CI: COP 981204-8517065) and COP 979585 (95%:COP 684912-1274258). Surgery was dominated by six months. icur at 20 years was COP 1033635/ QALY additional (95% CI: COP 840179- 1235323/additional QALY), with a 80% of probability that surgery be cost-useful when willingness to pay COP 5000000 is achieved. Conclusion: Medical treatment is more cost-effective than surgery in the short term. However, in the long term, surgery is more cost-effective than the medical treatment.

Introdução: ainda que existem vários tratamentos para a síndrome do túnel do carpo (STC) não se tem avaliado a eficiência na Colômbia. Objetivo: Determinar o motivo de custo-utilidade incremental (RCUI) do tratamento médico e cirúrgico em pacientes com STC. Materiais e métodos: realizou-se um estudo de custo utilidade desde a perspectiva social com pacientes maiores de 18 anos com diagnóstico de STC que receberam tratamento médico ou cirúrgico. Calcularam-se anos de vida ajustados à qualidade (AVAC) através do EQ-5D. Os custos foram obtidos a partir do manual tarifário Instituto da Segurança Social para o ano 2001 + 30%. Extrapolou-se a longo prazo mediante um modelo de Markov com uma taxa de desconto de 3,5 %. Realizou-se uma análise de sensibilidade probabilística usando simulação de Monte Carlo. Resultados: Participaram 53 pacientes, mulheres (71,7%); idade média de 55,5 anos. O 79% dos pacientes receberam tratamento médico. A conduta médica mais frequente foi a observação (28 pacientes; 66,7 %) e AINES (7pacientes; 16,6%). O tratamento médico proporcionou 0,33 AVAC (±0,11) e a cirurgia 0,37 (±0,10). O custo total médio, em pesos colombianos (COP) do tratamento médico aos 6 meses e 20 anos foi COP 132006 (IC 95 %: COP 70255 - 425341) e COP 483440 (IC 95%: COP 104310 - 862570) respectivamente. A cirurgia de COP 1972644 (IC 95%: COP 981204 - 8517065) e COP 979585 (IC 95 %: COP 684912 - 1274258). A cirurgia foi dominada aos 6 meses. A RCUI aos 20 anos foi de COP 1033635/AVAC adicional (IC 95%: COP 840179 - 1235323/AVAC adicional) com um 80% de probabilidade que a cirurgia seja custo útil quando existe uma disposição a pagar de COP 5000000. Conclusão: no curto prazo o tratamento médico é mais custo útil que a cirurgia. No longo prazo, a cirurgia tem maior probabilidade de ser custo útil.

Costo monetario del tratamiento de la enfermedad deAlzheimer en Colombia / Monetary cost of treatment for Alzheimer’s disease in Colombia

Las demencias y, en particular la enfermedad de Alzheimer, representan una carga financieraimportante para los sistemas de salud; sin embargo, los estudios de costo de la enfermedad en países en desarrolloson poco frecuentes.Objetivo: estimar el costo social potencial directo e indirecto de la enfermedad de Alzheimer por estados deseveridad en Colombia para el periodo 2010-2020.Materialers y métodos: se tómo el número de personas con la enfermedad de un trabajo preliminar queusó datos secundarios y un método de proyección de la población. Se asumió una duración promedio deltratamiento de la enfermedad de 8 años, 3 en estado leve, 3 en moderado y 2 en severo. La canasta de bienesy servicios asociados al tratamiento y cuidado de los pacientes se construyó para cada estado con base enhistorias clínicas, consulta con expertos y otras fuentes para estimar los precios unitarios. Las estimacionesse realizaron incluyendo y excluyendo el valor imputado del cuidado informal, valorado por el método delcosto de salarios dejados de percibir. Resultados: el costo mínimo directo promedio por paciente/año por estado de severidad estimado es: $1.5millones (leve), $4 millones (moderado) y $8.5 millones (severo).Conclusiones: las estimaciones de costo presentadas muestran que la enfermedad de Alzheimer tendrá uncosto alto para la sociedad colombiana en la medida que aumente el acceso al tratamiento. Los métodos queincorporan los requerimientos de cuidado según estados de la enfermedad son más apropiados y permitieronidentificar que las estimaciones de modelos internacionales que usan relaciones constantes de costo a PIB porpersona tienden a subestimar el costo monetario. Estimar los costos de enfermedades crónicas es clave parapara el planeamiento fiscal de políticas de salud...

Dementia, particularly Alzheimer’s disease, represents an important financial burden uponhealth systems; however cost-of-illness studies are not frequent in developing countries.Objective: to estimate the potential direct and indirect social cost for Alzheimer’s disease, by stages of severityin Colombia for the period 2010-2020.Materials and methods: the prevalence of the disease is taken from previous work that used secondary dataand a method of population projection. We assumed average treatment duration of the disease of 8 years,3 in mild condition, 3 in moderate and 2 in severe. The basket of benefits and services associated with thetreatment and care of patients was built for each stage based on medical records, consultation with expertsand other sources to estimate unitary prices. Estimates were performed including and excluding the imputedvalue of informal care, valued by the cost method of salaries not perceived. Finally, the aggregated cost wasadjusted by the cost of use of services, utilizing information reported in the provision module of the nationalinformation system on social protection (Ministry of Health).Results: the potential direct cost per stage of severity per patient...

Consenso de expertos de la Asociación Colombiana de Neurología parael tratamiento preventivo y agudo de la migraña / Expert consensus on the preventive and acute treatment of migraine on behalf of the Colombian Association of Neurology

La migraña es la cefalea primaria de mayor impacto en la población general; de acuerdo conla información local se calcula que al menos 3 millones de personas en Colombia padecen esta condición,conduciendo esta entidad a alta carga y discapacidad.Objetivo: Determinar información unificada respecto al tratamiento preventivo y agudo de los pacientescon migraña. Se incluye información del tratamiento de la migraña crónica y su asociación al uso excesivo deanalgésicos.Materiales y métodos: Consenso de expertos mediante metodología virtual Delphi en dos rondas con el grupototal y una con el grupo desarrollador. Se hizo una revisión de la literatura para obtener información destinadaal diseño de preguntas con relevancia clínica. Se incluyeron neurólogos de las principales regiones del país.Resultados: Se debe ofrecer tratamiento preventivo a los pacientes que sufren por lo menos 6 días al mes dedolor de cabeza por migraña durante 6 a 12 meses de acuerdo con las condiciones clínicas de cada paciente.Topiramato, ácido valproico/divalproato de sodio, metoprolol, propranolol, amitriptilina, y flunarizina sonsugeridos como medicamentos de primera línea.Conclusiones: Se obtienen recomendaciones y sugerencias del tratamiento agudo y preventivo de los pacientescon migraña. Se presentan recomendaciones para el tratamiento de casos refractarios y del uso excesivode analgésicos...

Migraine is the primary headache with the highest impact in the general population. Accordingto local information, about 3 million people in Colombia suffer from this neurological condition leading tohigh burden and disability.Objective: To provide uniform information regarding the acute and preventive treatment of patients withmigraine. Information about chronic migraine, medication overuse was considered.Materials and methods: Expert consensus by using online Delphi methodology. Three rounds were carriedout, the whole group participated in two of them and the developer group in the total number of rounds. Areview of the literature was conducted to obtain academic support to design questions with clinical relevance.Neurologists from the main Colombian regions were included...

[Delayed diagnosis of juvenile Huntington's diseases: case report]. / Retraso en el diagnóstico de un cuadro grave de enfermedad de Huntington juvenil: un reporte de caso.

Huntington's disease is a neurodegenerative disease that is clinically manifested as mood and personality changes, loss of cognitive functions and choreiform movements. The pattern of inheritance is autosomic dominant. It is due to the gradual expansion of a cytosine, adenine, guanine trinucleotide in a gene that codifies the protein Huntington. The molecular diagnosis must be performed to confirm the diagnosis. Genetic counseling must be carefully done due to the high suicide risk among these patients. We present the case of a fourteen-year-old male with a severe disease, poor social support and an unclear pattern of inheritance.

Retraso en el diagnóstico de un cuadro grave de enfermedad de Huntington juvenil: un reporte de caso / Delayed diagnosis of juvenile Huntington's diseases: case report

La enfermedad de Huntington es una enfermedad neurodegenerativa que se manifiesta con alteraciones motoras descritas típicamente como movimientos coreiformes, cambios en el estado de ánimo y pérdida de funciones cognitivas. El patrón de herencia de esta enfermedad es autosómico dominante. La alteración genética comprende una expansión inestable del triplete citosina, adenina, guanina en el gen que codifica la proteína huntingtina. La prueba molecular confirma el diagnóstico. El consejo genético debe ser prudente debido al alto riesgo de suicidio. Se presenta el caso de un joven de 14 años con una pobre red de apoyo y un cuadro clínico grave de esta enfermedad en el contexto de un patrón de herencia poco claro.

Huntington's disease is a neurodegenerative disease that is clinically manifested as mood and personality changes, loss of cognitive functions and choreiform movements. The pattern of inheritance is autosomic dominant. It is due to the gradual expansion of a cytosine, adenine, guanine trinucleotide in a gene that codifies the protein Huntington. The molecular diagnosis must be performed to confirm the diagnosis. Genetic counseling must be carefully done due to the high suicide risk among these patients. We present the case of a fourteen-year-old male with a severe disease, poor social support and an unclear pattern of inheritance.

Retraso en el diagnóstico de un cuadro grave de enfermedad de Huntington juvenil: un reporte de caso / Delayed diagnosis of juvenile Huntingtons diseases: case report

La enfermedad de Huntington es una enfermedad neurodegenerativa que se manifiesta con alteraciones motoras descritas típicamente como movimientos coreiformes, cambios en el estado de ánimo y pérdida de funciones cognitivas. El patrón de herencia de esta enfermedad es autosómico dominante. La alteración genética comprende una expansión inestable del triplete citosina, adenina, guanina en el gen que codifica la proteína huntingtina. La prueba molecular confirma el diagnóstico. El consejo genético debe ser prudente debido al alto riesgo de suicidio. Se presenta el caso de un joven de 14 años con una pobre red de apoyo y un cuadro clínico grave de esta enfermedad en el contexto de un patrón de herencia poco claro.(AU)

Huntingtons disease is a neurodegenerative disease that is clinically manifested as mood and personality changes, loss of cognitive functions and choreiform movements. The pattern of inheritance is autosomic dominant. It is due to the gradual expansion of a cytosine, adenine, guanine trinucleotide in a gene that codifies the protein Huntington. The molecular diagnosis must be performed to confirm the diagnosis. Genetic counseling must be carefully done due to the high suicide risk among these patients. We present the case of a fourteen-year-old male with a severe disease, poor social support and an unclear pattern of inheritance.(AU)

Retraso en el diagnóstico de un cuadro grave de enfermedad de Huntington juvenil: un reporte de caso. / [Delayed diagnosis of juvenile Huntingtons diseases: case report].

Huntingtons disease is a neurodegenerative disease that is clinically manifested as mood and personality changes, loss of cognitive functions and choreiform movements. The pattern of inheritance is autosomic dominant. It is due to the gradual expansion of a cytosine, adenine, guanine trinucleotide in a gene that codifies the protein Huntington. The molecular diagnosis must be performed to confirm the diagnosis. Genetic counseling must be carefully done due to the high suicide risk among these patients. We present the case of a fourteen-year-old male with a severe disease, poor social support and an unclear pattern of inheritance.

Derivative spectrum chromatographic method for the determination of trimethoprim in honey samples using an on-line solid-phase extraction technique.

A simple, selective and rapid analytical method for determination of trimethoprim (TMP) in honey samples was developed and validated. This method is based on a SPE technique followed by HPLC with photodiode array detection. After dilution and filtration, aliquots of 500 µL honey samples were directly injected to an on-line SPE HPLC system. TMP was extracted on an RP SPE column, and separated on a hydrophilic interaction chromatography column during HPLC analysis. At the first detection step, the noise level of the photodiode array data was reduced with two-dimensional equalizer filtering, and then the smoothed data were subjected to derivative spectrum chromatography. On the second-derivative chromatogram at 254 nm, the limit of detection and the limit of quantification of TMP in a honey sample were 5 and 10 ng/g, respectively. The proposed method showed high accuracy (60-103%) with adequate sensitivity for TMP monitoring in honey samples.

Actualización en migraña / Update on migraine headache

La migraña es un trastorno neurológico muy común; que afecta al 14,2 por ciento de las mujeres colombianas y al 5,0 por ciento de los colombianos. La Clasificación Internacional de las Cefaleas, Segunda Edición del 2004, agrupa a las cefaleas en primarias y secundarias. La migraña está incluida en una de las cuatro categorías de cefaleas primarias, otras son: la cefalea tipo-tensión, la cefalea en racimos y las otras cefaleas autónomas trigeminales. En esta edición se reestructuraron los criterios para migraña con aura, se introdujo la migraña crónica, y la “migraña” oftalmopléjica ahora es contemplada como una neuralgia craneal. Hay evidencias de que la migraña es un trastorno genético complejo. Se han descrito dos genes distintos asociados con la migraña hemipléjica familiar, un raro trastorno autosómico dominante. La migraña es considerada un factor de riesgo de enfermedad vascular cerebral porque las dos entidades comparten algunos mecanismos fisiopatogénicos como los cambios regionales en el flujo sanguíneo cerebral, las alteraciones endoteliales, y la hiperagregabilidad plaquetaria. La utilización cada vez más frecuente del ecocardiograma transesofágico ha hecho posible enfocar la atención en algunas anormalidades cardiacas: foramen oval permeable, aneurisma septal y los eventos vasculares cerebrales isquémicos. Actualmente hay una gran controversia sobre el manejo de estos hallazgos. Es necesario esperar los resultados de estudios bien diseñados para encontrar la relación entre las características clínicas de la migraña y la permeabilidad o el cierre de los defectos septales.

Migraine is a common neurological disorder affecting 13.8 per cent of the colombian women and 4.8 per cent of the colombian men. The International Classification of Headache Disorders, 2nd Edition 2004, groups headache disorders into primary and secondary headaches. Migraine is included into one of four categories of primary headaches (the others are tension-type headache, cluster headache and other trigeminal autonomic cephalalgias). In this 2nd edition of the classification, there is a restructuring of criteria for migraine with aura, chronic migraine has been added and ophthalmolplegic migraine is now considered a cranial neuralgia. There is increasing evidence that migraine is a complex genetic disorder. Two distinct single gene defects may account for familial hemiplegic migraine, a rare autosomal dominantly inherited form. Migraine has long been considered a risk factor for stroke since the two conditions share some physiopathogenic mechanisms such as regional changes in cerebral blood flow, platelet hyperagregability, andendothelial alterations. The widespread use of transesophageal echocardiography (TEE) has made possible to focus on the association between some cardiac abnormalities (patent foramen ovale and atrial septal aneurysm) and cerebral ischemic events. There is a hot controversy about the management of these findings and it would be necesary to waif for the results of further well-designed studies regarding the clinical characteristics of migraine attacks in relation to the right-to-left shunt opened and when it has been closed.

Resultados de la escala de Zung para ansiedad en pacientes con cefalea primaria / About Zung´s scale and primary headache

La relación entre cefalea y trastornos psiquiátricos es un fenómeno clínico muy bien reconocido, especialmente en los pacientes que consultan al especialista. La comorbilidad psiquiátrica (especialmente ansiedad y depresión) de las cefaleas primarias se ha demostrado en múltiples estudios epidemiológicos y se atribuye a factores psicopatológicos y fisiopatológicos comunes en ambas entidades. Incluso Freud a finales del siglo XIX asoció categóricamente los conceptos de psicopatología con la migraña de común ocurrencia (1).

Prevalence of migraine in Latin America.

OBJECTIVE: To determine the 1-year point prevalence of migraine among residents > or =15 years old in 12 Latin American urban communities, and record medical consultation preferences of the identified migraineurs. BACKGROUND: Prevalence of migraine with or without aura in Latin American urban communities has not been established by large-scale population studies. METHODS: A validated face-to-face interview questionnaire based on International Headache Society criteria was completed for all headache sufferers within selected households, in a cross-sectional study. The randomly selected populations were representative of urban communities from the six participating Latin American countries. The questionnaire used was identical in each of the six participating countries. RESULTS: Of the 8618 people available for screening, 62% reported headache and 2637 completed interview questionnaires. Age-adjusted 1-year prevalence of migraine with or without aura for each country was (female/male, %): Argentina 6.1/3.8, Brazil 17.4/7.8, Colombia 13.8/4.8, Ecuador 13.5/2.9, Mexico 12.1/3.9, and Venezuela 12.2/4.7. Migraine prevalence was highest in women aged 30 to 50 years. In the year prior to the study, 42% of individuals interviewed and identified with migraine reported consulting a health professional about their headaches, most frequently (14%) a general practitioner. No previous diagnosis of migraine was reported by 65% of individuals with headache. CONCLUSIONS: In agreement with previous epidemiologic reports, migraine is also a common disorder in Latin American urban communities and predominantly affects women aged 30 to 50 years. Consultation preferences are also similar to those of previous reports.

Clinical characteristics and patterns of medication use of migraneurs in Latin America from 12 cities in 6 countries.

OBJECTIVE: The objective of this study was to document the clinical characteristics of migraine and patterns of medication use in residents > or =15 years old in 12 Latin American urban communities. BACKGROUND: Few large-scale population studies have established the symptoms and disability associated with migraine with or without aura in Latin American urban communities or the pattern of medication use in these regions. METHODS: In this study, subjects in 12 urban communities, from 6 Latin American countries, were surveyed with a validated face-to-face interview questionnaire based on International Headache Society criteria for migraine. The questionnaire was completed during face-to-face interviews with headache sufferers within selected households and included questions about migraine symptoms, migraine-related disability, and the use of health-care resources and medications to treat migraines. RESULTS: Of the 8618 people available for screening, 62% suffered from headaches. Of individuals with migraine, 42% reported consulting a health-care professional about their headaches. Of the migraineurs, 94.2% reported moderate to severe pain. Associated symptoms of nausea or vomiting, photophobia, phonophobia, and osmophobia were common during migraine attacks in 30.3, 76.4, 85.1, and 47.7% of subjects, respectively. The majority of subjects suffered between one and eight migraines each month. Although no previous diagnosis of migraine was reported by 65% of headache sufferers, migraineurs lost an average of 8 days in the preceding 3 months in any of the following areas: school, work, household chores, and/or social, family, or leisure activities. The agents used most widely to treat migraine were paracetamol and salicylates, while nonsteroidal anti-inflammatory drugs, dypirone, and ergotamines were also commonly used. Medication use varied widely among countries, but was predominantly nonprescription. CONCLUSIONS: Migraine is a common disorder in Latin American urban communities imposing significant burden on individuals, families, and communities. The magnitude of the impact and the range of activities affected by migraine are similar to those of previous reports in other regions. The preponderance of nonprescription medications and the scarcity of migraine-specific triptans from the study findings are especially striking.

Estudio neuroepidemiológico nacional (EPINEURO) colombiano / National neuroepidemiological study in Colombia (EPINEURO)

OBJETIVO: Determinar la prevalencia de ocho problemas neurológicos -migraña, enfermedad cerebrovascular, enfermedad de Parkinson, neuropatía periférica, trastornos del desarrollo neurológico, epilepsia, demencia y secuelas de traumatismo craneoencefálico- en Colombia como parte del estudio neuroepidemiológico nacional (EPINEURO). MÉTODOS: Se realizó una encuesta transversal en dos fases entre septiembre de 1995 y gosto de 1996. En la primera fase se identificó a las personas que podían estar padeciendo alguna enfermedad neurológica y en la segunda se hizo el diagnóstico específico. Se xaminó una muestra de 8 910 personas distribuidas en proporción con la población de cada una de las cinco zonas geográficas de Colombia, que son las regiones entral, sudoccidental, noroccidental, oriental y la costa caribe. La evaluación se realizó según una versión odificada del protocolo de neuroepidemiología de la Organización Mundial de la Salud, además de un examen físico simplificado. A los posibles pacientes de demencia identificados se les aplicó un examen neuropsicológico, diseñado para este estudio, con el fin de profundizar en los aspectos cognoscitivos. Se aplicaron las escalas de Hachinski, Yesavage y Blessed y los criterios iagnósticos del NINCDS-ADRDA para la enfermedad de Alzheimer, los del NINDS-AIREN para la demencia de origen vascular y los del DSM-IV para todo tipo de demencia. Se realizó una ncuesta para determinar si había secuelas de traumatismo craneoencefálico. Las personas mayores de 12 años fueron evaluadas por neurólogos de adultos y los menores de 12 años por un neuropediatra. Se calcularon las prevalencias de trastornos neurológicos por edad y sexo, tanto por egión como para el país en su totalidad, y sus intervalos de confianza de 95 por ciento. RESULTADOS: La prevalencia por 1 000 habitantes de los trastornos investigados ueron las siguientes: migraña, 71,2 (intervalo de confianza de 95 por ciento [IC95 por ciento]: 65,5 a 76,8); trastornos del desarrollo neurológico, 46,1 (IC95 por ciento: 35,5 a 58,9); enfermedad cerebrovascular, 19,9 (IC95 por ciento: 14,3 a 27,4); demencia, 13,1 (IC95 por ciento: 8,5 a 9,3); epilepsia, 10,3 (IC95 por ciento: 8,5 a 13,0); neuropatía periférica, 8,5 (IC95 por ciento: 6,8 a 10,7); secuelas de traumatismo craneoencefálico, 6,4 (IC95 por ciento: 5,0 a 7,8) y enfermedad de Parkinson 4,7 (IC95 or ciento: 2,2 a 8,9)...

Enfermedad de Alzheimer / Alzheimer's disease

La enfermedad de Alzheimer es un trastorno neurodegenerativo con rasgos clínicos y patológicos característicos. Las variaciones clínicas son comunes, incluyendo diferencias en la tasa de progresión, patrón de déficits neuropsicológicos y ocurrencia de síntomas neuropsiquiátricos no-cognoscitivos. Actualmente no existen marcadores que permitan su detección presintomática o un diagnóstico premórbido definitivo. En la patología, los hallazgos característicos incluyen pérdida neuronal, ovillos neurofibrilares, placas neuríticas y angiopatía amiloide. Esta es una revisión de las definiciones clínicas actuales de la Enfermedad de Alzheimer. Describe una aproximación práctica al tratamiento farmacológico de los síntomas conductuales y del afecto asociados