Carboplatin Plus Vincristine as an Alternative Chemotherapeutic Scheme in Patients With Glioblastoma.

Background and objective Alternative chemotherapy regimens, including cisplatin, carmustine, or other agents, have been shown to be effective; however, the use of carboplatin plus vincristine (C/V) has not been studied before. In this study, we aimed to determine the survival rates in patients treated with C/V, by comparing our findings with treatments based on temozolomide (TMZ), and to explore a possible relationship with the methylation status of the methylguanine methyltransferase (MGMT) promoter in patients with glioblastoma (GB). Methods A retrospective cohort study was conducted involving 45 surgically treated patients diagnosed with GB. Fresh tissue samples were examined by the DNA bisulfite conversion method to determine methylation status. After surgery, different chemotherapy regimens were employed as adjuvants. Follow-up of participants was performed as outpatients at three-month intervals to determine overall survival (OS), by comparing the use of TMZ versus C/V. Results MGMT promoter methylation status could only be determined in 35 samples; 20 patients received adjuvant chemotherapy, of which 14 were treated with C/V and six with TMZ-based schemes. The median OS (mOS) was eight months (range: 1-24 months). OS was 57.25% at six months, 48.7% at 12 months, and 28.5% at 24 months. In the TMZ group, an OS of 83% was observed at 24 months. In the C/V group, OS was 71.4% at six months, 57.1% at 12 months, and 35.7% at 24 months. Patients who did not receive adjuvant chemotherapy treatment had the lowest survival rates with an OS of 39.9% at six months, 26.6% at 12 months, and 19.9% ​​at 24 months. Conclusions Based on our findings, C/V offers an accessible and effective alternative treatment when the TMZ-based scheme is not accessible, providing higher rates of OS compared to patients without chemotherapy management. The methylation status of the MGMT promoter is a significant prognostic factor, resulting in higher survival rates among patients when it is methylated.

Socioeconomic status and access to multiple sclerosis treatment in Mexico.

INTRODUCTION: Multiple sclerosis (MS) is a chronic neurological autoimmune condition and the leading non-traumatic cause of neurological disability worldwide. Disease-modifying therapies (DMT) directly impact on the long-term prognosis of patients with MS preventing relapses and the associated disability progression. Here, we analyzed the impact of socioeconomic status (SES) on DMT access in Mexican patients. METHODS: We evaluated the association between SES and DMT access using the MS registry from the National Institute of Neurology and Neurosurgery in Mexico City. We included 974 patients with MS (McDonald 2010 criteria). We categorized SES according to the 2018 Mexican Association of Market Research Agencies (AMAI) SES classification. We analyzed DMT type, MS phenotype, educational level, symptomatic onset to diagnosis, EDSS at arrival, as well as the progression index. Chi-squared and Wilcoxon tests were used, and multivariable analysis performed for DMT access. RESULTS: When comparing the lower versus higher levels of SES, a significant association was found on the percentage of patients with higher levels of disability (EDSS >6) at arrival, the proportion of patients not receiving any DMT and a higher proportion of secondary progressive MS (p=0.006, p<0.001and p=0.004, respectively). We also found that lower educational levels had a significance and inverse association with EDSS on first visit (p=0.019), symptomatic onset to diagnosis (p<0.001) and a higher disability status at arrival (EDSS >6, p=0.010). CONCLUSIONS: Our study suggests that SES is an important factor determining not only prompt but overall access to highly effective DMT. Lower SES are associated with greater levels of disability at the first clinic visit and a higher proportion of patients not receiving DMT up to 12 months of follow-up.

Effect of rituximab on disease activity in latin American patients with anti-aquaporin-4 (+) neuromyelitis optica spectrum disorder.

OBJECTIVES: The aim of the present study is to explore the efficacy of rituximab in patients with Neuromyelitis Optica spectrum disorders (NMOsd) with positive AQP4-IgG serostatus. PATIENTS AND METHODS: In this single center retrospective study, we recruited seropositive anti-AQP4 NMOsd patients who received treatment with Rituximab (RTX) for at least 2 years. Demographics were described and annualized relapse rate (AAR) and survival analysis were performed for time to relapse with Rituximab. All p values ≤0.05 we considered statistically significant. RESULTS: A total of 15 patients (100 % female) were identified. Mean age of disease onset was 34 ±â€¯11 years, mean time of disease was 8.11 ±â€¯4.04 years and the median number of relapses was 5 (2-16). Ten patients received an immunosuppressive agent before RTX. Mean age of RTX initiation was 37 ±â€¯12 with a mean treatment duration of 52 ±â€¯28 months. The median ARR before and after treatment with RTX was 2.08 vs 0.00, respectively, with a difference of -2.08 (p < 0.001) CONCLUSIONS: This study shows a statistically significant reduction in the ARR and an increase in the relapse-free rate in AQP4-IgG NMOsd patients treated with RTX. These findings support the use of rituximab in our population, and indirectly suggests that its prompt use could modify the course of the disease.

Air Pollution, Multiple Sclerosis and its Relevance to Mexico City.

Long-term exposure to air pollution has been linked with the development of neurodegenerative diseases. The proposed mechanisms include neuroinflammation and brain oxidative stress. Multiple sclerosis (MS) is a neurodegenerative disease with an auto-immune physiopathology and some studies have associated it with long-term exposure to airborne particulate matter. In this opinion we discuss the current body of knowledge regarding air pollution and the risk of MS as well as MS relapses. Also, its relevance in the case of Mexico City is discussed.

Cigarette Smoking, Alcohol Consumption and Overweight in Multiple Sclerosis: Disability Progression.

BACKGROUND: The rate at which disability progresses in multiple sclerosis (MS), and its severity, have been associated with modifiable lifestyle habits. OBJECTIVE: To investigate the risk of disability progression in MS patients according to tobacco and alcohol consumption and to the presence of overweight. METHODS: This was a follow-up of MS cases from a concluded case-control study (National Institute of Neurology and Neurosurgery, Mexico 2010-2013). The evolution in EDSS (Expanded Disability Scale Score) units was followed through a medical record review. Kaplan Meier statistics and multivariate Cox regression analysis were performed. RESULTS: Of 181 cases, 63.5% were women and 82.5% had relapsing remitting MS. Study duration was 19.95 ± 15.24 months. The disease progressed faster in daily smokers than in non-smokers (p = 0.0168). In overweight patients, disability progressed faster than in normal weight patients (p = 0.0249). Ex-consumers of alcohol had lower risk of progression than current consumers (HR = 0.33 CI 95% = 0.14-0.83, p = 0.019) and both daily and ex-smokers presented higher risk of progression than non-smokers (HR = 2.32 CI 95% = 1.14-4.72, p = 0.020 and HR = 3.56, CI 95% = 1.21-10.46, p = 0.021). Stratifying by gender, the effects of smoking and overweight were only found in men. CONCLUSIONS: Smoking is associated with rapid disability progression in MS. Our results suggest that cessation of tobacco and alcohol consumption could be clinically beneficial. Although there is association between overweight and disability progression in men, a further exploration of gender differences is necessary to corroborate this finding.

Clinical prognostic factors in adults with astrocytoma: Historic cohort.

OBJECTIVE: To explore the clinical prognostic factors for adults affected with astrocytoma. PATIENTS AND METHODS: Using a historic cohort, we selected 155 clinical files from patients with astrocytoma using simple randomization. The main outcome variable was overall survival time. To identify clinical prognostic factors, we used bivariate analysis, Kaplan Meier, the log rank test and the Cox regression models. The number of lost years lived with disability (DALY) based on prevalence, was calculated. RESULTS: The mean age at diagnosis was 45.7 years. Analysis according to tumour stage, including grades II, III and IV, also showed a younger age of presentation. Kaplan-Meier survival estimates showed that tumour grade, Karnofsky status (KPS) ≥70, resection type, chemotherapy, radiotherapy, alcohol consumption, familial history of cancer and clinical presentation were significantly associated with survival time. Using a proportional hazard model, age, grade IV, resection, chemotherapy+radiotherapy and KPS were identified as prognostic factors.The amount of life lost due to premature death in this population was 28 years. CONCLUSION: In our study, astrocytoma was diagnosed in young adults. The overall survival was 15 months, 9% (n=14) of patients presented a survival of 2 years, and 3% of patients survived 3 years. On average the number of years lost due to premature death and disability was 28.53 years.

[Prevalence, associated factors and phenomenology of psychosis in patients with Parkinson's disease]. / Prevalencia, factores asociados y fenomenología de la psicosis en pacientes con enfermedad de Parkinson.

INTRODUCTION: Psychosis associated with Parkinson's disease is a major neuropsychiatric complication; it has been reported that 60% of patients will develop psychosis during the disease evolution. Its pathophysiology is multifactorial and clinically psychotic phenomena include minor hallucinations and confusional states. MATERIAL AND METHODS: We performed a cross-sectional study in patients with Parkinson's disease from a tertiary hospital using a thoughtful neurological and neuropsychiatric evaluation along with specific scales for non-motor symptoms, depression, cognition, and presence and severity of psychotic symptoms and hallucinations. RESULTS: We included a total of 236 patients with Parkinson's disease, of which 33 (13.9%) patients met the criteria for psychosis at the time of the evaluation. Visual hallucinations were the most common symptom. Age (p = 0.004), age at onset of the disease (p = 0.007) and its duration (p = 0.004), use of levodopa (p = 0.02), and use of amantadine (p = 0.004) were the main factors associated with the presence of psychosis. CONCLUSION: Psychosis in Parkinson's disease is a relatively common manifestation and is mainly associated with clinical and demographic factors. Early recognition will optimize management and improve the quality of life of patients and their caregivers.

[Neuropsychiatry and creativity: "Starry night" of Van Gogh]. / Neuropsiquiatría y creatividad: «La noche estrellada¼ de Van Gogh.

The life of Vincent van Gogh (1853-1890) has been studied thoroughly by humanists and scientists alike. His biography is an archetype of the relationship between creativity and disease. In 1956, Henri Gastaut defined his diagnosis as temporal lobe epilepsy. The artist was known for an eccentric personality and unpredictable mood, with recurrent psychotic bouts through the last two years of his life. Several authors have considered the possibility that van Gogh also suffered from bipolar affective disorder. We conducted a biographical and epistolary review with the objective of analyzing the complexity of his disease and the effects it had on his art, which ultimately placed him as one of the greatest geniuses in art.

[Women's participation in science]. / Inserción de las mujeres en la ciencia.

The participation of women in higher education in Mexico took place in the late 19th and early 20th century. The rise of women's enrollment in universities known as the "feminization of enrollment" occurred in the last thirty years. In this review we analyze how the new conditions that facilitated better access to higher education are reflected in the inclusion of women in science. We include an overview of the issues associated with a change in the demographics of enrollment, segregation of academic areas between men and women and participation in post graduate degrees. We also review the proportion of women in science. While in higher education the ratio between male and women is almost 50-50 and in some areas the presence of women is even higher, in the field of scientific research women account for barely 30% of professionals. This is largely due to structural conditions that limit the access of women to higher positions of power that have been predominantly taken by men.

Inserción de las mujeres en la ciencia / Women's participation in science

La inserción femenina a la educación superior en México y en gran parte del mundo, sucede a finales del siglo XIX y principios del XX. Los últimos treinta años han sido testigos de un aumento de la presencia femenina en las universidades, fenómeno estudiado como la “feminización de la matrícula”. Presentamos una breve reflexión del tema, con el fin de analizar de qué forma estas nuevas condiciones en el acceso a la educación se reflejan en la inserción de las mujeres en el ámbito científico. Repasamos el tema de la recomposición matricular, la segregación por áreas de estudio, tanto de varones como de mujeres, la participación a nivel posgrado (especialidad, maestría y doctorado) e indagamos la proporción de mujeres en la ciencia. Mientras en la educación superior se habla de una proporción entre varones y mujeres de casi 50 a 50 y en algunas áreas se ha llegado a reportar mayor presencia femenina, en el ámbito de investigación científica las mujeres apenas representan 30%. Esto responde en gran medida a condiciones estructurales en las que aún prevalece la dificultad de las mujeres para acceder a territorios de mayor jerarquía que han sido preponderantemente masculinos.

The participation of women in higher education in Mexico took place in the late 19th and early 20th century. The rise of women's enrollment in universities known as the [quot ]feminization of enrollment[quot ] occurred in the last thirty years. In this review we analyze how the new conditions that facilitated better access to higher education are reflected in the inclusion of women in science. We include an overview of the issues associated with a change in the demographics of enrollment, segregation of academic areas between men and women and participation in post graduate degrees. We also review the proportion of women in science. While in higher education the ratio between male and women is almost 50-50 and in some areas the presence of women is even higher, in the field of scientific research women account for barely 30% of professionals. This is largely due to structural conditions that limit the access of women to higher positions of power that have been predominantly taken by men.

Severe impulsiveness as the primary manifestation of multiple sclerosis in a young female.

Severe impulsiveness in the absence of apparent neurological signs has rarely been reported as a clinical presentation of multiple sclerosis (MS). An 11-year-old female developed progressive and sustained personality disturbances including disinhibition, hypersexuality, drug abuse, aggressiveness and suicide attempts, without neurological signs. She was given several unsuccessful psychopharmacological and psychotherapeutic interventions. At age 21, a diagnosis of MS was made, confirmed by imaging, laboratory and neurophysiological studies. Although unusual, MS may produce pure neurobehavioral disturbances. In the present case, widespread demyelinization produced a complex behavioral disorder, with features compatible with orbitofrontal and Klüver-Bucy syndromes.

Imaging features of sellar cysticercosis.

Cases of sellar involvement of neurocysticercosis (NCC) are rare. Little is known about the mechanisms by which the parasite can compromise the pituitary gland. Although NCC damages sellar structures with direct compression by large cysts, extension through the basal cisterns and third ventricle with focal arachnoiditis can result as an inflammatory response. Evaluation for hypophyseal lesions in patients with NCC may allow for the diagnosis of unexplained loss of visual acuity and hormonal disturbances.

Las enfermedades neurológicas / The neurologic diseases

Neurologic diseases have important social and economic repercussions. The economic cost related to medications, caretakers, and therapists is evident, as well as the impact the disease may cause on the family. Epilepsy is the most frequent cause of medical care at the out-patient service of the Manuel Velasco Sußrez National Institute of Neurology and Neurosurgery (NINN), in Mexico City and the estimated annual prevalence of this disease is 5.9 per 1,000 inhabitants. Parkinson's disease, the most representative of movement disorders, affects 20 of the populating aged > 65 years. Depression and dementia are complex and heterogeneous neuropsychiatry disorders, representing the fifth cause of morbility after accidents, cardiovascular disease, liver cirrhosis and diabetes mellitus. During the last decades, encephalic trauma has been the first cause of mortality: among brain tumors, glioblastomas have the greatest impact. Among infectious disease of the central nervous system (CNS), which are relatively infrequent as compared to gastrointestinal or respiratory infections; viral encephalitis, AIDS-associated toxoplasmosis, and tuberculous meningitis are the most frequent discharge diagnoses at the NINN. The need for a national registration system of neurologic diseases is unquestionable. Such a system would provide accurate data regarding the magnitude of problems related with such disease and help design adequate care and prevention programs.

[The neurologic diseases]. / Las enfermedades neurológicas.

Neurologic diseases have important social and economic repercussions. The economic cost related to medications, caretakers, and therapists is evident, as well as the impact the disease may cause on the family. Epilepsy is the most frequent cause of medical care at the out-patient service of the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery (NINN), in Mexico City and the estimated annual prevalence of this disease is 5.9 per 1,000 inhabitants. Parkinson's disease, the most representative of movement disorders, affects 20% of the populating aged > 65 years. Depression and dementia are complex and heterogeneous neuropsychiatry disorders, representing the fifth cause of morbility after accidents, cardiovascular disease, liver cirrhosis and diabetes mellitus. During the last decades, encephalic trauma has been the first cause of mortality: among brain tumors, glioblastomas have the greatest impact. Among infectious disease of the central nervous system (CNS), which are relatively infrequent as compared to gastrointestinal or respiratory infections; viral encephalitis, AIDS-associated toxoplasmosis, and tuberculous meningitis are the most frequent discharge diagnoses at the NINN. The need for a national registration system of neurologic diseases is unquestionable. Such a system would provide accurate data regarding the magnitude of problems related with such disease and help design adequate care and prevention programs.

Amyotrophic lateral sclerosis in a secluded region in Mexico possibly related to lead toxicity / Esclerosis lateral amiotrofica posiblemente relacionada con intoxicación de plomo una area aislada de México

La esclerosis lateral amiotrófica (ELA) es un padecimiento con una distribución relativamente uniforme en el mundo. La relación entre la ELA y diversos factores ambientales tóxicos se ha documentado en múltiples estudios. Uno de los aspectos más relevantes para el estudio de dichos factores ambientales es el hallazgo de "brotes" de la enfermedad en sujetos cuyo único punto en común es compartir el mismo medio ambiente. El objetivo de éste estudio es investigar la presencia de un "brote" de ELA en la comunidad de Tetela del Río en Guerrero. Se realizó un cuestionario para recolectar posibles casos de la enfermedad así como factores de riesgo, además de mediciones de plomo en quince sujetos control de la comunidad. El cuestionario se aplicó casa por casa en la comunidad, se detectaron 5 posibles casos con disartria, disfagia y atrofia de las extremidades. Los niveles promedio de plomo en los controles fueron de 22.4 ug/dl, los cuales fueron significativamente mayores a los de una población control en Hidalgo (p<0.00001). En este estudio sólo se confirmó un caso definitivo de ELA, pero el testimonio de los pobladores de la comunidad apuntaron hacia otros 5 posibles casos. El estudio de los brotes de FLA provee de información muy valiosa para la detección de factores ambientales relacionados al desarrollo de la enfermedad, lo cual puede ayudar en la búsqueda de opciones terapéuticas.

Esclerosis multiple / Multiple sclerosis

Se analizan todos los aspectos de la esclerosis múltiple por un grupo de neurólogos del Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez y de otras instituciones. Contenido: 1) Epidemiología, por Carolina León y Teresa Corona. 2) Genética, por Astrid Rasmussen. 3) Fisiopatología, por Arturo Violante y Esperanza García. 4) Modelo experimental de encefalitis alérgica experimental, por Gabriela Ordóñez. 5) Manifestaciones clínicas, por Luis Ruano y Teresa Corona. 6) Aspectos psiquiátricos, por Ignacio Ruiz. 7) Estudio de gabinete y paraclínicos, por Alma Rosa Acevedo. 8) Diagnóstico por imagen, por Rafael Rojas. 9) Tratamiento, por Teresa Corona. 10) Rehabilitación neurológica, por Jorge Hernández. 11) Grupo de apoyo, por Yaneth Rodríguez