The Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) accurately classifies and differentiates psychotic experience levels in adolescents from the general population.

BACKGROUND: There is increasing interest in studying psychotic symptoms in non-clinical populations, with the Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) being one of the self-screening questionnaires used most commonly for this purpose. Further research is needed to evaluate the ability of the scale to accurately identify and classify positive psychotic experiences (PE) in the general population. AIM: To provide psychometric evidence about the accuracy of the CAPE-P15 for detecting PE in a sample of Chilean adolescents from the general population and classifying them according to their PE severity levels. METHOD: We administered the CAPE-P15 to a general sample of 1594 students aged 12 to 19. Based on Item Response Theory (IRT), we tested the accuracy of the instrument using two main parameters: difficulty and discrimination power of the 15 items. RESULTS: We found that the scale provides very accurate information about PE, particularly for high PE levels. The items with the highest capability to determine the presence of the latent trait were those assessing perceptual anomalies (auditory and visual hallucinations), bizarre experiences (a double has taken the place of others; being controlled by external forces), and persecutory ideation (conspiracy against me). CONCLUSIONS: The CAPE-P15 is an accurate and suitable tool to screen PE and to accurately classify and differentiate PE levels in adolescents from the general population. Further research is needed to better understand how maladaptive psychological mechanisms influence relationships between PE and suicidal ideation (SI) in the general population.

[LACTRIMS consensus document for the pharmacological treatment of the multiple sclerosis and its clinical variants]. / Documento de consenso de LACTRIMS para el tratamiento farmacologico de la esclerosis multiple y sus variantes clinicas.

INTRODUCTION. Multiple sclerosis (MS) it is not considered any more a rare disease in Latin America. Most of the Latin American countries have reported moderate or lower prevalence data. However only very few countries have developed therapeutic guidelines. LACTRIMS prepared this consensus document with specific recommendations for the treatment of the disease. DEVELOPMENT. Experts on treatment and clinical research on MS were invited by LACTRIMS in order to generate a initial document to be discussed in Quito, Ecuador. Several groups were organized in relation of the different clinical variants. These groups were coordinated by experts leaders and prepared a preliminary document that was discussed in Quito during July 8th and 9th, 2011. Finally the final version was submitted to the members and delegates of LACTRIMS in most of the Latin American countries who were able to make modifications and suggest changes to the final manuscript. CONCLUSIONS. Based on the different evidence levels and the AGREE criteria, the clinical variants were reviewed and recommendations were made for the use of drugs and different modifying disease therapeutic agents.

Pediatric renal transplantation: 13 years of experience--report from the Chilean Cooperative Multicenter Group.

Between 1989 and 2002, 178 renal transplants were performed in 168 pediatric patients in Chile. The mean age was 10.9 +/- 3.7 years (range 1 to 17.9). End-state renal disease etiologies were: congenital renal hypoplasia/dysplasia, chronic glomerulonephritis, and reflux nephropathy. Seventy received a graft from a living donor (LD), and 108 from a cadaveric donor (CD). Only 9% received antibody induction. Acute rejection episodes were reported in 76 patients: 38% in LD recipients and 48% in CD recipients (P = NS). One-, 3-, and 5-year graft survivals were 88%, 84%, and 76%, respectively, for LD and 86%, 79%, and 68% for CD recipients. Actuarial graft survival was significantly better among those patients with serum creatinine < 1 mg/dL at 1 year posttransplant compared with those with creatinine > 1 mg/dL (P < .05). The graft survival rate has improved from the first period (1989 to 1996) to the second period (1997 to 2002); (P = .05). Patient survival rates at 1, 3, and 5 years were 98%, 98%, and 98%, respectively, for LD, and 95%, 94%, and 94% for CD. Global height/age Z-score decreased from -0.7 at birth to -1.5 when dialysis started, and to -2.4 at the time of transplantation. The Z-score height/age at 1, 3, and 5 years posttransplantation was -2.25, -2.24, and -2.5. No significant differences were observed in transplant outcomes comparing patients younger than 7 years with those older ones. In conclusion, pediatric renal transplant has been performed in Chile with acceptable morbidity. The patient and graft survivals are similar to the reported international experience. In the last period there was a significant improvement in graft survival.

Tabaquismo y salud mental / Tobacco smoking and mental health

BACKGROUND: Smoking continues to be one of the most important health burdens worldwide. AIM: To describe smoking habits and associated risk factors in the population of Santiago, Chile. MATERIAL AND METHODS: A cross sectional study of a representative sample of the population, from 16 to 64 years old, residents of Santiago, Chile (total population: 3,237,286). A structured interview that included questions about use of tobacco, the CIS-R interviews, used for common mental disorders, were applied. RESULTS: From the sample of 4,693 households, 3,870 people were interviewed (52.2 per cent women, 47.8 men) and 10 per cent refused. Forty percent of per cent the population currently smoked (52.5 per cent men, 47.8 per cent women). Being a current smoker was associated with being younger than 55, male sex, and having a common mental disorder. DISCUSSION: Smoking is highly prevalent in Chile, as compared with developed countries and with some developing countries. Gender differences in use of tobacco have decreased. A higher risk of smoking for people with mental disorders is confirmed.

[Clinical characterization of 450 patients with cerebrovascular disease admitted to a public hospital during 1997]. / Caracterización clínica de 450 pacientes con enfermedad cerebrovascular ingresados a un hospital público durante 1997.

BACKGROUND: In Chile, cerebrovascular diseases are the fifth cause of death among men and the third cause among women. AIM: To assess the clinical features and management of patients with cerebrovascular disease admitted to a public hospital during 1997. PATIENTS AND METHODS: A retrospective analysis of clinical records of patients discharged with a diagnosis of cerebrovascular disease. Those records in which there was discordance between the discharge diagnosis and the clinical picture were not considered in the analysis. RESULTS: Of the 563 discharges from the hospital with the diagnosis of cerebrovascular disease, 487 records were located and 450 were considered in the analysis. Fifty four percent of patients were male and ages ranged from 17 to 96 years old. Fifty-one percent of patients had an ischemic stroke, 34% a cerebral hemorrhage, 12% a subarachnoidal hemorrhage and 3% a transient ischemic attack. There was a history of hypertension in 64% patients and 20% had an adequate treatment. Eighteen percent were diabetics, 34% had a heart disease and 20% had a previous episode of stroke. Mean hospital stay was 6.3 days in the emergency room and 11 days in the neurology ward. Hospital infections appeared in 21% of patients (respiratory in 68% and urinary in 22%), lethality was 30.5% and a CAT scan was done in 94%. At the moment of admission, 10% of patients had an evolution of less than 2 hours, 27% had an evolution between 2 and 6 hours and nine cases were potential eligible for thrombolysis. CONCLUSION: This is a picture of the local features of patients with cerebrovascular diseases that can be used as a reference for future studies.

Acetylcholinesterase and inhibitors: effects upon normal and regenerating nerves of the rat.

In peripheral nerves, the function of acetylcholinesterase (AChE) is not related to hydrolysis of acetylcholine. To test for a trophic role, AChE or its inhibitors were administered locally to normal and regenerating nerves of rats. In the normal nerve, neither AChE nor serum albumin affected the cytological pattern of the nerve. BW284c51, a specific inhibitor of AChE, resulted in demyelination, proliferation of Schwann cells and sprouting of axons after 5-7 days. Edrophonium or propidium, other specific inhibitors of AChE, did so to a much lesser extent. Vehicle, and iso-OMPA (inhibitor of pseudocholinesterases) did not affect the cytology of the nerve. Elongation of regenerating axons was evaluated at day 3 post-crush. Native AChE applied distal to the crush reduced the elongation of regenerating axons (- 36%), while serum albumin, heated AChE and filtered AChE did not. BW284c51, edrophonium or propidium enhanced the axonal elongation (33%) when they were administered for 2 days before, but not after, the crush. Iso-OMPA or vehicle administered before or after the crush were not effective. Thus, AChE reduces elongation of regenerating axons, while inhibition of AChE enhances elongation and affects the cytology of the normal nerve as well. We propose that AChE has a trophic role in mammalian peripheral nerves.

Regenerating axons of the rat require a local source of proteins.

Regenerating axons need proteins to grow and we explored whether a local supply is necessary. Crushed peroneal nerves were entubulated with silicone sleeves, plain or loaded with cycloheximide (CHX); some nerves were frozen to kill resident cells. When a plain sleeve was placed distal to the crush, axons regrew 5.0 mm in 3 days (pinch test), and 4.6 mm when the sleeve was placed around a frozen nerve (n.s). CHX administered distal to the crush reduced the elongation by approximately 58% (P < 0.01) in unfrozen or frozen nerves whilst its administration central to the crush was ineffectual. Immunostaining of nerves with GAP-43 gave similar values. Under the electron microscope, axonal sprouts were less frequent when CHX was used irrespective of the cellular or acellular condition of the nerve. Therefore, an inhibitor of protein synthesis reduces axonal regrowth, an effect mediated neither by parent neurones nor by resident cells. We propose that axons synthesize proteins.

Características y resultados del transplante renal en edad pediátrica: área Santiago-Sur / Characterists and results of the renal transplantation in pediatric age: south Santiago

Desde septiembre de 1981 a enero de 1995 se han trasplantado 52 niiíos, 22 hombres (42.3 por ciento) y 30 mujeres (57.7 por ciento), cuyas edades fluctúan entre 4 y 15 años (edad promedio 12.1 años). Complicaciones de tipo quirúrgico encontramos en 6 pacientes, la mayoría de ellas de tipo vascular y urológico, sólo una de ellas llevó a la pérdida del injerto. A los 2 meses de seguimiento 51 pacientes se encuentran vivos, 50 de ellos con el injerto funcionando con un promedio de creatinina plasmática de 1.0 mg/dl. A los 5 aiíos la sobrevida actuarial para los pacientes es de un 90 por ciento y para los injertos de un 50 por ciento. Al comparar este grupo de pacientes con un grupo seleccionado de trasplantes en edad adulta, nos encontramos que sus complicaciones son similares, al igual que la sobrevida de pacientes, aunque la sobrevida actuarial de injertos es más pobre. Las diferencias principales de ambos grupos se encuentran en la etiología de origen de la Insuficiencia renal crónica, donde en el grupo pediátrico las de tipo urológico alcanzan al 36 por ciento y en el grupo adulto sólo al 5 por ciento y respecto a la relación donante receptor, en que recibieron un órgano de uno de sus padres 42 (80.7 por ciento) de los niños y sólo 10 (19,2 por ciento) de los adultos, en cambio estos últimos lo recibieron de un hermano en un 67.3 por ciento de los casos lo que conlleve a ser un grupo de mejor histocompatibilidad. De hecho el promedio de crisis de rechazo agudo fue de 2.3 en niños y 1.5 para grupo de pacientes adultos

[Renal transplantation in patients with neurogenic bladder]. / Transplante renal en pacientes con vejiga neurogénica.

BACKGROUND: Renal transplantation can be done in patients with neurogenic bladder and clean intermittent self catheterization maintains renal function AIM: To retrospective assess the results of renal transplantation in patients with neurogenic bladder. PATIENTS AND METHODS: The medical records of seven patients aged 10 to 22 years old (3 female) followed during 7 to 32 months were reviewed. All patients had urinary tract infection, prior to transplantation, were instructed on self catheterization and received tri-associated immunosuppression. RESULTS: Grafts came from alive related donors in 5 patients and from cadavers in two. Prior to transplantation, three patients were subjected to nephrectomy and three to bladder enlargement, leaving a pigtail catheter. After transplantation, one lymphocele was drained, one uretherostomy due to an impacted lithiasis and one nephrectomy plus vesical enlargement due to intravesical pressures over 40 cm H2O, were done. One uretheral stricture was treated with dilatation. Seven episodes of pyelonephritis, 19 urinary tract infections and 77 asymptomatic bacteriurias were documented. Serum creatinine at the end of follow up ranged from 0.7 to 2.1 mg/dl. There were 0.7 acute rejection episodes per patient and all grafts survived. CONCLUSIONS: Renal transplantation in patients with neurogenic bladder is feasible, performing a vesical enlargement. There is however a high frequency of infectious episodes.

[Treatment of multiple sclerosis with interferons]. / Tratamiento de la esclerosis múltiple con interferones.

Despite the important achievements in clinical and experimental aspects of demylinating diseases and multiple sclerosis (MS), its pathogenesis still remains unknown. The most commonly held view is that it is an autoimmune disease, related in some way to a viral infection, that occurs in genetically susceptible basis. Based on this, many current treatments for MS are designed to modulate the immune response and interferons are an example. Only beta interferon (out of delta and gamma interferon) has a dose dependent efficacy in phase III clinical trials, as treatment for remitting-relapsing forms. It produces a reduction in exacerbation rates and in the burden of the disease, measured by Magnetic Resonance imaging. The clinical use of beta interferon considering the cost and large treatment period, must be cautious, reserving it only for confirmed remitting-relapsing modalities of MS. There is no clear cut evidence that beta interferon is useful for chronic-progressive MS.

[Neurology and HIV/AIDS infection: ethical problems]. / Neurologia e infección por el VIH-SIDA: problemas éticos.

Human immunodeficiency virus infection raises ethical issues in medical practice. This work presents several problems with ethical connotations related to HIV infections, observed by a neurologist during his medical practice. Patient-physician relationships, confidentiality, the request of patient consent to perform diagnostic procedures and reports to third parties are analyzed. The need for education and patient counseling about risk factors for infections is emphasized. Some features of clinical research in HIV infection such as the urging by the patients to simplify study protocols and limit sample sizes in clinical trials, are mentioned. Finally the possible solutions to these problems are discussed.

Laboratory evaluations in HIV-1-associated cognitive/motor complex.

Laboratory tests can provide useful information about the presence and effects of HIV-1 in the CNS, but have thus far not yielded definitive diagnostic or prognostic markers of HIV-1-related cognitive and motor complex. The most clinically useful laboratory procedures are MR imaging and CSF examinations. The routine clinical use of MR imaging and CSF examinations, however, is still restricted to providing information for detecting and excluding secondary effects of HIV-1 infection. MR imaging and CT do not appear to be sensitive enough at current resolutions to provide early detection of HIV-1 CNS effects nor to follow disease progression. Several CSF variables are extremely promising as early markers of primary HIV-1 infection of the brain, and may provide preclinical indications for onset of treatment and for evaluation of treatment efficacy. These include CSF quinolinic acid levels, acid dissociated p24 antigen levels, neopterin or beta 2m, intrathecal IgG synthesis rate, and possibly quantitated PCR levels of HIV-1 viral load. Procedures such as nuclear magnetic resonance spectroscopy, SPECT, PET, computerized EEG, EP, and ERPs are all promising candidates for early detection or localization of HIV-1-related brain dysfunction, but at this time all must still be considered primarily research tools. Before any of these procedures can provide reliable diagnostic and prognostic information about primary HIV-1 neurologic disease, currently on-going longitudinal evaluations of large numbers of asymptomatic HIV-1-infected individuals as they progress to neurologically symptomatic disease must be completed. There is currently no laboratory marker in blood or CSF that definitively predicts the risk for HIV-1-associated cognitive/motor complex. HIV-1-associated cognitive/motor complex remains a clinical diagnosis, which is made on the basis of positive neurologic signs and symptoms and abnormal neuropsychological findings after other causes of neurologic disease are excluded. Laboratory measures, such as the electrophysiologic methods and some CSF variables, are likely to remain adjuncts to the diagnosis because, with few exceptions, they provide data that are nonspecific as to etiopathogenesis. Dynamic imaging, electrophysiologic methods, and CSF indices provide presumptive evidence for the presence of HIV-1-associated CNS damage, and with clinical and neuropsychological evidence, could be used to establish a new definition of primary HIV-1-associated CNS disease along the lines used in establishing a diagnosis of multiple sclerosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Cerebrospinal fluid (CSF) analyses in HIV-1 primary neurological disease.

This paper will focus on CSF findings in HIV-1 Neurological Disease (ND). Why use CSF as exploration window of the HIV-CNS involvement? Traditionally, CSF analysis has been an effective diagnostic method as well as a means of monitoring treatment in several infectious and immune pathologies of the CNS. Consequently there is an abundance of mature background information [113, 145, 147] particularly in terms of detecting infectious agents, using IgG findings as immunological indexes, and utilizing CSF findings to map the evolution of ND. We will explore the papers that utilize CSF variables as dependent measures to explore the effects of HIV disease, particularly HIV ND, cited in Index Medicus and MEDLINE data base, and published in Spanish, Italian and English, between 1985 to 1991. We will restrict our review to those studies that exclude HIV cases with CNS opportunistic infections or neoplasms, and thus focus on what the CSF can tell us about the primary effects of HIV on the brain as defined above. The primary long-term goal is to find some elements of the CSF that would lead to an understanding of the etiopathogenesis of HIV ND. However, an almost equally important aim is to determine which CSF variables may be clinically predictive of HIV ND occurrence and progression. The latter variables can also be expected to provide the best measures of HIV ND treatment efficacy. This is particularly important since it is our contention that treatment of HIV ND will eventually be initiated and monitored on the basis of laboratory markers of HIV ND, most likely from the CSF. Finally, this summarized information would be useful in drafting a CSF profile in order to have a reference pattern for cases with complications. The data of this review will be broken down, when the information permits, according to clinical stage and presence or absence of clinical manifestations of ND.

[Migraine caused by ergotamine tartrate dependence]. / Jaqueca por dependencia al tartrato de ergotamina.

A 37-year-old patient had migraine without aura over a six year period. He developed tolerance and dependency to ergotamine tartrate defined as the irresistible and dependable use of the drug. This is contingent upon a self-sustaining, rhythmic headache/medication cycle. The diagnosis of this entity is clinical and is supported by the typical and expected evolution of the migraine in response to the sudden interruption of ergotamine tartrate use.

Vascular anastomosis techniques in renal transplants.

In our series of 250 RT's 192 (76.8%) from living donors and 58 (23.27%) from cadaver donors, there were 207 (88.8%) kidneys with a single renal artery, 40 (16%) with a double artery and 3 (1.2%) with a triple artery. End to side anastomosis to common iliac vessels was the most frequently used technique for kidneys with a single renal artery (52%). Extracorporeal renal surgery was performed on 83.7% of kidneys with multiple arteries. There were 32 (12.8%) complications with 6 (2.4%) unsuccessful RT's due to technical reasons. The actuarial survival of patients and grafts after 5 years from live donors was 87% and 69% and from cadaver donors was 78% and 46%, respectively.

Trasplante renal: análisis de 250 casos / Renal transplantation: analysis of 250 cases

Se presentan 250 trasplantes renales (TR) realizados en 238 pacientes, comparando los primeros 125 con los segundos 125 TR. Hubo 101 donantes vivos (80,8%) y 91 (72,8%) respectivamente. Se registraron 14 casos (11,2%) de complicaciones quirúrgicas - 7 vasculares, 4 urológicas y 3 varias - en los primeros, y 18 (14,4%) - 3 vasculares, 6 urológicas y 9 varias - en los segundos. Al cierre de la observación están vivos 217 pacientes (86,8%) y 170 (68%) con injerto funcionante, con una sobrevida a 10 años de pacientes e injertos de 79% y 47%

Epilepsia y embarazo. / Epilepsy and pregnancy

Se analizan tanto los efectos de la epilepsia sobre el embarazo, parto, puerperio y producto como los efectos del embarazo sobre la evolucion de la epilepsia.En termino generales, la epilepsia condiciona potencialmente mayores riesgos tanto para la embarazada como para el nino. Como normas basicas se pueden plantear: 1. El embarazo en si mismo no es indicacion de suspender el tratamiento anticonvulsivante pero es preferible que en los casos nuevos o de abandono previo, este no se inicie o retablezca en el primer trimestre de gestacion. 2. Durante el embarazo debe intentarse siempre la monoterapia antiepileptica. No debe utilizarse la trimetadiona que es toxica y teratogenica. Hay escasa experiencia con el empleo de acido valproico y de carbamazepina. 3. Los niveles plasmaticos de anticonvulsivantes deben ser monitorizados periodicamente durante el embazo. 4. Las embarazadas epilepticas deben ser referidas a las unidades de alto riesgo obsterico y controladas en ellas. 5.Los tratamientos anticonculsivantes no obligan a suspender o evitar la lactancia ya que el paso de droga a la leche es escaso