Combination of white matter hyperintensities and Aß burden is related to cognitive composites domain scores in subjective cognitive decline: the FACEHBI cohort.

BACKGROUND: To explore whether the combination of white matter hyperintensities (WMHs) and amyloid-beta (Aß) deposition is associated with worse cognitive performance on cognitive composites (CCs) domain scores in individuals with subjective cognitive decline (SCD). METHODS: Two hundred participants from the FACEHBI cohort underwent structural magnetic resonance imaging (MRI), 18F-florbetaben positron emission tomography (FBB-PET), and neuropsychological assessment. WMHs were addressed through the Fazekas scale, the Age-Related White Matter Changes (ARWMC) scale, and the FreeSurfer pipeline. Eight CCs domain scores were created using the principal component analysis (PCA). Age, sex, education, and apolipoprotein E (APOE) were used as adjusting variables. RESULTS: Adjusted multiple linear regression models showed that FreeSurfer (B - .245; 95% CI - .1.676, - .393, p = .016) and ß burden (SUVR) (B - .180; 95% CI - 2.140, - .292; p = .070) were associated with face-name associative memory CCs domain score, although the latest one was not statistically significant after correction for multiple testing (p = .070). There was non-significant interaction of these two factors on this same CCs domain score (p = .54). However, its cumulative effects on face-name associative performance indicated that those individuals with either higher WMH load or higher Aß burden showed the worst performance on the face-name associative memory CCs domain score. CONCLUSIONS: Our results suggest that increased WMH load and increased Aß are independently associated with poorer episodic memory performance in SCD individuals, indicating a cumulative effect of the combination of these two pathological conditions in promoting lower cognitive performance, an aspect that could help in terms of treatment and prevention.

Perceived discrimination in patients with multiple sclerosis and depressive symptomatology.

BACKGROUND: Multiple Sclerosis is the central nervous system's most common demyelinating disease and the second leading cause of neurological disability in young adults. Its natural development involves physical and cognitive impairment. Patients commonly perceive discrimination against them, regardless of its occurrence, accepting it as an inherent part of the disease. OBJECTIVE: This study aimed to determine the association between perceived discrimination and the depressive symptoms and physical disability present in patients diagnosed with multiple sclerosis, treated at the Demyelinating Diseases Clinic of the National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez. METHODS: A cross-sectional study was conducted in 98 patients diagnosed with multiple sclerosis. Demographic and clinical variables were obtained through clinical interviews. The severity of the disease was determined using the Extended Disability Status Scale (EDSS), depressive symptoms were assessed with the Beck Depression Inventory (BDI), and perceived discrimination was rated using the King Internalized Stigma Scale. RESULTS: The studied sample's mean age was 36.3 years, schooling 13.6 years, symptoms onset was at 26.2 years (with a delay in diagnosis of 3.2 years), and a disease evolution of 10.9 years. 71.4% were single; 52% had an unpaid work activity and 57.1% were women. The EDSS average was 3.5 points; 24.5% presented moderate to severe depressive symptoms and 53.1% referred perceived discrimination. CONCLUSIONS: Perceived discrimination in patients with multiple sclerosis was associated with earlier disease onset, depressive symptoms, and the lack of caregivers. Medical care and life quality improvement for this vulnerable group require greater education regarding the disease and the establishment of patient support programs.

Genome Wide Meta-Analysis identifies common genetic signatures shared by heart function and Alzheimer's disease.

Echocardiography has become an indispensable tool for the study of heart performance, improving the monitoring of individuals with cardiac diseases. Diverse genetic factors associated with echocardiographic measures have been previously reported. The impact of several apoptotic genes in heart development identified in experimental models prompted us to assess their potential association with human cardiac function. This study aimed at investigating the possible association of variants of apoptotic genes with echocardiographic traits and to identify new genetic markers associated with cardiac function. Genome wide data from different studies were obtained from public repositories. After quality control and imputation, a meta-analysis of individual association study results was performed. Our results confirmed the role of caspases and other apoptosis related genes with cardiac phenotypes. Moreover, enrichment analysis showed an over-representation of genes, including some apoptotic regulators, associated with Alzheimer's disease. We further explored this unexpected observation which was confirmed by genetic correlation analyses. Our findings show the association of apoptotic gene variants with echocardiographic indicators of heart function and reveal a novel potential genetic link between echocardiographic measures in healthy populations and cognitive decline later on in life. These findings may have important implications for preventative strategies combating Alzheimer's disease.

Targeted PEG-poly(glutamic acid) complexes for inhalation protein delivery to the lung.

Pulmonary delivery is increasingly seen as an attractive, non-invasive route for the delivery of forthcoming protein therapeutics. In this context, here we describe protein complexes with a new 'complexing excipient' - vitamin B12-targeted poly(ethylene glycol)-block-poly(glutamic acid) copolymers. These form complexes in sub-200nm size with a model protein, suitable for cellular targeting and intracellular delivery. Initially we confirmed expression of vitamin B12-internalization receptor (CD320) by Calu-3 cells of the in vitro lung epithelial model used, and demonstrated enhanced B12 receptor-mediated cellular internalization of B12-targeted complexes, relative to non-targeted counterparts or protein alone. To develop an inhalation formulation, the protein complexes were spray dried adopting a standard protocol into powders with aerodynamic diameter within the suitable range for lower airway deposition. The cellular internalization of targeted complexes from dry powders applied directly to Calu-3 model was found to be 2-3 fold higher compared to non-targeted complexes. The copolymer complexes show no complement activation, and in vivo lung tolerance studies demonstrated that repeated administration of formulated dry powders over a 3 week period in healthy BALB/c mice induced no significant toxicity or indications of lung inflammation, as assessed by cell population count and quantification of IL-1ß, IL-6, and TNF-α pro-inflammatory markers. Importantly, the in vivo data appear to suggest that B12-targeted polymer complexes administered as dry powder enhance lung retention of their protein payload, relative to protein alone and non-targeted counterparts. Taken together, our data illustrate the potential developability of novel B12-targeted poly(ethylene glycol)-poly(glutamic acid) copolymers as excipients suitable to be formulated into a dry powder product for the inhalation delivery of proteins, with no significant lung toxicity, and with enhanced protein retention at their in vivo target tissue.

Correlations between plasma and PET beta-amyloid levels in individuals with subjective cognitive decline: the Fundació ACE Healthy Brain Initiative (FACEHBI).

BACKGROUND: Peripheral biomarkers that identify individuals at risk of developing Alzheimer's disease (AD) or predicting high amyloid beta (Aß) brain burden would be highly valuable. To facilitate clinical trials of disease-modifying therapies, plasma concentrations of Aß species are good candidates for peripheral AD biomarkers, but studies to date have generated conflicting results. METHODS: The Fundació ACE Healthy Brain Initiative (FACEHBI) study uses a convenience sample of 200 individuals diagnosed with subjective cognitive decline (SCD) at the Fundació ACE (Barcelona, Spain) who underwent amyloid florbetaben(18F) (FBB) positron emission tomography (PET) brain imaging. Baseline plasma samples from FACEHBI subjects (aged 65.9 ± 7.2 years) were analyzed using the ABtest (Araclon Biotech). This test directly determines the free plasma (FP) and total plasma (TP) levels of Aß40 and Aß42 peptides. The association between Aß40 and Aß42 plasma levels and FBB-PET global standardized uptake value ratio (SUVR) was determined using correlations and linear regression-based methods. The effect of the APOE genotype on plasma Aß levels and FBB-PET was also assessed. Finally, various models including different combinations of demographics, genetics, and Aß plasma levels were constructed using logistic regression and area under the receiver operating characteristic curve (AUROC) analyses to evaluate their ability for discriminating which subjects presented brain amyloidosis. RESULTS: FBB-PET global SUVR correlated weakly but significantly with Aß42/40 plasma ratios. For TP42/40, this observation persisted after controlling for age and APOE ε4 allele carrier status (R2 = 0.193, p = 1.01E-09). The ROC curve demonstrated that plasma Aß measurements are not superior to APOE and age in combination in predicting brain amyloidosis. It is noteworthy that using a simple preselection tool (the TP42/40 ratio with an empirical cut-off value of 0.08) optimizes the sensitivity and reduces the number of individuals subjected to Aß FBB-PET scanners to 52.8%. No significant dependency was observed between APOE genotype and plasma Aß measurements (p value for interaction = 0.105). CONCLUSION: Brain and plasma Aß levels are partially correlated in individuals diagnosed with SCD. Aß plasma measurements, particularly the TP42/40 ratio, could generate a new recruitment strategy independent of the APOE genotype that would improve identification of SCD subjects with brain amyloidosis and reduce the rate of screening failures in preclinical AD studies. Independent replication of these findings is warranted.

Ensayo pictórico: Imágenes en trasplante de páncreas: ¿qué debemos buscar? / Pictorial essay: Imaging in pancreas transplants: what should we look for?

El trasplante de páncreas es una alternativa terapéutica para pacientes diabéticos con complicaciones metabólicas severas y/o enfermedad renal crónica terminal. En el 80% de los casos, se realiza trasplante simultáneo de páncreas y riñón. El ultrasonido (US) es la técnica de elección para una primera evaluación del injerto, principalmente el modo Doppler espectral. Este último permite la evaluación de la vasculatura y perfusión de injerto. La tomografía computada (TC) y resonancia magnética (RM) se reservan para la evaluación de complicaciones (Tabla 1). Se realizó una revisión retrospectiva de una serie casos de trasplante páncreas-riñón realizada en nuestra institución entre los años 2014 y 2017, con un total de 12 casos.

Pancreas transplantation is a therapeutic alternative for diabetic patients with severe metabolic complications and/or terminal chronic kidney disease. In 80% of cases, a simultaneous transplant of pancreas and kidney is performed. Ultrasound (US) is the technique of choice for a first evaluation of the implant, mainly the spectral Doppler mode, which allows evaluation of the graft vasculature and perfusion. Computed tomography (CT) and magnetic resonance imaging (MRI) are reserved for the evaluation of complications (Table). A retrospective review of a series of cases of pancreas-kidney transplantation performed at our institution between 2014 and 2017 was carried out, with a total of 12 cases.

Pancreatitis post quirúrgica: una entidad clínica para recordar / Postoperative pancreatitis: a clinical entity to remember

Postoperative pancreatitis is a rare entity characterized by the presence of clinical and imagenological pancreatic inflammation after surgery of the near or far gastrointestinal tract. The cause is probably multifactorial, with no preventive measures. Diagnostic dilemma and morbidity and mortality associated with this condition makes this case interesting. We describe the case of a 65 years old female presenting acute pancreatitis attributed to surgery performed 3 days before to resolve intestinal obstruction.

La pancreatitis post-cirugía es una entidad poco frecuente caracterizada por la presencia clínica e imagenológica de inflamación del páncreas luego de una cirugía del tracto gastrointestinal. La causa es probablemente multifactorial, y no existen medidas preventivas. El dilema del diagnóstico y la morbi-mortalidad asociadas a esta condición hace que este caso sea muy interesante. Describimos el caso de un sujeto de sexo femenino de 65 años, con pancreatitis aguda atribuida a una cirugía realizada 3 días antes con el objetivo de resolver una obstrucción intestinal.

Paciente joven con nódulos pulmonares / Young patient with pulmonary nodules

Describimos el caso de una paciente de 33 años que ingresó por dolor centrotorácico de características pleuríticas, tos, disnea y síndrome constitucional. En la radiografía de tórax se observaron infiltrados pulmonares nodulares bilaterales. Tras la realización de una biopsia pulmonar se llegó al diagnóstico de micosis pulmonar causada por Cryptococcus neoformans.La criptococosis pulmonar es una entidad poco habitual, que puede afectar tanto a individuos inmunodeprimidos como a inmunocompetentes, aunque con menor frecuencia en estos últimos.Este caso demuestra la importancia de considerar causas in-fecciosas en el diagnóstico diferencial de nódulos pulmonares. Destacamos a su vez lo poco habitual de la infección por Cryp-tococcus en pacientes inmunocompetentes

The case of a 33 year-old patient is described; she was admitted to hospital due to pleuritic chest pain, cough, dyspnoea and constitutional syndrome. Infiltrated bilateral lung nodules were observed in the chest x-ray. After performing a lung biopsy, the diagnosis was lung micosis due to Cryptococcus neoformans. Lung cryptococcus is an uncommon entity that can affect both immunodeficient and immunocompetent individuals, although less frequent in these latter. This case demonstrates the importance of considering infec-tious causes in the differential diagnosis of pulmonary nodules. At the same time, it must be noted that infections due to cryptococcus is in immunocompetent patients are rare

Proteomic analysis of grapevine (Vitis vinifera L.) leaf changes induced by transition to autotrophy and exposure to high light irradiance.

Using a proteomics approach, we evaluated the response of heterotrophic and autotrophic leaves of grapevine when exposed to high light irradiation. From a total of 572 protein spots detected on two-dimensional gels, 143 spots showed significant variation caused by changes in the trophic state. High light treatment caused variation in 90 spots, and 51 spots showed variation caused by the interaction between both factors. Regarding the trophic state of the leaf, most of the proteins detected in the heterotrophic stage decreased in abundance when the leaf reached the autotrophic stage. Major differences induced by high light were detected in autotrophic leaves. In the high-light-treated autotrophic leaves several proteins involved in the oxidative stress response were up-regulated. This pattern was not observed in the high-light-treated heterotrophic leaves. This indicates that in these types of leaves other mechanisms different to the protein antioxidant system are acting to protect young leaves against the excess of light. This also suggests that these protective mechanisms rely on other sets of proteins or non-enzymatic molecules, or that differences in protein dynamics between the heterotrophic and autotrophic stages makes the autotrophic leaves more prone to the accumulation of oxidative stress response proteins. BIOLOGICAL SIGNIFICANCE: Transition from a heterotrophic to an autotrophic state is a key period during which the anatomical, physiological and molecular characteristics of a leaf are defined. In many aspects the right functioning of a leaf at its mature stage depends on the conditions under what this transition occurs. This because apart of the genetic control, environmental factors like mineral nutrition, temperature, water supply, light etc. are also important in its control. Many anatomical and physiological changes have been described in several plant species, however in grapevine molecular data regarding changes triggered by this transition or by light stress are still scarce. In this study, we identify that the transition from heterotrophic to autotrophic state in grapevine triggers major changes in the leaf proteome, which are mainly related to processes such as protein synthesis, protein folding and degradation, photosynthesis and chloroplast development. With the exception of proteins involved in carbon fixation, that increased in abundance, most of the proteins detected during the heterotrophic stage decreased in abundance when the leaf reached its autotrophic stage. This is most likely because leaves have reached their full size and from now they have to work as a carbon source for sink organs located in other parts of the plant. Despite the potential control of this transition by light, to date, no studies using a proteomics approach have been conducted to gain a broader view of the effects of short-term high light stress. Our results indicate that short-term high light exposure has a major impact on the proteome of the autotrophic leaves, and trigger a differential accumulation of several proteins involved in the oxidative stress response. Surprisingly, heterotrophic leaves do not display this pattern which can be attributed to a lower sensitivity of these leaves to high light stimulus. In fact we discovered that heterotrophic leaves are more tolerant to light stress than autotrophic leaves. This finding is of high biological significance because it helps to understand how young leaves are able to evolve to autotrophy in areas where high light intensities are predominant. This also reveals in this type of leaves the existence of alternative mechanisms to address this stressful condition. These observations provide new insights into the molecular changes occurring during transition of leaves to autotrophy particularly when this transition occurs under high light intensities. This for example occurs during the springtime when the grapevine buds burst and the young leaves are suddenly exposed to high light intensities.

Ouabain activates NFκB through an NMDA signaling pathway in cultured cerebellar cells.

Na,K-ATPase, an ion pump, has been shown to interact with other proteins in signaling complexes in cardiac myocytes, renal and glial cells, and several other cell types. Our previous in vivo studies indicated that intrahippocampal administration of ouabain (OUA), an inhibitor of Na,K-ATPase, induces NFκB activation, leading to an increase in mRNA levels of target genes of this transcription factor in the rat hippocampus. The present work investigated whether OUA can regulate NF-κB in primary cultured rat cerebellar cells. Cells were treated with different concentrations of OUA (1, 10 or 100 µM) for different periods of time (1, 2 and 4 h). OUA induced a time- and concentration-dependent activation of NFκB (peak of activation: 10 µM, 2 h), involving both p50/p65 and p50/p50 NFκB dimers. OUA (10 µM, 2 h) induced upregulation of tumor necrosis factor α (Tnf-α), interleukin-1ß (Il-1ß), and brain derived neurotrophic factor (Bdnf) mRNA levels. Both NFκB activation and gene expression activation induced by OUA (10 µM) were abolished when cells were pre-treated for 20 min with MK-801 (N-Methyl-D-Aspartate (NMDA) receptor antagonist), manumycin A (farnesyltransferase inhibitor), PP-1(Src-family tyrosine kinase inhibitor) and PD98059 (mitogen-activated protein kinase (MAPK) inhibitor). OUA (10 µM) alone or in the presence of MK-801, PP-1, PD98059 did not cause cell death or DNA fragmentation. These findings suggest that OUA activates NFκB by NMDA-Src-Ras-like protein through MAPK pathways in cultured cerebellar cells. This pathway may mediate an adaptive response in the central nervous system.

Estudio comparativo de la personalidad del paciente con dolor lumbar crónico y sujetos control mediante el uso del Inventario de Temperamento y Carácter / No disponible

La personalidad impacta sobre la forma en la que las personas con lumbalgia crónica enfrentan el dolor. Se ha identificado la relación entre ciertas características de la personalidad con el desarrollo y mantenimiento del dolor crónico. Los estudios sobre lumbalgia crónica y la personalidad mediante el modelo psicobiológico de la personalidad son escasos y tendrían un valor heurístico para facilitar el desarrollo de investigación en este campo. Objetivos: comparar las dimensiones de temperamento y carácter entre pacientes con lumbalgia crónica y sujetos control; y comparar las características de personalidad entre pacientes con dolor de intensidad leve y aquellos con dolor de intensidad moderada/severa. Método: se reclutaron 46 pacientes diagnosticados de lumbalgia crónica del Hospital General de México y 46 sujetos controles pareados por género y edad. Se evaluaron las características clínicas de la lumbalgia crónica. Las dimensiones de la personalidad fueron evaluadas mediante el Inventario de Temperamento y Carácter (ITC). Resultados: los pacientes mostraron una mayor puntuación en la dimensión de temperamento "búsqueda de la novedad" (NS) y menor puntuación en la "evitación al daño" (HA); así como menor puntuación en la dimensión de "cooperatividad" (CO). Los pacientes con mayor intensidad de dolor mostraron una tendencia a una mayor HA. Discusión: los resultados apoyan el modelo de atribución temor/evitación que asume que las interpretaciones catastróficas del dolor, fomentan el miedo y las conductas evitativas, empeorando el padecimiento. El estudio de la personalidad en pacientes con lumbalgia crónica brinda nuevos conocimientos sobre las áreas de intervención psicosocial requeridas por estos pacientes (AU)

Personality has an important role in the way patients with chronic low back pain face pain. Some personality features have been associated to the development and the maintenance of chronic pain. Studies of chronic low back pain and personality according to the psychobiological model of personality are scarce and will have a heuristic value to promote research in this field. Objectives: to compare temperament and character dimensions between patients with chronic low back pain and control subjects; ant to compare personality features between patients with low intensity pain and those with pain of moderate/severe intensity. Method: a total of 46 patients with chronic low back pain were recruited from the Hospital General de México and were matched by age and gender with 46 control subjects. Clinical features of the disorder were assessed. Personality dimensions were evaluated with the Temperament and Character Inventory (TCI). Results: patients exhibited higher scores on the temperament dimension "novelty seeking" (NS) and lower scores on "harm avoidance" (HA), also, lower scores were found on the character dimension "cooperativeness" (CO). Patients with moderate/severe pain reported a tendency to a higher HA. Discussion: our results support the attribution fear/avoidance model which presumes that catastrophic interpretations of pain give rise to fear and avoidant behaviors which worsens the pain problem. The study of personality in patients with chronic low back pain gives new information related to the psychosocialinterventions required for these patients (AU)

Influence of N-methyl-D-aspartate receptors on ouabain activation of nuclear factor-κB in the rat hippocampus.

It has been shown that ouabain (OUA) can activate the Na,K-ATPase complex and mediate intracellular signaling in the central nervous system (CNS). Inflammatory stimulus increases glutamatergic transmission, especially at N-methyl-D-aspartate (NMDA) receptors, which are usually coupled to the activation of nitric oxide synthase (NOS). Nuclear factor-κB (NF-κB) activation modulates the expression of genes involved in development, plasticity, and inflammation. The present work investigated the effects of OUA on NF-κB binding activity in rat hippocampus and the influence of this OUA-Na,K-ATPase signaling cascade in NMDA-mediated NF-κB activation. The findings presented here are the first report indicating that intrahippocampal administration of OUA, in a concentration that did not alter Na,K-ATPase or NOS activity, induced an activation of NF-κB, leading to increases in brain-derived neurotrophic factor (Bdnf), inducible NOS (iNos), tumor necrosis factor-α (Tnf-α), and B-cell leukemia/lymphoma 2 (Bcl2) mRNA levels. This response was not linked to any significant signs of neurodegeneration as showed via Fluoro-Jade B and Nissl stain. Intrahippocampal administration of NMDA induced NF-κB activation and increased NOS and α(2/3) -Na,K-ATPase activities. NMDA treatment further increased OUA-induced NF-κB activation, which was partially blocked by MK-801, an antagonist of NMDA receptor. These results suggest that OUA-induced NF-κB activation is at least in part dependent on Na,K-ATPase modulatory action of NMDA receptor in hippocampus. The interaction of these signaling pathways could be associated with biological mechanisms that may underlie the basal homeostatic state linked to the inflammatory signaling cascade in the brain.

Incontinencia pigmenti en madre e hija: relato de caso clínico / Mother and daughter incontinentia pigmenti: case report

Incontinentia pigmenti (IP) is a rare genodermatosis linked to the X chromosome. It affects variably all tissues derives from neuroecthoderm such as skin, hair, nails, eyes and central nervous system. Early diagnosis allows the study of eventual multisystem involvement. Clinical case: We describe a 6 m.o. girl, controlled from the first week of life for a dermatological feature characterized by linear lesions, which were vesicular, then verrucous, and finally hyperpigmented. IP diagnostic family, determined by maternal history of similar lesions.

La incontinentia pigmenti (IP) es una genodermatosis rara ligada al cromosoma X. Afecta en forma variable a los tejidos derivados del neuroectodermo, como la piel, pelos, uñas, ojos y el sistema nervioso central. Su conocimiento y diagnóstico precoz permite estudiar un eventual compromiso multisistémico. Describimos el caso de una niña de 6 meses de edad, controlada desde la primera semana de vida por un cuadro dermatológico caracterizado por lesiones lineales vesiculosas, verrucosas y posteriormente hiperpigmentadas. Se plantea el diagnóstico de IP familiar, determinado por antecedentes maternos de lesiones similares.

Esclerosis tuberosa en el adulto: hallazgos en tomografía computada multicorte, presentación de un caso clínico y revisión de literatura / Tuberous sclerosis in adults: Multi slice computed tomography findings: case report and literature review

Tuberous sclerosis, also known as tuberous sclerosis complex, is an autosomal dominant, multisystemic, neurocutaneous disease characterized by a wide range of hamartomatous lesions involving the skin, brain, kidneys, heart, etc. In most cases, it is diagnosed in childhood. Diagnosis in adult patients is usually made by renal failure and lung or dermatologic alterations. We report the case of a 57-year-old female patient with mental retardation and flank pain. A literature review on imaging manifestations of this rare disease is also provided.

La esclerosis tuberosa también conocida como complejo esclerosis tuberosa es una enfermedad autosómica dominante, multisistémica, neurocutánea caracterizada por un amplio espectro de lesiones hamartomatosas que afectan la piel, cerebro, riñones, corazón, etc. La mayoría de las veces es diagnosticada en la niñez. El diagnóstico en pacientes adultos se realiza generalmente por falla renal y alteraciones pulmonares o dermatológicas. Presentamos el caso de una paciente de 57 años con discapacidad mental y dolor en ambos flancos, lo que acompañamos de una revisión de la literatura respecto de las manifestaciones imagenológicas de esta rara enfermedad.

Prevalencia del intervalo QT prolongado en diferentes patrones electrocardiográficos: estudio por teleelectrocardiografía / Increased Q-T interval in different electrocardiographic patterns: a remote recording electrocardiographic study

Introducción: El intervalo QT prolongado ha sido identificado como factor de riesgo de arritmias ventriculares incluso en personas aparentemente sanas. El objetivo de este estudio fue establecer la prevalencia de QTc prolongado en electrocardiogramas normales, con bloqueo completo de rama (BCR) y con crecimiento de ventrículo izquierdo (HVI). Métodos y Resultados: Se consideró como prolongado un valor > 440 mseg, en cada una de 4 derivaciones: D1, aVL, V5 y V6, consensuado por dos observadores. El grupo 1 estuvo formado por 8.459 trazados normales: de ellos un 84 por ciento tenían un QTc normal y un 16 por ciento tenían un QTc prolongado. El grupo 2 consistió en 2.647 trazados con bloqueo completo de rama, 532 trazados con bloqueo completo de rama izquierda (BCRI) y 2.115 con bloqueo completo de rama derecha (BCRD). De los BCRI un 51,5 por ciento de los trazados tenían QTc prolongado, lo cual observamos sólo en un 25 por ciento de los trazados con BCRD. El grupo 3 estuvo conformado por 2.503 trazados con HVI, 377 por criterio de voltaje (grupo 3a), 1.083 por criterio de voltaje y alteración de repolarización (grupo 3b) y 1.043 HVI sólo por criterio de alteración de repolarización (grupo 3c). Un 28 por ciento de las HVI por criterio de voltaje (grupo 3a) y un 29 por ciento de HVI por alteración de repolarización (grupo 3c) tenían un QTc prolongado. De las HVI por voltaje y alteración de repolarización (grupo 3b) un 42 por ciento tenían QTc prolongado. De las HVI con QTc largo, un 7.6 por ciento tenían QTc > 500 mseg. Al desglosar las HVI por grupos el grupo 3a tenía 4,7 por ciento de los trazados con QTc largo > 500 mseg, el grupo 3b un 7,9 por ciento y el grupo 3c, un 8.3 por ciento. Conclusiones: Se concluye la alta prevalencia de QTc prolongado incluso en ECG con morfología normal, pero especialmente en BCRI y en HVI por voltaje más alteraciones de repolarización. La prolongación de QTc en BCR no mostró correlación con la ...

Background. Increased Q-T interval has been identified as a risk factor for ventricular arrhythmia including normal subjects. Aim. To establish the prevalence of an increased QTc in normal electrocardiograms (N) an in those with complete bundle branch block (RBBB or LBBB) or left ventricular hypertrophy (L VH). Method. D1, aVL, V5 and V6 leads were analyzed; a > 440ms QTC agreed upon by 2 observers was considered prolonged. Results: an increased QTc was observed in 16 percent> of 8459 N subjects, 51.5 percent> of subjects with LBBB and 25 percent of those with RBBB. Among subjects with LVH, 28 percent of those with voltage only criteria for LVH and 29 percent of those with ST-T changes but no voltage criteria had increased QTc. In contrast, 42 percent> of patients with LVH exhibiting both diagnostic criteria had increased QTc. In 7.6 percent> of LVH subjects with increased QTc, this interval was >500ms, which broke down as follows: LVH by voltage criteria alone 4.7 percent>, ST-T changes alone 7.9 percent > and LVH with both voltage and ST-T criteria 8.3 percent>. In patients with complete bundle branch block, the duration of the QRS interval was not related to QTc. Conclusion. A prolonged QTc is a frequent finding in normal ECGs, much more so in subjects with LVH associated to voltage and ST-T criteria. The prognostic impact of a prolonged QTc in patients with complete bundle branch block deserves further study.

Evaluación clínica de la terapia con dexametasona e ibuprofeno en cirugía de los terceros molares retenidos

La eliminación quirúrgica de los terceros molares ocasiona considerable dolor, edema y disfunción. Los factores que contribuyen a estas secuelas son complejos, pero muchos de ellos son relativos al proceso inflamatorio. Las estrategias farmacológicas para minimizar las manifestaciones clínicas del trauma quirúrgico son dirigidas hacia el bloqueo de la inflamación aguda. Los corticoesteroides han sido sugeridos para la reducción del edema posterior a procedimientos quirúrgicos, incluyendo la remoción de los terceros molares. Sin embargo, su uso es tema controversial debido a su potencial tóxico. Otros autores recomiendan la terapia combinada de esta droga con AINEs, como el Ibuprofeno.Objetivos:el objetivo de este estudio doble ciego fue evaluar y comparar un glucocorticoide como lo es la dexametasona en combinación con ibuprofeno y placebo para el control de la inflamación debida a la cirugía de los terceros molares. Así como también dilucidar su verdadero potencial tóxico. Métodos: se seleccionaron al azar 30 pacientes (9 de sexo masculino y 21 de sexo femenino) de 15 a 35 años, divididos en dos grupos: el primero recibió 8 mg de Dexametasona (Decalona®) y el segundo placebo, una hora antes de la cirugía por vía intramuscular. Ambos grupos recibieron 400 mg de Ibuprofeno (Brugesic®) por vía oral cada 6 horas durante dos días y 500 mg de amoxicilina (Trimoxal®) cada 8 horas por 7 días. El efecto antiinflamatorio del tratamiento fue evaluado por tres métodos: subjetivo, medición de referencias anatómicas y por un método computarizado de fotografías digitales. Mientras que el dolor fue evaluado mediante la Escala Visual Análoga. Resultados: los resultados obtenidos demostraron la superioridad de la terapia con dexametasona e ibuprofeno para el control del edema postoperatorio sobre la terapia con ibuprofeno exclusivamente. No se encontraron diferencias estadísticamente significativas en cuanto al dolor. También se demostró la ausencia de complicaciones postoperatorias y reacciones adversas al administrar dexametasona con la posología indicada.(AU)

Tractografía y tensor de difusión en el estudio por resonancia magnética del nervio mediano: reporte de un caso / Tractography and diffusion tensor imaging in the study of the median nerve by magnetic resonance imaging: a case report

Introduction: Magnetic resonance imaging (MRI) is an essential tool for the study of central nervous system disorders. Several studies consider the application of diffusion tensor imaging (DTI) and tractography in the study of peripheral nerves. Methodology: We performed tractography and DTI in two female patients, one with a confirmed carpal tunnel syndrome and the other in good health conditions. Values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded. Results: The average FA valué of the fiber was 0.461 (case) and 0.632 (control). No differences were reported between the average valúes of the ADC of the fiber. Discussion: We were able to represent the tract of the median nerve by using a software fortractography reconstruction. The morphology and valúes of quantitative analysis of DTI depend directly on the reconstruction algorithm used, mainly on the minimum FA value of the fiber to be reconstructed. The value of the FA, obtained by zone, was the most constant variable, being lower for the case.

Introducción: La resonancia magnética es una herramienta indispensable en el estudio de enfermedades del sistema nervioso central. Varios estudios consideran la aplicación del tensor de difusión (DTI) y tractografía en el estudio de nervios periféricos. Metodología: Se realizó tractografía y DTI en dos mujeres, una con síndrome del túnel carpiano confirmado y otra sin patología. Se consignaron valores de fracción de anisotropía (FA) y coeficiente de difusión aparente (ADC). Resultados: El valor promedio de FA de la fibra fue 0,461 (caso) y 0,632 (control). No hubo diferencias entre valores promedios de ADC de fibras. Discusión: Se logró representar el tracto del nervio mediano utilizando software de reconstrucción de tractografía. La morfología y valores del análisis cuantitativo del DTI dependen directamente del algoritmo de reconstrucción utilizado, especialmente del umbral mínimo de FA de la fibra a reconstruir. El valor más constante es FA, obtenido por zona, siendo menor en el caso.

Edema pulmonar neurogénico secundario a crisis epiléptica: presentación de un caso y revisión de la literatura / Neurogenic pulmonary edema secondary to epileptic seizures: report of a case and a short review

The acute neurogenic pulmonary edema (NPE) is a kind of pulmonary edema that occurs as a result of a variety of injuries of the central nervous system. Usually it is underdiagnosed. It has been reported in many diseases and direct injuries of the central nervous system. We present the clinical case of a middle age women with a neurogenic pulmonary edema secondary to a epileptic seizure. We made a review of the literature with special emphasis on clinical implications and treatment.

El edema pulmonar agudo neurogénico (EPN) es un tipo de edema pulmonar que ocurre como consecuencia de una variada gama de lesiones del sistema nervioso central. Generalmente es subdiagnosticado. Se ha reportado en múltiples patologías y lesiones directas del sistema nervioso central. Presentamos el caso clínico de una mujer de mediana edad, con edema pulmonar agudo secundario a una crisis convulsiva epiléptica. Se realiza una revisión de la literatura con especial énfasis en las implicancias clínicas y tratamiento.

Florid reactive periostitis ossificans of the distal ulna.

Florid reactive periostitis is the term used to describe a benign disease characterized by aggressive periosteal reaction and benign soft-tissue inflammation. Although it is considered rare, there are numerous reports in the literature that refer to this disease with different names such as parosteal fasciitis, fasciitis ossificans, benign fibro-osseous pseudotumor, pseudomalignant osseous tumor of soft tissue, and bizarre parosteal osteochondromatous proliferation. As a result, the nomenclature is confusing, and some authors have placed florid reactive periostitis ossificans into the heterogeneous group of pseudomalignant osseous tumors of soft tissue or proliferative periosteal processes, whereas other authors place this entity in the myositis ossificans group. In the same manner, florid reactive periostitis has been considered to be a previous stage of bizarre parosteal osteochondromatous proliferations. This article presents a case of florid reactive periostitis ossificans of the distal ulna in a 13-year-old boy. The patient presented with a painful lesion in the distal ulna, and plain radiographs suggested the presence of a quickly growing periosteal lesion with associated calcification and soft tissue mass. Histologically, the appearance was that of reactive periostitis. The clinical, radiological, and histologic features of florid reactive periostitis are described.