Neuropsychiatric phenotypes of anti-NMDAR encephalitis: a prospective study.

BACKGROUND: Patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments. METHODS: A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF. RESULTS: After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia-delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia. CONCLUSIONS: Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia-delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE.

[Primary central nervous system lymphoma: clinical experience in a neurological center]. / Linfoma primario del sistema nervioso central: experiencia clinica en un centro neurologico.

INTRODUCTION: Primary lymphoma of the central nervous system is a variety of non-Hodgkin's lymphoma that accounts for 4-5% of intracranial tumours and 5% of all lymphomas. It has its origin in the brain, the eyes, the leptomeninges and the spinal cord with no systemic evidence of lymphomatoid activity; the subtype of lymphoma is predominantly of B-type cells. PATIENTS AND METHODS: We conducted a descriptive study of the patients diagnosed with primary brain lymphoma who were attended to at third-level centres in Mexico between the years 1980 and 2016. Patients who had been screened for systemic lymphoma were included. The results were analysed by means of simple frequencies, and disease-free and overall survival time was analysed by Kaplan-Meier curves; the differences among curves were analysed by means of log rank. RESULTS: Of a total of 215 patients, there were only 74 cases. By sex, 45% were females and 55% were males. Regarding age, 36.7% were over 60 years old. The most frequent clinical manifestations were motor loss (60%) and cognitive disorders (52%). Most patients received some form of chemotherapy (89%). The only significant factor for radiological response and clinical prognosis was the combined use of radiochemotherapy (p = 0.04493). CONCLUSION: Lymphoma is a tumorous condition with a high clinicoradiological response to treatment, although the response is not long-lasting. Its early identification and multidisciplinary management are essential for a more favourable prognosis in these patients.

TITLE: Linfoma primario del sistema nervioso central: experiencia clinica en un centro neurologico.Introduccion. El linfoma primario del sistema nervioso central es una variedad de linfoma no Hodgkin que representa el 4-5% de los tumores intracraneales y el 5% de todos los linfomas. Se origina en el encefalo, los ojos, la leptomeninge y la medula espinal sin evidencia sistemica de actividad linfomatoide; el subtipo de linfoma mayoritariamente es de celulas de tipo B. Pacientes y metodos. Estudio descriptivo de los pacientes diagnosticados con linfoma cerebral primario que fueron atendidos en centros de tercer nivel en Mexico entre los años 1980 y 2016. Se incluyo a los pacientes que contaran con cribado para busqueda de linfoma sistemico. Los resultados se analizaron mediante frecuencias simples; en el caso del tiempo libre de enfermedad y supervivencia global, mediante curvas de Kaplan-Meier, y las diferencias entre curvas, mediante log rank. Resultados. En un total de 215 pacientes solo hubo 74 casos. El 45% fueron mujeres y el 55%, hombres. El 36,7% eran mayores de 60 años. Las manifestaciones clinicas mas frecuentes fueron deficit motor (60%) y alteraciones cognitivas (52%). La mayoria recibio alguna forma de quimioterapia (89%). El unico factor significativo para respuesta radiologica y pronostico clinico era el uso combinado de radioquimioterapia (p = 0,04493). Conclusion. El linfoma representa una patologia tumoral con alta respuesta clinicorradiologica al tratamiento, aunque la respuesta no es duradera. Es fundamental su identificacion temprana y el tratamiento multidisciplinario para el mejor pronostico de estos pacientes.

Radiotherapy plus temozolomide or PCV in patients with anaplastic oligodendroglioma 1p19q codeleted. / Radioterapia mas temozolomida o PCV en pacientes con oligodendroglioma anaplasico con codelecion 1p19q.

INTRODUCTION: Radiotherapy with procarbazine, lomustine, and vincristine (PCV) improves overall survival in patients with anaplastic oligodendroglioma 1p19q codeleted. PATIENTS AND METHODS: This retrospective analysis investigated outcomes in patients with anaplastic oligodendroglioma 1p19q codeleted compared two different protocols (radiotherapy plus temozolomide or PCV). The primary end points were overall survival and progression-free survival. Secondary endpoint was the radiological response. RESULTS: A total of 48 patients were included. Mean age was 43 years (range: 19-66 years), 26 were male (54.1%). Twenty-one patients received PCV and 27 temozolomide. The baseline characteristics were not difference between the groups. The progression-free survival and overall survival in the PCV group were 7.2 and 10.6 years respectively and temozolomide were 6.1 and 9.2 years, both statistically significant. The radiological response was present in 80.9% in PCV arm and 70.2% in temozolomide arm there was not statistical differences. The multivariate Cox model showed only the significant parameters the use of PCV protocol. The toxicity grade 3 or 4 was present in 42.8% in PCV arm and 11.1% in temozolomide arm. CONCLUSIONS: The most common strategy in the Latin America community is the substitution of the PCV for temozolomide. This retrospective study showed superior efficacy of PCV than temozolomide. The Latin American community effort must be made to be able to have the drugs to available for using as a first line of treatment.

TITLE: Radioterapia mas temozolomida o PCV en pacientes con oligodendroglioma anaplasico con codelecion 1p19q.Introduccion. La radioterapia con procarbacina, lomustina y vincristina (PCV) mejora la supervivencia global en pacientes con oligodendroglioma anaplasico con codelecion 1p19q, pero no esta disponible en America Latina. Pacientes y metodos. Analisis retrospectivo comparando dos protocolos diferentes, radioterapia mas temozolomida o PCV, en pacientes con oligodendroglioma anaplasico con codelecion 1p19q. Los objetivos primarios fueron la supervivencia global y la supervivencia libre de progresion, y el objetivo secundario, la respuesta radiologica. Resultados. Se incluyo a 48 pacientes, 26 de ellos varones (54,1%), con una edad media de 43 años (rango: 19-66 años). Veintiun pacientes recibieron PCV, y 27, temozolomida. Las caracteristicas iniciales no tuvieron diferencias entre los grupos. La supervivencia libre de progresion y la supervivencia global en el grupo con PCV fueron de 7,2 y 10,6 años, y en el grupo de temozolomida, de 6,1 y 9,2 años, respectivamente, unos resultados estadisticamente significativos. Hubo respuesta radiologica en el 80,9% en el brazo de PCV y el 70,2% en el brazo de temozolomida. El analisis multivariado de Cox mostro como unico parametro significativo el uso del protocolo PCV. El grado de toxicidad 3-4 estuvo presente en el 42,8% en el brazo de PCV y en el 11,1% en el brazo de temozolomida. Conclusiones. La estrategia mas comun en America Latina es la sustitucion de PCV por temozolomida. Este estudio retrospectivo mostro una eficacia superior de PCV que de la temozolomida. La diferencia obliga a la comunidad latinoamericana a hacer un esfuerzo colectivo para poder tener acceso a los medicamentos para su uso como primera linea de tratamiento.

El mango: aspectos agroindustriales, valor nutricional/funcional y efectos en la salud / Mango: agroindustrial aspects, nutritional/functional value and health effects

Objetivo: Revisar y discutir la información más reciente sobre el valor agroindustrial, funcional y nutricional de uno de los frutos de mayor cultivo, exportación y consumo en México: el Mango. Métodos: Se realizó una búsqueda en diversas bases de datos (PubMed, Cochrane, ScienceDirect) y documentos de libre acceso (Google Scholar) sobre Mangifera indica L. Esta información fue posteriormente sub-clasificada en aspectos agroindustriales, nutricionales, funcionales y efectos a la salud. Resultados: Uno de cada veinte mangos consumidos mundialmente, es mexicano. 'Ataulfo' es la variedad la de mayor importancia agronómica. El procesamiento mínimo de su pulpa (MP) genera residuos de cáscara (MC) y semilla con alto potencial nutracéutico. MP y MC son buenas fuentes de ascorbato, fructosa, fibra dietarias soluble (MP, almidones y ramnogalacturonanos) e insoluble (MC, ligninas y hemicelulosa) y lípidos funcionales (MP). MP y MC poseen un perfil de compuestos fenólicos (CF) monoméricos (MP) como el acido gálico y el protocatehuico y poliméricos (MC) como la β-PGG asociados con efectos anti-obesigénicos, anti-inflamatorios, anti-cancerigenos y anti-diabeticos. Estos beneficios son dependientes de la bioaccesibilidad (liberación de su matriz alimentaria) y destino metabólico (biodisponibilidad) de estos CF. Discusión: El mango resulta una valiosa fuente de compuestos antioxidantes con comprobado beneficio a la salud. Sin embargo, factores como la variedad, temporalidad de cultivos, tratamientos pre y post-cosecha, extracción de bioactivos y algunas barreras fisiológicas pueden modificar su potencial nutracéutico (AU)

Objective: To review and discuss the latest information on agroindustrial, functional and nutritional value of one of the most produced/consumed fruit crop in México: The mango. Methods: A search was conducted in several databases (PubMed, Cochrane, ScienceDirect) and public repositories (Google Scholar) on Mangifera indica L. This information was further sub-classified into agroindustrial, nutritional, functional aspects and health effects. Results: One out of twenty mangoes consumed worldwide is Mexican. The variety 'Ataulfo' variety is the most important crop. Minimal processing of its pulp (MP) generates peel (MC) and seeds as biowastes, which have nutraceutical potential. MP and MC are good sources of ascorbate, fructose, soluble (MP, starches and rhamnogalacturonans) and insoluble (MC, lignin and hemicelluloses) dietary fibers as well as functional lipids (MP). MP and MC are good sources of monomeric (MP) phenolic compounds (PC) such as gallic and protocatehuic acids and polymeric PC (MC) such as β-PGG with associated anti-obesigenic, anti-inflammatory, anti-carcinogenic and anti-diabetic potential. However, these benefits are dependent on their bioaccessibility (release from its food matrix) and metabolic fate (bioavailability). Discussion: Mango is a valuable source of antioxidant compounds with proven health benefits. However, factors such as its variety, seasonality, pre and post-harvest handling, extraction of bioactives and some physiological barriers, can modify their nutraceutical potential (AU)

[Mango: agroindustrial aspects, nutritional/functional value and health effects]. / El mango: aspectos agroindustriales, valor nutricional/funcional y efectos en la salud.

OBJECTIVE: To review and discuss the latest information on agroindustrial, functional and nutritional value of one of the most produced/consumed fruit crop in México: The mango. METHODS: A search was conducted in several databases (PubMed, Cochrane, ScienceDirect) and public repositories (Google Scholar) on Mangifera indica L. This information was further sub-classified into agroindustrial, nutritional, functional aspects and health effects. RESULTS: One out of twenty mangoes consumed worldwide is Mexican. The variety "Ataulfo" variety is the most important crop. Minimal processing of its pulp (MP) generates peel (MC) and seeds as biowastes, which have nutraceutical potential. MP and MC are good sources of ascorbate, fructose, soluble (MP, starches and rhamnogalacturonans) and insoluble (MC, lignin and hemicelluloses) dietary fibers as well as functional lipids (MP). MP and MC are good sources of monomeric (MP) phenolic compounds (PC) such as gallic and protocatehuic acids and polymeric PC (MC) such as -PGG with associated anti-obesigenic, anti-inflammatory, anti-carcinogenic and anti-diabetic potential. However, these benefits are dependent on their bioaccessibility (release from its food matrix) and metabolic fate (bioavailability). DISCUSSION: Mango is a valuable source of antioxidant compounds with proven health benefits. However, factors such as its variety, seasonality, pre and post-harvest handling, extraction of bioactives and some physiological barriers, can modify their nutraceutical potential.

Objetivo: Revisar y discutir la información más reciente sobre el valor agroindustrial, funcional y nutricional de uno de los frutos de mayor cultivo, exportación y consumo en México: el Mango. Métodos: Se realizó una búsqueda en diversas bases de datos (PubMed, Cochrane, ScienceDirect) y documentos de libre acceso (Google Scholar) sobre Mangifera indica L. Esta información fue posteriormente sub-clasificada en aspectos agroindustriales, nutricionales, funcionales y efectos a la salud. Resultados: Uno de cada veinte mangos consumidos mundialmente, es mexicano. "Ataulfo" es la variedad la de mayor importancia agronómica. El procesamiento mínimo de su pulpa (MP) genera residuos de cáscara (MC) y semilla con alto potencial nutracéutico. MP y MC son buenas fuentes de ascorbato, fructosa, fibra dietarias soluble (MP, almidones y ramnogalacturonanos) e insoluble (MC, ligninas y hemicelulosa) y lípidos funcionales (MP). MP y MC poseen un perfil de compuestos fenólicos (CF) monoméricos (MP) como el acido gálico y el protocatehuico y poliméricos (MC) como la -PGG asociados con efectos anti-obesigénicos, anti-inflamatorios, anti-cancerigenos y anti-diabeticos. Estos beneficios son dependientes de la bioaccesibilidad (liberación de su matriz alimentaria) y destino metabólico (biodisponibilidad) de estos CF. Discusión: El mango resulta una valiosa fuente de compuestos antioxidantes con comprobado beneficio a la salud. Sin embargo, factores como la variedad, temporalidad de cultivos, tratamientos pre y post-cosecha, extracción de bioactivos y algunas barreras fisiológicas pueden modificar su potencial nutracéutico.

[Nutritional status in patients with recurrent glioblastoma]. / Évaluation du statut nutritionnel chez les patients présentant un glioblastome en récidive.

INTRODUCTION: Nutritional status is a major clinical parameter in multiple cancers. Indeed, nutritional status is a prognostic factor and a predictor of response and toxicity to treatments in breast and lung cancers for instance. To our knowledge, in patients suffering from malignant primary brain tumors, nutritional status has been poorly investigated. METHODS: Nutritional status of 26 glioblastoma patients relapsing after a first line of treatment was studied. The body mass index (BMI), the prognostic inflammatory and nutritional index (PINI) and the instant nutritional score (INS) were assessed. RESULTS: The BMI was abnormal in 12 patients, two were malnourished while 10 were overweight. The BMI was not correlated to age of patients. Overweight status did not impact patient survival but it was associated with reduced performance status. The PINI was abnormal in three patients. Finally, the INS was abnormal in 24 patients, noted 2 (n=22) or 4 (n=4). CONCLUSIONS/DISCUSSION: Our results were not in favor of systematic nutritional support in patients with recurrent glioblastoma after a first line of treatment. Being overweight does not influence prognosis but may influence performance status. Steroid therapy and chemotherapy (inducing sodium and water retention and lymphopenia) weaken the relevance of BMI and INS for nutritional assessment in patients with recurrent glioblastoma. Further studies using additional nutritional tests in larger, independent and prospective cohorts of patients are warranted to obtain more details.

[Management of primary central nervous system lymphoma]. / Prise en charge des lymphomes primitifs du système nerveux central.

Primary CNS lymphoma is the malignant brain tumor whose prognosis has improved the most the two past decades. The majority of the patients achieve a complete remission with treatment and a substantial minority may hope to be cured. The treatment includes high-dose methotrexate polychemotherapy combined or not with whole brain radiotherapy (WBRT). Elderly patients who are exposed to a high risk of treatment induced neurotoxicity need a specific management avoiding or defering WBRT. In young patients, the main questions concerning the treatment are the role of consolidation WBRT and intensive chemotherapy with peripheral blood stem cell rescue in the initial treatment of PCNSL. As recently shown, national and international collaborative efforts make now possible randomized trials for this rare disease, which would contribute to better define the treatment strategy. New insights in PCNSL tumorigenesis would help to better understand the heterogeneity of outcome and to develop efficient targeted therapies.

Síndrome de Klüver-Bucy secundario a metástasis de meduloblastoma / Klüver-Bucy syndrome secondary to medulloblastoma metastasis

No disponible

No disponible

Cefalea en racimos episódica sintomática, como primera manifestación de prolactinoma / Symptomatic episodic cluster headache as the first symptom of a prolactinoma

No disponible

No disponible

[Increased risk of neoplasia among relatives of glioma patients]. / Incremento en el riesgo de neoplasia entre familiares de pacientes con glioma.

INTRODUCTION: Some previous studies have suggested familial aggregation of gliomas, although the results have not always been replicated. SUBJECTS AND METHODS: In the present study of a Mexican population, we compared 100 cases of glioma with 124 healthy unrelated controls, as well as their 1st, 2nd and 3rd degree relatives (n = 3,575 and 4,520 respectively). RESULTS: The relatives of the cases had a significantly higher risk of developing brain tumors than the relatives of controls (OR = 5.3; p < 0.05; 95% CI = 1.1-25.7), and their risk of developing any cancer was also increased (OR = 2; p < 0.05; 95% CI = 1.16-3.51), this risk was twofold for men when compared to females (OR = 2; p < 0.05; 95% CI = 1.15-3.37). CONCLUSION: The present study supports familial aggregation of brain tumors and warrants further research into their genetic etiology.

Incremento en el riesgo de neoplasia entre familiares de pacientes con glioma / Increased risk of neoplasia among relatives of gliomapatients

Introducción. Estudios previos han sugerido que existe agregación familiar de gliomas; sin embargo, los resultados no siempre han sido replicables. Sujetos y métodos. En el presente estudio de una población mexicana, comparamos 100 casos de glioma con 124 controles sanos no emparentados, así como sus familiares de primer, segundo y tercer grado (n = 3.575 y 4.520, respectivamente). Resultados. Los familiares de los casos tuvieron un riesgo significativamente mayor de desarrollar tumores cerebrales que los familiares de los controles (odds ratio, OR = 5,3; p < 0,05; intervalo de confianza al 95%, IC 95% = 1,1-25,7), su riesgo de desarrollar cualquier tipo de cáncer también fue mayor (OR = 2; p < 0,05; IC 95% = 1,16-3,51), y este riesgo fue el doble para varones que para mujeres (OR = 2; p < 0,05; IC 95% = 1,15-3,37). Conclusión. El presente estudio apoya la existencia de agregación familiar de neoplasias cerebrales y obliga a profundizar en el estudio de su etiología genética

Introduction. Some previous studies have suggested familial aggregation of gliomas, although the results have not always been replicated. Subjects and methods. In the present study of a Mexican population, we compared 100 cases of gliomawith 124 healthy unrelated controls, as well as their 1st, 2nd and 3rd degree relatives (n = 3,575 and 4,520 respectively).Results. The relatives of the cases had a significantly higher risk of developing brain tumors than the relatives of controls (OR = 5.3; p < 0.05; 95% CI = 1.1-25.7), and their risk of developing any cancer was also increased (OR = 2; p < 0.05; 95% CI = 1.16-3.51), this risk was twofold for men when compared to females (OR = 2; p < 0.05; 95% CI = 1.15-3.37). Conclusion. The present study supports familial aggregation of brain tumors and warrants further research into their genetic etiology