Rare Image of Epidural Catheter Fracture in Lumbar Analgesia.

Objective: Accidental fracture of epidural analgesia catheters has a very low incidence of 2.5 per 100,000 anesthesia. A rare image of the fracture is reported. Methods: A 42-year-old female patient was attending a cesarean section eight years earlier to her consult. In the cesarean section, she received regional epidural anesthesia, and the main complaint was low back pain, specifically between the spinous processes L2 and L3. The somatic pain had been presenting intermittently for eight years. The sagittal section of magnetic resonance imaging of the lumbar spine showed a "golf club" image from the midline to the laminae of L2 and L3 with the subcutaneous tissue. Results: A small right hemilaminectomy was performed to remove the complete catheter, which did not adhere, but was coiled in the S-shape. The catheter was trapped between the left facets of L2 and L3 laterally than through the midline. Several risk factors and therapeutic procedures have been proposed. Conclusion: In a systematic review, 24 articles were reported on this specific issue. No surgical procedure and follow-up were informed by 8 authors. Surgical remotion by laminectomy was used in 9 articles, surgical explanation by skin incision was reported by 4 authors, and remotion by endoscopy was reported in 1 article. Two articles not reported solution.

Innovative perspectives in limbic surgery using deep brain stimulation.

Limbic surgery is one of the most attractive and retaken fields of functional neurosurgery in the last two decades. Psychiatric surgery emerged from the incipient work of Moniz and Lima lesioning the prefrontal cortex in agitated patients. Since the onset of stereotactic and functional neurosurgery with Spiegel and Wycis, the treatment of mental diseases gave attention to refractory illnesses mainly with the use of thalamotomies. Neurosis and some psychotic symptoms were treated by them. Several indications when lesioning the brain were included: obsessive-compulsive disorder, depression, and aggressiveness among others with a diversity of targets. The indiscriminately use of anatomical sites without enough scientific evidence, and uncertainly defined criteria for selecting patients merged with a deficiency in ethical aspects, brought a lack of procedures for a long time: only select clinics allowed this surgery around the world from 1950 to the 1990s. In 1999, Nuttin et al. began a new chapter in limbic surgery with the use of Deep Brain Stimulation, based on the experience of pain, Parkinson's disease, and epilepsy. The efforts were focused on different targets to treat depression and obsessive-compulsive disorders. Nevertheless, other diseases were added to use neuromodulation. The goal of this article is to show the new opportunities to treat neuropsychiatric diseases.

Dexmedetomidina vía nasal en colecistectomía laparoscópica / Dexmedetomidine intranasally in laparoscopic cholecystectomy

Resumen: Introducción: la dexmedetomidina es un adyuvante en el manejo anestésico perioperatorio y si se administra por vía nasal las dosis requeridas tienen mínimos efectos secundarios. Material y métodos: ensayo clínico aleatorizado doble ciego en pacientes sometidos a colecistectomía laparoscópica con anestesia general, comparando la dexmedetomidina intranasal (1 μg/kg de peso ideal) contra placebo, se comparó el efecto analgésico postoperatorio por medio de la escala visual análoga del dolor (EVA) y el consumo de opioides transanestésico. El análisis estadístico se realizó con t de Student y exacta de Fisher. Resultados: se incluyeron 54 pacientes aleatorizados en dos grupos: dexmedetomidina y control. El 81.5% de los sujetos fueron mujeres, no se encontró diferencia entre los grupos en las variables demográficas. La media de la calificación EVA a los 60 minutos para el grupo dexmedetomidina fue (2.89 ± 1.9), estadísticamente inferior comparada contra el grupo control (5.78 ± 2.3) (p ˂ 0.0001). El consumo de opioides para dexmedetomidina fue (0.424 ± 0.074 μg/h) estadísticamente menor al control (0.697 ± 0.136 μg/h) (p ˂ 0.0001) con un tamaño del efecto de Cohen de 250%. Conclusiones: disminución significativa en EVA y en el consumo de opioides con el uso de dexmedetomidina intranasal en colecistectomía laparoscópica.

Abstract: Introduction: dexmedetomidine is and useful adjuvant agent in the perioperative anesthetic management associated to nasal administration with minimum adverse effects. Material and methods: a randomized, controlled, double blind, clinical trial was carried out in elective patients undergoing laparoscopic cholecystectomy with general anesthesia. Aim of this study was to compare the postoperative analgesic effect through visual analogue scale (VAS) and the perioperative opioid consumption. Dexmedetomidine was administrated intranasally (1 μg/kg dose) versus placebo. Statistical analysis was realized through student t and Fisher Test. Results: 54 patients were randomized in two groups: dexmedetomidine vs control. Not significant differences were found between both groups in demographic variables but 81.5% were women. Mean of VAS score at 60 minutes was significantly inferior (2.89 ± 1.9) versus control group (5.78 ± 2.3) (p ˂ 0.0001). Mean of opioids consumption in dexmedetomidine group (0.424 ± 0.074 μg/h) was significant minor of control group (0.697 ± 0.136 μg/h) (p ˂ 0.0001). Size effect through Cohen test was 250%. Conclusion: statistically decrease in VAS and in opioid consumption was observed using dexmedetomidine nasally in laparoscopic cholecystectomy.

Prognostic factors of unilateral prelemniscal radiations radiofrequency lesions: A surgical technique for the treatment of Parkinson's disease motor symptoms.

OBJECTIVE: A group of patients with Parkinson's disease (PD) were managed with unilateral prelemniscal radiation radiofrequency lesions (U-Raprl). The current study aims to evaluate prognostic factors that could influence clinical response. METHODS: Patients previously diagnosed with PD managed with U-Raprl were included in the study, classifying them into two groups according to their percentage of clinical response ( 1.5), Age (p < 0.0001, ∆ = 2.38), Evolution (p < 0.0001, ∆ = 2.38), and post-operative UPDRS (p < 0.01, ∆ = 1.38). The qualitative analysis of the distribution regarding the responder group shows that those patients with an age under 58 years, an evolution fewer than 7 years, and a preoperative HYS score smaller than 2, showed a response ≥ 50% according to the UPDRS-III in all cases. CONCLUSION: U-Raprl is a highly effective procedure with a 5-year persistence of improvement. The most relevant prognostic factors to consider for a clinical response according to UPDRS-III greater than 50% are age under 58 years, less than 7 years of PD evolution, and HYS less or equal to 3.

The Inflammatory Biomarkers Behavior Profile of Patients Following Elective Degenerative Spine Surgery and Differences Compared to Those Coursing With a Postoperative Spinal Infection: Protocol for a Systematic Review.

BACKGROUND: The incidence of postoperative spinal infection (PSI) ranges from 0% to 10%, with devastating effects on the patient prognosis because of higher morbidity while increasing costs to the health care system. PSIs are elusive and difficult to diagnose, especially in the early postoperative state, because of confusing clinical symptoms, rise in serum biomarkers, or imaging studies. Current research on diagnosis has focused on serum biomarkers; nevertheless, most series rely on retrospective cohorts where biomarkers are studied individually and at different time points. OBJECTIVE: This paper presents the protocol for a systematic review that aims to determine the inflammatory biomarker behavior profile of patients following elective degenerative spine surgery and their differences compared to those coursing with PSIs. METHODS: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. This protocol was registered at PROSPERO on January 19, 2022. We will include studies related to biomarkers in adult patients operated on for degenerative spinal diseases and those developing PSIs. The following information will be extracted from the papers: (1) study title; (2) study author; (3) year; (4) evidence level; (5) research type; (6) diagnosis group (elective postoperative degenerative disease or PSI); (7a) region (cervical, thoracic, lumbosacral, and coccygeal); (7b) type of infection by anatomical or radiological site; (8) surgery type (including instrumentation or not); (9) number of cases; (10) mean age or individual age; (11) individual serum biomarker values from the preoperative state up to 90 days postoperative for both groups, including (10a) interleukin-6, (10b) presepsin, (10c) erythrocyte sedimentation rate, (10d) leukocyte count, (10e) neutrophil count, (10f) C-reactive protein, (10g) serum amyloid, (10h) white cell count, (10i) albumin, (10j) prealbumin, (10k) procalcitonin, (10l) retinol-associated protein, and (10m) Dickkopf-1; (11) postoperative days at symptoms or diagnosis; (12) type of organism; (13) day of starting antibiotics; (14) duration of treatment; and (15) any biases (including comorbidities, especially those affecting immunological status). All data on biomarkers will be presented graphically over time. RESULTS: No ethical approval will be required, as this review is based on published data and does not involve interaction with human participants. The search for this systematic review commenced in February 2021, and we expect to publish the findings in mid-2023. CONCLUSIONS: This study will provide the behavior profile of biomarkers for PSI and patients following elective surgery for degenerative spinal diseases from the preoperative period up to 90 days postoperative, providing cutoff values on the day of diagnosis. This research will provide clinicians with highly trustable cutoff reference values for PSI diagnosis. Finally, we expect to provide a basis for future research on biomarkers that help diagnose more accurately and in a timely manner in the early stages of illness, ultimately impacting the patient's physical and mental health, and reducing the disease burden. TRIAL REGISTRATION: PROSPERO CRD42022304645; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304645. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41555.

Correlation of Biomarkers of Endothelial Injury and Inflammation to Outcome in Hospitalized COVID-19 Patients.

COVID-19 can trigger an intense systemic inflammation and prothrombotic state, leading to a rapid and disproportionate deterioration of lung function. An effective screening tool is essential to identify the patients at risk for severe disease. This observational study was conducted on hospitalized patients with moderate and severe COVID-19 pneumonia in a general hospital in Mexico City between 1 March 2021 and 15 March 2021. Serum samples were analyzed to explore the role of biomarkers of inflammation, coagulation, oxidative stress, and endothelial damage with the severity of the disease. Our results demonstrated that Syndecan-1 and nitrites/nitrates showed a high correlation in severely ill patients. In conclusion, COVID-19 patients with elevated levels of SDC-1 were associated with severe disease. This molecule can potentially be used as a marker for the progression or severity of COVID-19. Preservation of glycocalyx integrity may be a potential treatment for COVID-19.

Incobotulinum toxin type A for treatment of chronic myofascial pain.

PURPOSE: This study assessed the effectiveness of incobotulinum toxin type A (IBTx) for chronic myofascial pain affecting the masseter and temporal muscles. METHODS: Twenty two patients who received a diagnosis of chronic masseter and temporalis myofascial pain were evaluated by using a visual analog pain scale (VAS), digital pressure algometry, and the SF-36 Health Survey at baseline (T0), before IBTx injection. Patients were again evaluated at 2 months (T1) and 7 months (T2) after IBTx injection. RESULTS: VAS scores for pain significantly differed (P = 0.029, Friedman test). Post-hoc tests showed a significant reduction in pain at 2 months (T0-T1) and 7 months (T0-T2) (P = 0.011 and P = 0.028, respectively; Wilcoxon test) but not between 2 and 7 months (P = 0.676; Wilcoxon test). There was no significant difference in pressure algometry values (P = 0.385, Friedman test). Quality of life (QOL) assessment showed a significant difference (P = 0.002, Friedman test). Post-hoc tests showed a significant improvement in QOLat 2 months, but no significant difference at 7 months (P = 0.004 and P = 0.260, Wilcoxon test). CONCLUSION: IBTx injection resulted in safe, effective short-term pain relief for patients with chronic facial pain affecting the masseter and temporalis muscles.

Validation of the Comic Strip Test to evaluate empathy in a Mexican population sample.

INTRODUCTION: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. OBJECTIVE: Validation of the Comic Strip Test to evaluate empathy. METHOD: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. RESULTS: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. CONCLUSIONS: The Comic Strip Test was validated with parametric psychometric parameters.

Effect of unilateral amygdalotomy and hypothalamotomy in patients with refractory aggressiveness.

BACKGROUND: Neurosurgical treatment, although controversial, is considered a useful resource in the treatment of chronic psychiatric diseases such as refractory aggressiveness. OBJECTIVE: To evaluate the clinical results and side effects of posteromedial hypothalamotomy associated with amygdalotomy in patients with refractory aggressiveness. METHOD: A clinical trial was conducted in patients with chronic aggressiveness and refractory to pharmacological treatment. A central amygdalotomy associated with posteromedial hypothalamotomy was performed using thermo-coagulation by radiofrequency. The degree of aggressiveness was quantified by the Yudofsky's global scale of aggression. Postoperative changes in aggressive behavior continued to be evaluated every 6 months for at least 36 months. RESULTS: A statistically significant change in aggressive behavior was observed during 36 months of follow-up. The collateral effects of the association of both procedures are described, the most frequent being drowsiness and some cases of reduction in sexual behavior. CONCLUSION: Symmetric and simultaneous unilateral lesions of the central nucleus of the amygdala and the posteromedial hypothalamus contralateral to motor dominance give the same clinical effect in the reduction of the pathological aggression that the bilateral lesions.

[Validación de la prueba de Tiras cómicas para evaluar la empatía en una muestra de población mexicana].

INTRODUCTION: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. OBJECTIVE: Validation of the Comic Strip Test to evaluate empathy. METHOD: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. RESULTS: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. CONCLUSIONS: The Comic Strip Test was validated with parametric psychometric parameters.

ANTECEDENTES: La empatía es la capacidad de un individuo para entender al otro desde el punto de vista cognitivo y emocional. La empatía es un constructo complejo que representa un reto en su evaluación, por lo cual es necesario contar con instrumentos validados en población mexicana. OBJETIVO: Validación de la prueba de Tiras cómicas para evaluar empatía. MÉTODO: Muestreo por conveniencia, se midió la consistencia interna, la validez convergente con el coeficiente de empatía, la validez de constructo con análisis factorial y la capacidad de discriminar entre sujetos con déficit de empatía por psicopatología con controles por medio de una curva Receiver Operating Characteristic (ROC) por sus siglas en inglés. RESULTADOS: La escala de Tiras cómicas se evaluó en 86 controles, 19 pacientes con esquizofrenia, a de Cronbach = 0.894. La correlación con el coeficiente de empatía fue de 0.88, con una sensibilidad del 81.3% y la especificidad del 38%. CONCLUSIONES: Se validó la prueba de Tiras cómicas con adecuados parámetros psicométricos.

[Efecto de la amigdalotomía e hipotalamotomía unilateral en pacientes con agresividad refractaria].

BACKGROUND: Neurosurgical treatment, although controversial, is considered a useful resource in the treatment of chronic psychiatric diseases such as refractory aggressiveness. OBJECTIVE: To evaluate the clinical results and side effects of posteromedial hypothalamotomy associated with amygdalotomy in patients with refractory aggressiveness. METHOD: A clinical trial was conducted in patients with chronic aggressiveness and refractory to pharmacological treatment. A central amygdalotomy associated with posteromedial hypothalamotomy was performed using thermo-coagulation by radiofrequency. The degree of aggressiveness was quantified by the Yudofsky's global scale of aggression. Postoperative changes in aggressive behavior continued to be evaluated every 6 months for at least 36 months. RESULTS: A statistically significant change in aggressive behavior was observed during 36 months of follow-up. The collateral effects of the association of both procedures are described, the most frequent being drowsiness and some cases of reduction in sexual behavior. CONCLUSION: Symmetric and simultaneous unilateral lesions of the central nucleus of the amygdala and the posteromedial hypothalamus contralateral to motor dominance give the same clinical effect in the reduction of the pathological aggression that the bilateral lesions.

ANTECEDENTES: El tratamiento neuroquirúrgico, aunque polémico, se considera un recurso útil en el tratamiento de enfermedades psiquiátricas crónicas como la agresividad refractaria. OBJETIVO: Evaluar los resultados clínicos y los efectos colaterales de la hipotalamotomía posteromedial (HPM) asociada a amigdalotomía en pacientes con agresividad refractaria. MÉTODO: Se realizó un ensayo clínico en pacientes con agresividad crónica y refractaria a tratamiento farmacológico. Se les realizó amigdalotomía central asociada a HPM mediante termocoagulación por radiofrecuencia. El grado de agresividad se cuantificó mediante la escala global de agresividad de Yudofsky. Los cambios postoperatorios en la conducta agresiva continuaron siendo evaluados cada 6 meses durante al menos 36 meses. RESULTADOS: Se observó un cambio estadísticamente significativo de la conducta agresiva, a lo largo de 36 meses de seguimiento. Se describen los efectos colaterales de la asociación de ambos procedimientos, siendo el de mayor frecuencia la somnolencia y algunos casos de reducción en la conducta sexual. CONCLUSIÓN: Las lesiones unilaterales simétricas y simultáneas del núcleo central de la amígdala y del hipotálamo posteromedial contralaterales a la dominancia motora dan el mismo efecto clínico en la reducción de la agresividad patológica que las lesiones bilaterales.

Efecto de la estimulación magnética transcraneal sobre la recuperación motora del miembro torácico en la enfermedad vascular cerebral. Revisión sistemática / Effect of transcraneal magnetic stimulation on the motor recovery of the thoracic limb in cerebrovascular disease a systematic review

Introducción. Existen estudios donde se ha utilizado la estimulación magnética transcraneal (EMT) inhibitoria contralesional y excitatoria ipsilesional como terapia coadyuvante en la rehabilitación motora del miembro torácico; sin embargo, no existe un consenso respecto a las variables de estimulación ni sobre sus resultados clínicos. Objetivo. Describir los resultados de los ensayos clínicos donde se ha aplicado EMT en la rehabilitación en pacientes con enfermedad vascular cerebral (EVC). Pacientes y métodos. Se realizó la revisión sistemática de la base de datos PubMed. Fueron seleccionados los estudios catalogados como originales en idioma inglés, cuya población tuvo afectación de miembro torácico tras una EVC. Se excluyeron todos los estudios piloto, además de estudios que incluyeran pacientes bajo tratamiento farmacológico o alguna intervención diferente a terapia física u ocupacional. Dada la heterogeneidad percibida en los estudios, no fue posible aplicar estadística inferencial, únicamente se empleó estadística descriptiva. Resultados. Fueron seleccionados siete estudios. Se identificaron 259 casos con una edad media de 64,3 ± 4,28 años (rango: 35-89 años). Los protocolos de EMT, en su mayoría, se realizaron mediante estimulación de tipo inhibitoria contralesional. Hubo resultados positivos en cinco estudios. Conclusión. De acuerdo con los resultados obtenidos, existen indicios de que la EMT podría contribuir a la mejoría del control motor del miembro torácico en los pacientes con secuelas por EVC

Introduction. There have been studies in which contralesional inhibitory and ipsilesional excitatory transcranial magnetic stimulation (TMS) has been used as coadjuvant therapy in the motor rehabilitation of the thoracic limb in patients. However, there is no consensus regarding the stimulation variables or their clinical outcomes. Aim. To describe the results of clinical trials where TMS has been applied in rehabilitation in patients with cerebrovascular disease (CVD). Patients and methods. A systematic review of the PubMed database was performed. The articles cataloged as originals in English, whose population had limitation of thoracic limb after CVD were selected. Pilot studies, as well as studies in which patients under pharmacological treatment included any intervention other than physical or occupational therapy were excluded. Given their heterogeneity, it was not possible to apply inferential statistics, only descriptive statistics were use. Results. Seven studies were identified; 259 cases with an age of 64.3 ± 4.28 years (range: 35-89 years) were reported. The TMS protocols, for the most part, were performed by contralesional inhibitory type stimulation. There were positive results in five studies. Conclusion. In accordance with the results obtained, we observed that TMS could contribute to the improvement of motor control of the thoracic limb in patients with sequelae due to CVD

Tratamiento de la agresividad refractaria mediante amigdalotomía e hipotalamotomía posteromedial por radiofrecuencia / Treatment of refractory aggressiveness by amygdalotomy and posteromedial hypothalamotomy by radiofrequency

Introducción. Dado que, en algunas circunstancias, las conductas defensivas o de ataque muestran un patrón de dominancia motora, tal como se observa en los sujetos dedicados a los deportes de contacto o de lucha, se consideró que la conducta agresiva tiene un patrón motor dominante. Con el fin de evitar los problemas funcionales descritos con los procedimientos de lesión bilateral tanto del núcleo central de la amígdala como del hipotálamo posteromedial, se decidió combinarlos; es decir, realizar amigdalotomía del núcleo central de la amígdala e hipotalamotomía posteromedial de manera unilateral y simultánea, basándose en la dominancia motora del paciente mediante la prueba de Edimburgo. Pacientes y métodos. Este estudio muestra la experiencia quirúrgica en una serie de nueve pacientes con el diagnóstico de síndrome neuroagresivo resistente al tratamiento farmacológico. Dentro del protocolo de estudio, se les realizó resonancia magnética cerebral para descartar la presencia de neoplasias, enfermedades vasculares, infecciones y trastornos degenerativos. El grado de agresividad se cuantificó mediante la escala global de agresividad de Yudofsky. Adicionalmente, se determinó la dominancia manual a través de la prueba de Edimburgo. Resultados y conclusiones. El buen control de la agresividad se observó de modo inmediato. En algunos casos fue necesario reducir la medicación de antipsicóticos o benzodiacepinas, ya que aumentaban la agresividad. Sólo un caso requirió una segunda cirugía. Se logró seguimiento del 100% de los casos en 24 meses y del 78% en 36 meses

Introduction. Since, under certain circumstances, defensive or attacking behaviours display a pattern of motor dominance, as observed in subjects who participate in contact or fighting sports, aggressive behaviour was considered to have a dominant motor pattern. With the aim of preventing the functional problems reported with bilateral lesion procedures involving both the central nucleus of the amygdala and the posteromedial hypothalamus, the decision was made to combine them; thus, an amygdalotomy of the central nucleus of the amygdala and a posteromedial hypothalamotomy were to be performed simultaneously and unilaterally, on the basis of the motor dominance of the patient determined by means of the Edinburgh test. Patients and methods. This study describes the surgical experience in a series of nine patients diagnosed with refractory neuroaggressive syndrome. As part of the study protocol, a magnetic resonance brain scan was performed to rule out the presence of neoplasms, vascular diseases, infections and degenerative disorders. The degree of aggressiveness was quantified using Yudofsky's Overt Aggression Scale. Additionally, manual dominance was determined by means of the Edinburgh test. Results and conclusions. Good control of aggressiveness was seen immediately. In some cases it was necessary to reduce the antipsychotic or benzodiazepine medication, as it was seen to increase aggressiveness. Only one case required a second surgical intervention. Follow-up was achieved in 100% of the cases at 24 months and 78% at 36 months

Validación de la prueba de Tiras cómicas para evaluar la empatía en una muestra de población mexicana / Validation of the Comic strip test to assess empathy in a Mexican population sample

Resumen Antecedentes: La empatía es la capacidad de un individuo para entender al otro desde el punto de vista cognitivo y emocional. La empatía es un constructo complejo que representa un reto en su evaluación, por lo cual es necesario contar con instrumentos validados en población mexicana. Objetivo: Validación de la prueba de Tiras cómicas para evaluar empatía. Método: Muestreo por conveniencia, se midió la consistencia interna, la validez convergente con el coeficiente de empatía, la validez de constructo con análisis factorial y la capacidad de discriminar entre sujetos con déficit de empatía por psicopatología con controles por medio de una curva Receiver Operating Characteristic (ROC) por sus siglas en inglés. Resultados: La escala de Tiras cómicas se evaluó en 86 controles, 19 pacientes con esquizofrenia, a de Cronbach = 0.894. La correlación con el coeficiente de empatía fue de 0.88, con una sensibilidad del 81.3% y la especificidad del 38%. Conclusiones: Se validó la prueba de Tiras cómicas con adecuados parámetros psicométricos.

Abstract Introduction: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. Objective: Validation of the Comic Strip Test to evaluate empathy. Method: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. Results: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. Conclusions: The Comic Strip Test was validated with parametric psychometric parameters.

Efecto de la amigdalotomía e hipotalamotomía unilateral en pacientes con agresividad refractaria / Effect of tonsillotomy and unilateral hypothalamotomy in patients with refractory aggressiveness

Resumen Antecedentes: El tratamiento neuroquirúrgico, aunque polémico, se considera un recurso útil en el tratamiento de enfermedades psiquiátricas crónicas como la agresividad refractaria. Objetivo: Evaluar los resultados clínicos y los efectos colaterales de la hipotalamotomía posteromedial (HPM) asociada a amigdalotomía en pacientes con agresividad refractaria. Método: Se realizó un ensayo clínico en pacientes con agresividad crónica y refractaria a tratamiento farmacológico. Se les realizó amigdalotomía central asociada a HPM mediante termocoagulación por radiofrecuencia. El grado de agresividad se cuantificó mediante la escala global de agresividad de Yudofsky. Los cambios postoperatorios en la conducta agresiva continuaron siendo evaluados cada 6 meses durante al menos 36 meses. Resultados: Se observó un cambio estadísticamente significativo de la conducta agresiva, a lo largo de 36 meses de seguimiento. Se describen los efectos colaterales de la asociación de ambos procedimientos, siendo el de mayor frecuencia la somnolencia y algunos casos de reducción en la conducta sexual. Conclusión: Las lesiones unilaterales simétricas y simultáneas del núcleo central de la amígdala y del hipotálamo posteromedial contralaterales a la dominancia motora dan el mismo efecto clínico en la reducción de la agresividad patológica que las lesiones bilaterales.

Abstract Background: Neurosurgical treatment, although controversial, is considered a useful resource in the treatment of chronic psychiatric diseases such as refractory aggressiveness. Objective: To evaluate the clinical results and side effects of posteromedial hypothalamotomy associated with amygdalotomy in patients with refractory aggressiveness. Method: A clinical trial was conducted in patients with chronic aggressiveness and refractory to pharmacological treatment. A central amygdalotomy associated with posteromedial hypothalamotomy was performed using thermo-coagulation by radiofrequency. The degree of aggressiveness was quantified by the Yudofsky's global scale of aggression. Postoperative changes in aggressive behavior continued to be evaluated every 6 months for at least 36 months. Results: A statistically significant change in aggressive behavior was observed during 36 months of follow-up. The collateral effects of the association of both procedures are described, the most frequent being drowsiness and some cases of reduction in sexual behavior. Conclusion: Symmetric and simultaneous unilateral lesions of the central nucleus of the amygdala and the posteromedial hypothalamus contralateral to motor dominance give the same clinical effect in the reduction of the pathological aggression that the bilateral lesions.

Primary Prophylaxis to Prevent the Development of Hepatic Encephalopathy in Cirrhotic Patients with Acute Variceal Bleeding.

Background and Aim: Variceal bleeding is the second most important precipitating factor related to the development of episodic hepatic encephalopathy; but to date there are no recommendations to prevent this complication. The aim of this study was to compare if primary prophylaxis with lactulose or L-ornithine L-aspartate or rifaximin, in cirrhotic patients with variceal bleeding, is better than placebo for avoiding the development of hepatic encephalopathy. Methods: A randomized, double-blind, placebo-controlled clinical trial (ClinicalTrials.gov identifier: NCT02158182) which included cirrhotic patients with variceal bleeding, without minimal or clinical hepatic encephalopathy at admission. Findings: 87 patients were randomized to one of four groups. The basal characteristics were similar between groups. Comparatively with placebo, the frequency with regard to the development of hepatic encephalopathy was as follows: lactulose (54.5% versus 27.3%; OR = 0.3, 95% CI 0.09-1.0; P = 0.06); L-ornithine L-aspartate (54.5% versus 22.7%, OR = 0.2, 95% CI 0.06-0.88; P = 0.03); rifaximin (54.5% versus 23.8%; OR = 0.3, 95% CI 0.07-0.9; P = 0.04). There was no significant difference between the three groups receiving any antiammonium drug (P = 0.94). In the group receiving lactulose, 59.1% had diarrhea, and 45.5% had abdominal discomfort, bloating, and flatulence. Two patients (10%) treated with lactulose and a patient (4.5%) in the placebo group developed spontaneous bacterial peritonitis due to E. coli; one of them died due to recurrent variceal bleeding. There were no other adverse effects. Conclusions: Antiammonium drugs, particularly L-ornithine L-aspartate and rifaximin, proved to be effective in preventing the development of hepatic encephalopathy in those cirrhotic patients with variceal bleeding.

Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response.

BACKGROUND: Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis. METHODS: We searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures. FINDINGS: Thirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas--anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate--27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible. CONCLUSIONS: Our analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome.

[Effect of metformin addition to an acute lymphoblastic leukemia chemotherapy treatment]. / Metformina adicionada a la quimioterapia contra la leucemia linfoblástica aguda.

BACKGROUND: Recently it has been reported a benefit effect with the use of metformin in patients with malignant disease. Our objective was to evaluate the effect of adding metformin to chemotherapy regimen over the percentage of early relapse in acute lymphoblastic leukemia. METHODS: A prospective, longitudinal and experimental study was performed in patients with de novo acute lymphoblastic leukemia enrolled in the Hospital General de México. They were divided in two groups: first group received chemotherapy + metformin (850 mg three times a day); second group only received standard chemotherapy. The sample was randomized 3:1 in favor of the second group. RESULTS: 93 patients were included (73 treated with chemotherapy + metformin and 20 received standard chemotherapy), with 303 ± 53 days of follow-up. Complete remission was higher in the group without metformin (81.3 % [n = 61] versus 70 % [n = 14]), which also presented more patients with relapse (47.9 % versus 25 %). Overall survival at one year was of 68 % and free survival disease was 64 %, without significant differences between groups. Absence of metformin was the only variable of adverse prognostic considered significant (p = 0.55). Cox regression showed that adding metfomin reduced 56 % the risk of relapse. CONCLUSIONS: The adding metformin to the treatment of leukemias showed that was useful in our research. However, randomized and double-blind studies must be designed in order to express final recommendations about its use.

INTRODUCCIÓN: se ha informado efecto benéfico con metformina en pacientes con cáncer. El objetivo de esta investigación fue evaluar el efecto de adicionar metformina a la quimioterapia sobre las recaídas tempranas en pacientes con leucemia linfoblástica aguda. MÉTODOS: estudio prospectivo, longitudinal y experimental de pacientes portadores de leucemia linfoblástica aguda de novo, realizado en el Hospital General de Mexico. La muestra fue dividida en dos brazos de tratamiento: uno recibió metformina (850 mg cada ocho horas) + quimioterapia; otro recibió únicamente quimioterapia estándar. La distribución de los pacientes fue aleatoria, 3:1 a favor del segundo brazo. RESULTADOS: se incluyeron 93 pacientes (73 recibieron quimioterapia + metformina y 20, quimioterapia estándar); el seguimiento fue de 303 ± 53 días. La remisión completa fue mayor en el grupo sin metformina comparado con el que recibió quimioterapia + metformina (81.3 % [n = 61] y 70 % [n = 14], respectivamente), al igual que las recaídas (47.9 y 25 %, respectivamente). La supervivencia global a un año fue de 68 % y la supervivencia libre de la enfermedad fue de 64 %, sin diferencias entre los grupos. La única variable de pronóstico adverso con relevancia significativa fue la ausencia de metformina (p = 0.55). La regresión de Cox demostró que adicionarla redujo 56 % el riesgo de recaída. CONCLUSIONES: la adición de metformina al tratamiento de la leucemia fue de utilidad en nuestra investigación, sin embargo, deberán diseñarse estudios aleatorizados y doble ciego para emitir recomendaciones definitivas.

[Effect of posteroventral pallidotomy on event-related P300 in Parkinson's disease]. / Efecto de la palidotomía unilateral sobre el P300 en la enfermedad de Parkinson.

BACKGROUND: Ablative procedures are still frequent for the surgical treatment of Parkinson's disease (PD). Although the P300 component has been used to assess cognitive changes induced by levodopa and deep brain stimulation (DBS), the effects caused by unilateral pallidotomy remain unknown. MATERIAL AND METHODS: P300 amplitude and latency in 10 PD patients who underwent unilateral pallidotomy with and without levodopa treatment were compared with 10 healthy controls. Measurements in patients were performed 6 months before and after surgery while only once in controls, throughout the 6-month lapse between the comparative measurements performed in patients. RESULTS: Statistical differences in P300 amplitude and latency were found between the control and PD groups (p < 0.001). On the other hand, there were no differences between the groups with the use of the levodopa treatment or surgery. DISCUSSION: Lack of statistically significant results after six months of pallidotomy or treatment with levodopa suggests an absence of cognitive impairment. Our results obtained with P300 in which safety of surgical treatment has been assessed in PD are consistent with those of other procedures, such as DBS.