Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity.

BACKGROUND: Spasticity is a common problematic symptom in Multiple Sclerosis with over one third of patients failing first line therapies. Intrathecal baclofen is a safe and efficacious option for treatment resistant spasticity. Anecdotally patients report improved concentration/cognitive performance when switching to intrathecal baclofen (ITB) from systemic medications. AIM: To explore whether subjects who proceed with ITB pump implantation for spasticity management and reduce oral anti-spasticity agents will have improved cognitive function. METHODS: Subjects were admitted for trial of ITB via lumbar puncture and subsequent pump implantation. Spasticity and cognitive measures before ITB trial and 3 months post implant were recorded. Paired t-test or Wilcoxon Signed Ranks test was used for within subject change and effect sizes (Cohen's dz) were calculated. Subgroup analysis of those on ≥2, or ≤ 1 spasticity medications at baseline was performed. RESULTS: 27 subjects with MS completed per protocol. Mean age 46 years [26 - 56], disease duration 15 years [6 - 26], RRMS = 3, SPMS = 17 and PPMS=7. The majority were on multiple spasticity medications. Spasticity scores significantly improved post pump implant. Mean ITB dose at 3 months was 143 mcg / day and 19 discontinued all other treatments for spasticity. There was no deterioration on any cognitive or mood measure. An improvement of moderate effect size was found in Backwards Digit Span (d=0.41, p=0.059) and HADS - anxiety (d=0.37, p=0.097). Fatigue Severity Scale score decreased substantially (d=0.81, p=0.005). Small improvements in Symbol Digit Modalities Test score (d=0.24) and Sustained Attention to Response Task response time (d=0.23) were non-significant. Performance on other measures did not change. Effect sizes were larger in subgroup on ≥2 oral spasticity medications at baseline, compared to the group on ≤1 medication (SDMT, d=0.42 vs d=0.07; Backwards digit span 0.45 vs 0.28; HADS-anxiety 0.39 vs 0.32; HADS-depression d=0.32 vs 0.05 and FSS, d= 1.14 vs 0.42). CONCLUSIONS: In a pilot study exploring the impact of ITB on cognition, spasticity scores improved universally and beneficial effects on some measures of fatigue, anxiety, auditory attention and verbal working memory were found. Improvement of speed of processing in those withdrawing higher doses of oral medication was also demonstrated suggesting that switching to ITB has added cognitive and psychological benefits for people with MS.

Evaluation of the impact of intrathecal baclofen on the walking ability of people with Multiple Sclerosis related spasticity.

BACKGROUND: Spasticity is a frequent and disabling symptom in people with Multiple Sclerosis (MS). Intrathecal baclofen (ITB) is an effective but infrequently used treatment in ambulant people. OBJECTIVE: To evaluate the impact of ITB on ambulation in people with moderate to severe MS related spasticity. METHODS: Data was collected prospectively regarding spasticity and ambulation at baseline, after ITB trial via lumbar puncture, 3 months and annually thereafter. RESULTS: 30 subjects; Mean age 47.9 (26-64), 67% female, mean EDSS 6.5 [6.5-7.5]. Reduction in mean Ashworth score (pre 1.44: post 0.98, p<0.001) and Penn spasm score (pre 3: post 1; p<0.001) was shown. 20 people (67%) proceeded with implantation; lower limb MRC power was predictive of proceeding to pump (OR 2.98; 95% CI 1.01 - 8.7; p <0.05). In those proceeding to implantation there was no difference in 10mTW at 1 year (ANOVA (F(3,24) = 2.6, p=0.13). Currently, 15 (75%) remain ambulatory (mean 3.75 years, range 1-9). After implant, 17 (85%) discontinued all oral anti-spasticity treatments conferring other benefits. CONCLUSION: Ambulation in people with MS can be preserved for several years whilst effectively treating spasticity with ITB with careful patient selection; ITB should not be considered a last resort.

Changes in metal contents in shrimp cultured in NW Mexico (2000-2010).

This study shows the concentrations of Cd, Cu, Pb, and Zn in the muscle and hepatopancreas of Pacific white shrimps, Litopenaeus vannamei, cultured during 2010 in 26 commercial farms of the three main producer states of the Mexican NW, Sonora, Sinaloa, and Nayarit and compares the results to those obtained in 2000 using samples collected in16 farms of the same states. No significant changes were detected in Cd concentrations, but the 2010 Zn levels were significantly higher in all states in the hepatopancreas and in Sinaloa in the case of the muscle. Cu showed a tendency to higher hepatopancreas values in 2010, but differences were significant only in Sonora and for the global mean value. In contrast, Pb was one order of magnitude lower in both organs in 2010, possibly because of the almost 15 years since leaded gasoline was discontinued in Mexico.

Diet and metabolic syndrome.

Given the higher burden of risk factors for metabolic syndrome (MetS) on morbidity and mortality, it is critical to prevent the development of metabolic syndrome in the first place. While dietary habits have been favorably associated with some of the factors included in the definition of metabolic syndrome, limited and inconsistent data have been reported on the role of nutrition in the development of metabolic syndrome. Currently, there is no consensus as to which dietary patterns would confer the lowest risk of MetS. Identification of dietary patterns, food groups, or nutrients that may lower the incidence of metabolic syndrome could improve prevention strategies as well as prognosis among subjects with existing MetS. This manuscript reviews current evidence on dietary patterns, consumption of fat, whole grains, carbohydrate quality and quantity, and moderate alcohol consumption as they relate to metabolic syndrome.

Resultado del tratamiento percutáneo de las bifurcaciones coronarias / Outcomes of Percutaneous Coronary Interventions in Coronary Artery Bifurcation Lesions

Introducción El surgimiento de los stents liberadores de droga (SLD) ha disminuido la tasa de reintervención del vaso tratado (RVT). No obstante, incluso con SLD, el tratamiento percutáneo de lesiones en bifurcación aún constituye un desafío debido a una tasa todavía elevada de RVT. Objetivo Evaluar los resultados clínicos en pacientes con bifurcaciones tratados con SLD o sin éstos en un centro de alto volumen. Material y métodos Desde abril de 2003 hasta agosto de 2006 se realizaron 1.910 angioplastias; 235 (12,3%) pacientes presentaron bifurcaciones. Resultados La edad de los pacientes incluidos fue de 62 ± 11 años; el 86% era de sexo masculino, el 19,2% padecía diabetes y el 22,7% tenía cirugía coronaria previa. El 54% de los pacientes presentaron bifurcaciones verdaderas. Se utilizó SLD en el 44,3%; el 22,5% requirió el implante de dos stents (en ambas ramas), mientras que el procedimiento se concluyó con kissing balloon final en el 24,5% de los casos. En el seguimiento alejado (mediana 430 días), la RVT fue del 16,7%, 13,9% con SLD y 17,2% con stent convencional (SC) (p = ns). La tasa de trombosis angiográfica fue del 3%, 1,9% para SLD y 4,6% para stent convencional (p = ns). Las tasas de infarto y muerte cardíaca fueron del 3,4% y del 2,9%, respectivamente, sin diferencias entre los dos grupos. La tasa combinada de muerte cardíaca, infarto, trombosis y RVT fue del 21,7%, 16,3% con SLD y 25,2% con stent convencional (p = 0,04). Conclusión El tratamiento percutáneo de lesiones en bifurcación continúa siendo un desafío. Es probable que técnicas más simples con implante de un solo stent, preferentemente SLD, y la implementación de kissing balloon final sea la opción más recomendable en la mayoría de los casos.

Background Drug-eluting stents (DESs) have reduced the target lesion revascularization (TLR) rate. Percutaneous coronary interventions in coronary artery bifurcation lesions are still a challenge, even in the DESs era, due to a high TLR rate. Objective To assess the clinical outcomes in patients with coronary artery bifurcation lesions treated with DESs in a high-volume center. Material and Methods From April 2003 to August 2006, 1,910 percutaneous coronary interventions were performed; 235 patients (12.3%) presented coronary artery bifurcation lesions. Results Patients characteristics were as follows: mean age was 62±11 years, 86% were men, 19.2% had diabetes mellitus and 22.7% had a history of coronary artery bypass graft surgery. Fifty-four percent of patients presented true bifurcation lesions. DESs were implanted in 44.3% of cases; two stents were placed in both branches in 22.5% of patients, and a final kissing balloon concluded 24.5% of the procedures. At late follow-up (median 430 days) TLR rate was 16.7%, 13.9% with DESs and 17.2% with bare-metal stents (p=ns). The rate of angiographic stent thrombosis was 3%, 1.9% for DESs and 4.6% for bare-metal stents (p=ns). No differences were observed between both groups in the incidence of infarction and cardiovascular mortality (3.4% for DESs and 2.9% for bare-metal stents). The combined rate of cardiovascular mortality, infarction, thrombosis and TLR was 16.3% in patients with DESs and 25.2% in the bare-metal stents group (p=0.04). Conclusion Percutaneous coronary interventions in coronary artery bifurcation lesions are still a challenge. Probably, in most cases it would be better to perform the simplest techniques -placement of only one stent, preferably a DES- with a final kissing balloon.

Pérdida del precondicionamiento isquémico: ¿un fenómeno relacionado con el envejecimiento? / Loss of Ischemic Preconditioning: An Aging Related Phenomenon

Introducción La edad es un predictor independiente de riesgo en pacientes con enfermedad coronaria. Esto podría explicarse por la falta de adaptación a la isquemia miocárdica aguda. El precondicionamiento es un mecanismo por el cual episodios repetitivos de isquemia inducen en el miocardio una tolerancia mayor a episodios subsiguientes. Objetivo Evaluar el desarrollo de precondicionamiento isquémico en pacientes añosos. Material y métodos Se incluyeron 65 pacientes sometidos a angioplastia coronaria electiva (< 70 años [n = 47] y ≥ 70 años [n = 18]). Se evaluó el desarrollo de precondicionamiento durante tres períodos de oclusión coronaria. Por ECG intracoronario se midió la elevación del ST al final de cada dilatación y se registró el porcentaje de resolución del ST a la tercera dilatación respecto del máximo valor registrado. Los datos se presentan como mediana e intervalo intercuartil 25/75%. Resultados No hubo diferencias significativas en las características clínicas basales. El máximo ST registrado, el ST a la tercera dilatación y el porcentaje de resolución del ST fueron 14 (9/24) mm, 8 (4/14) mm y 23,8% (0/55,5) para los pacientes jóvenes y 9,5 (5/18) mm (p = ns), 6,5 (4/ 16) mm (p = ns) y 5,5% (0/20) (p = 0,04) para los añosos. Al estratificar por grupos etarios, la proporción de pacientes que alcanzaron una resolución del ST ≥ 50% mostró una distribución lineal por chi cuadrado de tendencia (p = 0,025). Conclusiones Nuestro estudio sugiere que el precondicionamiento isquémico se encontraría disminuido en pacientes añosos. La funcionalidad de este mecanismo menguaría en forma progresiva con el envejecimiento.

Introduction Age is an independent risk predictor in patients with coronary disease. This could be explained by the lack of adaptation to acute myocardial ischemia. Preconditioning is a mechanism whereby repeated ischemia episodes induce in the myocardium an increased tolerance to further episodes. Objective To assess the development of ischemic preconditioning in elderly patients. Material and methods Sixty five patients who underwent elective coronary angioplasty were enrolled (<70 years [n=47] and ³70 years [n=18]). Preconditioning development was assessed during three periods of coronary occlusion. ST elevation at the end of each dilation was measured by intra coronary EKG, and ST resolution percentage after the third dilation was recorded and compared to the maximum recorded value. Data are presented as mean and inter-quartile interval 25/75%. Results There were no significant differences in the clinical baseline characteristics. The maximum ST recorded, ST after the third dilation and ST resolution percentage were 14 (9/24) mm, 8 (4/14) mm y 23.8% (0/55.5) for the young patients and 9.5 (5/ 18) mm (p = ns), 6.5 (4/16) mm (p=ns) and 5.5% (0/20) (p=0.04) for the elderly. Upon stratification per age group, the ration of patients that reached an ST resolution ≥ 50% showed a linear distribution by chi square for trend (p=0.025). Conclusions Our study suggests that ischemic preconditioning would be decreased in elderly patients. The functionality of this mechanism would progressively decrease with aging.

Hemorragia cerebelosa neonatal: a propósito de un caso

Teniendo en cuenta que las lesiones del sistema nervioso central ocupan un lugar importante en la morbimortalidad neonatal, presentamos el caso de un recién nacido a término, sexo masculino, nacido en parto distócico, con hipoxia severa al nacer, que presentó manifestaciones clínicas de una hemorragia intracraneal. En ultrasonido transfontanelar se observó una imagen compatible con una hemorragia de cerebelo, la cual se corroboró con la TAC de cráneo. Es egresado vivo los 17 días...(AU)

Epidemiología y clínica de la enfermedad inflamatoria pelvica

Con el objetivo de mejorar el diagnóstico y la conducta en las pacientes portadoras de una enfermedad inflamatoria pélvica aguda se realizó una investigación retrospectiva, longitudinal y analítica que envolvió a 103 pacientes ingresadas por esta enfermedad en el Hospital Docente Gineco Obstétrico "Justo Legón Padilla" entre enero y junio de 1998. Las variables analizadas fueron: edad, antecedentes de importancia en los tres meses previos al ingreso, síntomas y signos, forma clínica, operación realizada y cifras de eritrosedimentación al ingreso y al egreso. El análisis estadístico se realizó a través del porciento, la media, la desviación estándar y el estadígrafo Z con nivel de significación de p < 0,05 (significativo) y p < 0,01 (muy significativo). Obtuvimos significación estadística en las pacientes que tuvieron un aborto previo tres meses antes del ingreso y que sus edades oscilaban entre 20 y 29 años, así como las que tenían antecedentes de colocación de DIU con edades comprendidas entre 30 y 39 años; la triada de dolor, fiebre y leucorrea se presentó en la mayoría de los pacientes, el dolor a la palpación del útero y el crecimiento de este fue el signo fundamental. La endometritis fue la forma clínica más frecuente, siendo significativa en el grupo de menos de 20 años. La revisión de cavidad fue el tratamiento quirúrgico más empleado. Los valores medios de eritrosedimentación al egreso disminuyeron en relación con el ingreso...(AU)

Terapia cognitiva lúdica grupal (estudio experimental) diseño de un manual de consulta y de un programa de atención integral en gerontopsiquiatra / Group playful cognitive therapy (experimental study). Design of a consulation manual and a program of integral attencion in gerontopsychiatry

Objetivos: A fin de ayudar a encontrar una respuesta al problema creciente del anciano con patología psiquiátrica, los autores diseñaron un programa de atención integral dirigido a esta población. También elaboraron un manual de consulta gerontopsiquiátrica y encontraron que la terapia cognitiva-lúdica grupal beneficia estos pacientes. Metodología: los autores revisaron los aspectos relativos a la gerntopsiquiatría usando MEDLINE y recopilaron información desde otras fuentes bibliográficas. Diseñaron un programa para la atención integral al anciano con patología psiquiatrita. A fin de probar los beneficios de la terapia cognitiva lúdica grupal en pacientes geriátricos, los autores crearon un grupo de cuarenta pacientes de sesenta y más, años de edad quienes llenaron los criterios de DSM IV para los diagnósticos desordenes depresivos y/o demencia. Veinticuatro de esos pacientes recibieron terapia cognitiva-lúdica grupal y dieciséis conformaron el grupo control. La terapia en grupo en grupo se desarrolló en tres módulos de diez sesiones cada uno. La variable farmacológica se controló estrechamente. Resultados: Se elaboró un manual de consulta gerontopsiquiátrica metodológicamente organizado, de acuerdo a la información procesada encontrada por MEDLINE y otros recursos bibliográficos. Los pacientes que recibieron terapia cognitiva-lúdica de grupo mostró unos importantes efectos terapéuticos sobre los síntomas depresivos en los ancianos, en forma similar a lo reportado en la literatura sobre los diferentes grupos de edad. El programa diseñado por los autores es aplicable en cualquier institución psiquiátrica en Colombia y muestra una buena factibilidad logística y económica

Prerenal azotemia: differentiation of hyperureagenesis from renal hypoperfusion using urinary urea nitrogen data.

Blood urea nitrogen (BUN) rises disproportionately to serum creatinine in patients with prerenal azotemia whether due to impaired hemodynamics or excessive ureagenesis. To determine whether urinary urea nitrogen excretion rates can distinguish between these caused of hyperuremia we performed a cross-sectional observational study to compare urinary urea nitrogen excretion rates in a highly selected group of patients with prerenal azotemia. Patients who had stable serum creatinine levels, BUN: serum creatinine ratios exceeding 20:1, and progressive azotemia were identified from the hospital laboratory data base. Using conventional clinicolaboratory criteria, 27 patients were diagnosed with either renal hypoperfusion (group I; n = 17) or hyperureagenesis ((group II; n = 10). Random urine sampling for electrolytes, osmolality, creatinine, and urea nitrogen was followed by 24 h collection for creatinine clearance and urinary urea nitrogen. There were no significant differences in age, gender, absolute levels of BUN, or BUN: serum creatinine ratios between the groups. Creatinine clearance (ml/min/1.73 m2) (ml/s/1.73 m2) was lower in group I than in group II (21 +/- 16 vs 36 +/- 13; p < 0.05) (0.35 +/- 0.27 vs 0.60 +/- 0.22; p < 0.05). Twenty-four hour urinary urea nitrogen levels were significantly different (group I, 4.8 +/- 2.9 vs. group II, 13.6 +/- 3.2 gm; p < 0.001) (group I, 171 +/- 300 vs. group II, 486 +/- 114 mmol; p < 0.001). Random urine urea excretion indices were less discriminating but nevertheless still capable of separating the groups. Timed as well as random urine urea nitrogen determinations may assist in differentiating prerenal azotemia due to renal hypoperfusion from hyperureagenesis. Differentiation of these causes of prerenal azotemia might prevent iatrogenic overhydration of patients with azotemia incorrectly attributed to hemodynamic disturbances.

Infusión intracardíaca de cristaloides: informe de 1 caso / Intracardiac crystalloid infusion: case report

Se informa sobre 1 caso de infusion intracardiaca de cristaloides como medida inicial de reanimacion. El procedimiento está indicado en toracotomia de resucitacion por desangramiento. Se revisa la literatura disponible y se discuten las alternativas de manejo. La infusion intracardiaca de cristaloides y sangre es uno de los objetivos terapéuticos de la toracotomía de resucitación.

Trace metal concentrations and their distribution in the lobster Panulirus inflatus (Bouvier, 1895) from the Mexican Pacific coast.

The concentration and distribution of Fe, Mn, Ni, Cu, Co, Cd, Cr and Zn among the tissues of female and male lobster Panulirus inflatus from the Pacific coast of México were determined. Distinct inter-tissue and intersize differences in metal concentrations were observed. In general, highest Zn concentrations were found in viscera while highest Cu levels occurred in the gill and gonadal material. The highest Mn, Ni, Cr and Co concentrations were observed in exoskeleton and highest in eggs and gills. Cadmium was undetectable (<0.05 microg g(-1)) in most tissues, only muscle and viscera contained low but detectable amounts. A positive relationship between size and metal concentration was observed only for Zn contained in the muscle of females and males, for Zn contained in the gonad of females, for Mn contained in the gonad of males and for Cu associated with muscle of males. These results are discussed with regard to trace metal concentrations found in temperate and tropical regions.

Measurements of formaldehyde and acetaldehyde in the atmosphere of Mexico City.

Ambient levels of carbonyls were measured at the University of Mexico campus, Mexico City. Only formaldehyde and acetaldehyde were measured, since aldehydes with higher molecular weight were not detected. The most abundant aldehyde was formaldehyde, with an overall ratio CH3CHO/H2CO of 0.43. Maximum concentrations occurred for formaldehyde at 10:00 h while for acetaldehyde at 8:00 h. Comparing the concentration measured in this work with those in urban areas it was found that the formaldehyde and acetaldehyde levels in Mexico City are among the highest reported in the literature.

Tratamiento no quirúrgico de hemorroides: ligadura con bandas de látex. Informe de 63 pacientes ambulatorios / Non-surgical treatment of hemorrhoids

En el tratamiento de las hemorroides sintomáticas se han descrito varias tecnicas, siendo la hemorroidectomia quirurgica el metodo con que clasicamente se ha tratado esta entidad; ya en la epoca de los antiguos babilonios esta era una cirugia popular (1). A pesar de los excelentes resultados obtenidos en el control de los sintomas, la morbilidad del procedimiento, especialmente el dolor, es significativa (2). Lo anterior ha generado a lo largo de los años la aparicion de alternativas con resultados comparables, pero con una morbilidad más baja (3). Una de estas alternativas es la ligadura con bandas de latex descrita por Blaisdell (4) y modificada y popularizada por Barren a partir de 1963 (5). Desde esa epoca se han publicado varios trabajos en los que se demuestran los beneficios de esta alternativa por su simplicidad, seguridad y aceptacion por los pacientes (6-10). Este estudio tiene como objetivo evaluar nuestra experiencia en el tratamiento de pacientes con hemorroides sintomáticas (grados I a III) que fueron tratados ambulatoriamente mediante ligadura con bandas de latex (ligadura de Barron).

Scavenging of atmospheric formaldehyde by wet precipitation.

Despite the great importance that formaldehyde has in atmospheric photochemistry, few studies have been reported on rain water. In this paper, concentrations of HCHO in rain fractions within rain events are presented. Two sampling sites were chosen: one at Mexico City, a great polluted urban area, and the second at Rancho Viejo, a forested area under the meteorological influence of the city. The results show a general decrease during the early portion of the rain event. This seems to indicate that below-cloud scavenging is the most important mechanism while, from the small variations observed in the latter portion of the rainfall, it is possible to assume within-cloud scavenging as the predominant mechanism. Using the HCHO concentrations in rain water, the mixing ratios were estimated for the two sampling sites. The values were 0.68 ppb and 0.44 ppb at Mexico City and Rancho Viejo, respectively. Measurements at ground level in Mexico City gave a mean HCHO concentration in air of 24 ppb, much higher than the estimated mixing ratio. The high levels of HCHO found in ambient air and in rain water reflect anthropogenic emissions as the potential atmospheric sources.

[Phytophotodermatitis. Some photobiological aspects of psoralens]. / Fitofotodermatitis. Algunos aspectos fotobiológicos de los psoralenes.

The frequency of plant dermatitis, in general, depends on the type of plants, the climate, occupation and lifestyle of the local inhabitants. Many plants produce adverse effects on the skin like irritation, allergic reactions and phototoxicity. Generally, allergic contact dermatitis is emphasized but it is necessary to give more attention to phototoxicity produced by plants. The patients may be exposed not only to the phototoxic plant itself but also to its derivatives in perfumes, cosmetics and industry.