Biomarcadores genéticos en sangre, una nueva herramienta para el diagnóstico, pronóstico y supervivencia en pacientes con gliomas de alto grado / Genetic biomarkers in blood, a new tool for diagnosis, prognosis, and survival in patients with high-grade gliomas / Biomarcadores genéticos no sangue, uma nova ferramenta para diagnóstico, prognóstico e sobrevida em pacientes com gliomas de alto grau

Durante mucho tiempo, la clasificación de los tumores del sistema nervioso central (SNC) se ha basado en hallazgos histológicos respaldados por pruebas complementarias, como la inmunohistoquímica, establecidas en tejidos. La quinta edición de la clasificación de tumores del SNC de la Organización Mundial de la Salud (OMS), publicada en 2021 (SNC-5) incorpora numerosos marcadores moleculares con utilidad clínico-patológica que son importantes para una clasificación más precisa de las neoplasias del SNC. Ello permiten ayudar a definir los gliomas difusos del adulto, oligodendroglioma mutado para el gen de la IDH (isocitrato deshidrogenasa láctica), con codeleción 1p/19q grados 2 a 3, astrocitoma mutado para IDH sin codeleción 1p/19q, grados 2 a 4 y glioblastoma (GBM) silvestre para IDH. La mediana de sobrevida en los pacientes con GBM es de solo 14.6 meses, debido a la resistencia al protocolo de terapia más utilizado en el mundo, el cual involucra cirugía, radioterapia y quimioterapia con temozolamida (TMZ), un potente alquilante genotóxico. Los criterios de selección del tratamiento y la estimación del pronóstico en pacientes con esta enfermedad son clínico-patológicos. En los últimos años se reportaron numerosas alteraciones moleculares que amplían la comprensión de la biología de estos tumores, pero solo unas pocas influyen como biomarcadores en la toma de decisiones clínicas y del tratamiento. En este artículo se revisan las alteraciones moleculares reportadas para gliomas de alto grado en sangre periférica, también se resalta la importancia de estandarizar nuevos biomarcadores junto a los hallazgos histológicos para mejorar el conocimiento de estos tumores.

For a long time, the classification of central nervous system (CNS) tumors has been based on histological findings supported by complementary tests, such as immunohistochemistry, established in tissues. The fifth edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System, published in 2021 (CNS-5), incorporates numerous molecular markers with clinical-pathological utility that are important for a more accurate classification of CNS neoplasms. These markers help to define adult diffuse gliomas, including IDH-mutant oligodendroglioma with 1p/19q codeletion (grades 2-3), IDH-mutant astrocytoma without 1p/19q codeletion (grades 2-4), and wild-type IDH glioblastoma (GBM). The median survival in patients with GBM is only 14.6 months, primarily due to resistance to the most widely used treatment protocol worldwide, which involves surgery, radiotherapy, and chemotherapy with temozolomide (TMZ), a potent genotoxic alkylating agent. The selection criteria for treatment and the estimation of prognosis in patients with this disease are predominantly based on clinical and pathological factors. In recent years, numerous molecular alterations have been reported, expanding our understanding on the biology of these tumors. However, only a few of these molecular alterations serve as biomarkers that influence clinical decision-making and treatment strategies. This article reviews the molecular alterations reported in peripheral blood for high-grade gliomas and emphasizes the importance of standardizing new biomarkers alongside histological findings to enhance our knowledge of these tumors.

Por muito tempo, a classificação dos tumores do sistema nervoso central (SNC) baseou-se em achados histológicos respaldados por exames complementares, como a imuno-histoquímica, estabelecidos nos tecidos. A quinta edição da classificação de tumores do SNC da Organização Mundial da Saúde (OMS), publicada em 2021 (CNS-5), incorpora inúmeros marcadores moleculares com utilidade clinicopatológica importantes para uma classificação mais precisa das neoplasias do SNC. Isso permite definir gliomas difusos adultos, oligodendroglioma mutado para o gene IDH (lactic isocitrato desidrogenase), com codeleção 1p/19q graus 2 a 3, astrocitoma mutado para IDH sem codeleção 1p/19q, graus 2 a 4 e wild- tipo glioblastoma (GBM) para IDH. A sobrevida mediana em pacientes com GBM é de apenas 14,6 meses, devido à resistência ao protocolo terapêutico mais utilizado no mundo, que envolve cirurgia, radioterapia e quimioterapia com temozolamida (TMZ), um potente alquilador genotóxico . Os critérios de seleção para o tratamento e estimativa do prognóstico em pacientes com essa doença são clínico-patológicos. Nos últimos anos, foram relatadas inúmeras alterações moleculares que ampliam o entendimento da biologia desses tumores, mas apenas algumas influenciam na decisão clínica e terapêutica como biomarcadores. Este artigo revisa as alterações moleculares relatadas para gliomas de alto grau no sangue periférico, destacando também a importância da padronização de novos biomarcadores juntamente com os achados histológicos para melhorar o conhecimento desses tumores

Hallazgos radiológicos de un astrocitoma pilocítico diseminado, en una adolescente colombiana / Radiological findings of a disseminated pilocytic astrocytoma in a Colombian teenager

El astrocitoma pilocítico (AP) es el tumor más común del sistema nervioso central (SNC) en la población pediátrica. Es considerado un glioma circunscrito debido a su curso benigno. Aparece como una lesión bien determinada, típicamente quística, con un nódulo mural hiperintenso. Tiene una lenta tasa de crecimiento y baja celularidad. El AP se origina principalmente en el cerebelo, la vía óptica y la región hipotalámica/quiasmática. Se presenta un caso inusual de diseminación de un AP de fosa posterior al canal espinal en una adolescente de 16 años.

Pilocytic astrocytoma (PA) is the most common Central Nervous System (CNS) tumor in the pediatric population. It is regarded as a Circumscribed Glioma, due to its benign course. PA is a well-circumscribed, typically cystic lesion with a hyper-intense mural nodule. It shows a slow rate of growth and low cellularity. PA arises mostly in the cerebellum, optic pathway and hypothalamic/chiasmatic region. We report an unusual case of PA dissemination from the posterior fossa to the spinal canal in a 16 year old teenager.

Validation of Thwaites Index for diagnosing tuberculous meningitis in a Colombian population.

OBJECTIVE: To determine the diagnostic accuracy of Thwaites Index (TI) in a Colombian population to distinguish meningeal tuberculosis (MTB) from bacterial meningitis (BM) and from non-tuberculous meningitis. Exploratory analyses were conducted to assess the TI's validity for patients with human immunodeficiency virus (HIV) and children above six-years-old. METHODS: The study included 527 patients, the TI was calculated and results compared with those of a reference standard established by expert neurologists. Sensitivity, specificity, area under the curve of receiver-operator characteristics (AUC-ROC) and likelihood ratios were calculated. RESULTS: The AUC-ROC to distinguish MTB from non-tuberculous meningitis was 0.72 (95% CI: 0.67-0.77) for HIV negative adults. AUC-ROC was 0.62 (95% CI: 0.50-0.74) for HIV positive adults and 0.83 (95% CI: 0.68-0.97) for children. For distinguishing MTB from BM the AUC-ROC was 0.78 (95% CI: 0.73-0.83); furthermore, the AUC-ROC was 0.57 (95% CI: 0.31-0.83) for HIV positive adults and 0.86 (95% CI: 0.73-0.99) for children. CONCLUSION: The TI was sensitive but not specific when used to distinguish MTB from BM in HIV negative adults. In HIV positive adults the index had low diagnostic accuracy. Moreover, the TI showed discrimination capability for children over 6years; however, research with larger samples is required in these.

Multicentric study of epidemiological and clinical characteristics of persons injured in motor vehicle accidents in Medellín, Colombia, 2009-2010 / Estudio multicéntrico de las características epidemiológicas y clínicas de las personas lesionadas en accidentes de tránsito en Medellín, Colombia, 2009-2010

Introduction: Traffic accidents (TA) cause 1.23 million deaths each year worldwide while between 20 and 50 million persons are injured each year. In 2011 in Medellin, Colombia, there were 307 traffic deaths and 23,835 injured with 411 accidents for each 10,000 vehicles. Objective: The purpose of the study was to describe the epidemiologic and clinical characteristics, as well as the quality of life and disability outcomes for those injured in traffic accidents in Medellin. Methods: This prospective, descriptive, cross-sectional study collected data from 834 patients that were classified with the New Injury Severity Score (NISS) , the WHO-DAS-II (Disability Assessment) Scale and the SF-36 Health Survey. Results: Three-fourths (75.8%) of the patients were male. Eighty-one percent (81.0%) of patients were involved in motorcycle accidents, with 45.6% suffering moderate trauma, and 32.6% experiencing severe trauma. Of the patients with severe trauma, 8.5% were not wearing helmets. Half of the sample (49.7%) injured their extremities. The WHODAS-II domains most affected were: Activities outside the home (62.0%), Housework (54.3%) and Moving in one's environment (45.2%). Quality of life areas affected were: Physical role (20.3%), Body pain (37.3%), Emotional role (44.1%), Physical functioning (52.6%). Conclusions: Patients with more severe injuries had higher levels of disability and a worse quality of life. Motorcycles made up a large proportion of traffic accidents in this city and mitigation strategies to reduce this public health problem should particularly focus on this high-risk group.

Antecedentes: Los accidentes de tránsito (AT) causan 1.23 millones de muertes en el mundo, y entre 20 y 50 millones sufren lesiones no fatales. En Medellín (Colombia) en el 2011 hubo 307 muertos en AT y 23.835 heridos, con 411 accidentes por cada 10.000 vehículos. Objetivo: Describir las características epidemiológicas, clínicas, de calidad de vida y discapacidad de los pacientes luego de un AT en Medellín. Métodos: Estudio descriptivo trasversal prospectivo del estado inicial de una cohorte de 834 pacientes, clasificados de acuerdo a la gravedad de trauma (NISS) y las escalas WHO-DAS II y SF-36. Resultados: En el 81% de los AT estuvieron involucradas motos, con lesiones moderadas en el 45.6 %, y graves en el 32.6% de ellos. No utilizaban casco el 8.5% de los pacientes con NISS grave. En el 49.7% se afectaron los miembros inferiores. Los dominios del WHO-DAS II más afectados fueron: actividades fuera del hogar (62.0%) actividades domésticas (54.3%) y moverse en el entorno (45.2%). La calidad de vida comprometió los dominios de desempeño físico (20.3%), dolor corporal (37.3%), desempeño emocional (44.1%) y funcionamiento físico (52.6%). Conclusiones: Los pacientes con lesiones más graves tuvieron mayor compromiso en la discapacidad y en la calidad de vida. Esta carga de enfermedad la producen principalmente los AT en los que están involucradas las motos.

Multicentric study of epidemiological and clinical characteristics of persons injured in motor vehicle accidents in Medellín, Colombia, 2009-2010.

INTRODUCTION: Traffic accidents (TA) cause 1.23 million deaths each year worldwide while between 20 and 50 million persons are injured each year. In 2011 in Medellin, Colombia, there were 307 traffic deaths and 23.835 injured with 411 accidents for each 10.000 vehicles. OBJECTIVE: The purpose of the study was to describe the epidemiologic and clinical characteristics, as well as the quality of life and disability outcomes for those injured in traffic accidents in Medellin. METHODS: This prospective, descriptive, cross-sectional study collected data from 834 patients that were classified with the New Injury Severity Score (NISS) , the WHO-DAS-II (Disability Assessment) Scale and the SF-36 Health Survey. RESULTS: Three-fourths (75.8%) of the patients were male. Eighty-one percent (81.0%) of patients were involved in motorcycle accidents, with 45.6% suffering moderate trauma, and 32.6% experiencing severe trauma. Of the patients with severe trauma, 8.5% were not wearing helmets. Half of the sample (49.7%) injured their extremities. The WHODAS-II domains most affected were: Activities outside the home (62.0%), Housework (54.3%) and Moving in one's environment (45.2%). Quality of life areas affected were: Physical role (20.3%), Body pain (37.3%), Emotional role (44.1%), Physical functioning (52.6%). CONCLUSIONS: Patients with more severe injuries had higher levels of disability and a worse quality of life. Motorcycles made up a large proportion of traffic accidents in this city and mitigation strategies to reduce this public health problem should particularly focus on this high-risk group.

ANTECEDENTES: Los accidentes de tránsito (AT) causan 1.23 millones de muertes en el mundo, y entre 20 y 50 millones sufren lesiones no fatales. En Medellín (Colombia) en el 2011 hubo 307 muertos en AT y 23.835 heridos, con 411 accidentes por cada 10.000 vehículos. OBJETIVO: Describir las características epidemiológicas, clínicas, de calidad de vida y discapacidad de los pacientes luego de un AT en Medellín. MÉTODOS: Estudio descriptivo trasversal prospectivo del estado inicial de una cohorte de 834 pacientes, clasificados de acuerdo a la gravedad de trauma (NISS) y las escalas WHO-DAS II y SF-36. RESULTADOS: En el 81% de los AT estuvieron involucradas motos, con lesiones moderadas en el 45.6 %, y graves en el 32.6% de ellos. No utilizaban casco el 8.5% de los pacientes con NISS grave. En el 49.7% se afectaron los miembros inferiores. Los dominios del WHO-DAS II más afectados fueron: actividades fuera del hogar (62.0%) actividades domésticas (54.3%) y moverse en el entorno (45.2%). La calidad de vida comprometió los dominios de desempeño físico (20.3%), dolor corporal (37.3%), desempeño emocional (44.1%) y funcionamiento físico (52.6%). CONCLUSIONES: Los pacientes con lesiones más graves tuvieron mayor compromiso en la discapacidad y en la calidad de vida. Esta carga de enfermedad la producen principalmente los AT en los que están involucradas las motos.

Neuropsicología del trauma craneoencefálico en Cali, Colombia / Traumatic brain injury neuropsychology in Cali, Colombia / Neuropsicologia do traumatismo cranioencefálico em Cali, na Colômbia

Objetivo: realizar un análisis comparativo entre un grupo control y pacientes con trauma craneoencefálico (TCE) para determinar si existen diferencias neuropsicológicas a los seis meses de evolución y así orientar programas de intervención acordes con las necesidades de esta población. Materiales y métodos: se evaluó un total de setenta y nueve pacientes con antecedente de TCE con mínimo de seis meses de evolución y setenta y nueve sujetos en grupo control, el cual presentó una escolaridad promedio de once años frente a nueve años del grupo de TCE; ambos grupos con una media de treinta y cuatro años de edad, sin antecedentes neurológicos y/o psiquiátricos. La media del Glasgow en el grupo de TCE se ubicó en un rango moderado con una puntuación de once. Se aplicó la evaluación neuropsicológica breve en español Neuropsi a los dos grupos. Resultados: los grupos muestran diferencias significativas (p ≤ 0,05) en las tareas de orientación, atención, memoria, lenguaje, lectura y escritura. Conclusiones: el TCE deja secuelas neuropsicológicas significativas, aun seis meses después de ocurrido el evento traumático. Estos hallazgos sugieren que los pacientes con TCE requieren de tratamiento después de superar la etapa inicial.

Objetive: comparative analysis between control group and patients with TBI to determine whether there neuropsychological differences at 6 months of evolution, to guide timely intervention commensurate with the needs of this population. Materials and methods: a total of 79 patients with a history of TBI with a minimum of 6 months of evolution and 79 control subjects were evaluated. Both groups with a mean age of 34 and without previous neurological or psychiatric disorders and an average schooling of 11 years for the control group and 9 years for the TBI group. The Glasgow Coma Scale in the TBI group was classified as moderate with 11 points. The Brief Neuropsychological Evaluation in Spanish Neuropsi was applied to both groups. Results: significant differences (p≤0.05) in the tasks of orientation, attention, memory, language, reading and writing were found. Conclusions: TBI generates significant neuropsychological changes, even six months after discharge from the health service. It suggests that patients with head injury require treatment after overcoming the initial stage.

Objetivo: realizar uma análise comparativa entre um grupo controle e pacientes com traumatismo cranioencefálico, TCE, para determinar se existem diferenças neuropsicológicas aos seis meses de evolução e assim orientar programas de intervenção conforme com as necessidades desta população. Materiais e métodos: avaliou-se um total de setenta e nove pacientes com antecedente de TCE com um mínimo de seis meses de evolução e setenta e nove pessoas em grupo controles, que apresentou uma escolaridade média de onze anos frente a nove anos do grupo de TCE; ambos os grupos com uma média de trinta e quatro anos de idade, sem antecedentes neurológicos ou psiquiátricos. A média de Glasgow no grupo de TCE localizou-se em uma distância moderada com uma pontuação de onze. Aplicou-se a avaliação neuropsicológica breve em espanhol Neuropsi aos dois grupos. Resultados: os grupos mostram diferenças significativas (p≤0,05) nas tarefas de orientação, atenção, memória, linguagem, leitura e escrita. Conclusões: o TCE deixa sequelas neuropsicológicas significativas, ainda seis meses depois de acontecido o evento traumático. Estas descobertas sugerem que os pacientes com TCE requerem de tratamento depois de superar a etapa inicial.

Predisposition to accelerated Alzheimer-related changes in the brains of human immunodeficiency virus negative opiate abusers.

Cognitive impairment is a recognized effect of drug misuse, including the use of opiates. The pathological basis for this is unknown but the temporal and frontal cortices have been implicated. We have shown previously that deposits of hyperphosphorylated tau in drug user brains exceed those seen in age-matched controls. The present quantitative study of hyperphosphorylated tau and beta amyloid in drug user brains allows comparison with the related pathology in Alzheimer's disease. Brains were obtained from the Edinburgh Medical Research Council Brain Banks, comprising 39 human immunodeficiency virus negative drug users, five subjects with Alzheimer's disease and 37 age-matched, cognitively normal controls, all legally and ethically approved for research. Hyperphosphorylated tau positive (AT8, AT100) neuropil threads were significantly increased in the frontal and temporal cortex, and in the locus coeruleus, of drug users aged > 30 years (all P = 0.04). Under the age of 30 years, drug users showed a similar increase in neuropil threads compared with controls, but this reached significance only in the frontal cortex (P = 0.03). Immunopositivity for both three- and four-repeat tau was present in drug user brains. There was a direct relationship between the numbers of neuropil threads and of neurofibrillary tangles: neurofibrillary tangles were sparse in brains that had neuropil thread counts below 200 cm(2). Hyperphosphorylated tau positive neuropil threads increased at a faster rate in drug users than in controls and the levels of the phosphorylating enzyme, GSK-3, was raised in drug user brains. Beta amyloid (AB4, AB42 and 4G8) was raised in drug user brains (mainly as shadow plaques) but not significantly different from controls and there was no correlation between high beta amyloid and hyperphosphorylated tau in individual cases. Hyperphosphorylated tau levels correlated significantly (P = 0.038) with microglial activation in drug users but not in controls. The levels of hyperphosphorylated tau in drug users fell far short of those seen in Alzheimer's disease but overlapped with those in elderly controls. We conclude that drug users show early Alzheimer's disease-related brain pathology that may be the basis for cognitive impairment and that neuroinflammation is an early accompanying feature. This provides an opportunity to study the pathogenesis of tau pathology in the human brain.

The effects of illicit drugs on the HIV infected brain.

Evidence accumulating from clinical observations, neuroimaging and neuropathological studies suggests that illicit drug abuse accentuates the adverse effects of HIV on the central nervous system (CNS). Experimental investigation in cell culture models supports this conclusion. Injecting drug abuse is also a risk factor for the acquisition of HIV infection, the incidence of which continues to rise in intravenous drug users (IVDU) even in countries with access to effective therapy. In order to understand the interactions of drug abuse and HIV infection, it is necessary to examine the effects of each insult in isolation before looking for their combined effects. This review traces progress in understanding the pathogenesis of HIV related CNS disorders before the introduction of effective therapy and compares the state of our knowledge now that effective therapy has significantly modified disease progression. The additional impact of intravenous drug abuse on HIV-associated brain disease, then and now, is also reviewed. Predictions for the future are discussed, based on what is known at present and on recently emerging data.

Análisis retrospectivo de historias clínicas de pacientes intervenidos por Cirugía Maxilofacial en el Hospital General de Medellín / Comparative study of the retention of abutments of maryland bridges with and without proximal grooves

Introducción y objetivos: El trauma maxilofacial representa un problema importante de morbilidad enColombia, situación que motivó a evaluar las principales etiologías, los diferentes tipos de fracturas, laedad, el género, los días de estancia y las complicaciones que se presentaron en el Hospital Generalde Medellín en el área de cirugía maxilofacial. Materiales y Métodos: se realizó un estudio descriptivoretrospectivo basado en información tomada de historias clínicas de 663 pacientes intervenidosen el área de cirugía maxilofacial en el Hospital General de Medellín entre los años 2004 a 2006.Resultados: Los accidentes de tránsito con un 57.9 por ciento (384 pacientes) fueron la principal etiologíade los traumas maxilofaciales, Las fracturas mandibulares fueron las de mayor incidencia con un47.4 por ciento (314), seguido por las fracturas del malar con un 32.4 por ciento (215).El rango de edad osciló entre1 y 95 años con un promedio de 29, y el 81.7 por ciento del los pacientes fueron hombres.Conclusiones:Los traumas maxilofaciales afectaron principalmente las estructuras mandibular, malar y los tejidosblandos, en consecuencia de los accidentes de tránsito como primer factor etiológico en la poblaciónjoven adulta, la mayoría de ellos de sexo masculino.

Introduction and objectives: The purpose of this study was to evaluate the main causes, type offractures, age, sex, length of hospital stay and complications presented in Oral Surgery and MaxillofacialService of the Medellin General Hospital. Materials and Methods: A descriptive retrospectivestudy was carried out based on information taken the clinical charts of 663 patients treated by theOral Surgery and Maxillofacial Service between 2004 and 2006. Results: Automobile accidents representedthe highest cause of trauma with 57.9 percent of cases (384 patients). Mandibular fractures hada higher incidence with 47.4 percent (314) followed by malar fractures with 32.4 percent (215). The age rangevaried between 1 and 95 years of age with an average of 29 years; 81.7 percent of patients treated weremale. Conclusions: Maxillofacial trauma affected mainly manibular, malar and soft tissue structureswith as automobile accidents being the main cause and affecting mostly young males.

Neurobiology of multiple insults: HIV-1-associated brain disorders in those who use illicit drugs.

Despite two decades of research, certain aspects of HIV-related central nervous system (CNS) disease remain poorly understood. HIV targets microglia and macrophages within the CNS and enters the brain compartment early. However, HIV is there held in check apparently until the onset of significant immune compromise, when viral replication, microglial activation, neuronal damage, and cognitive impairment are likely to ensue. Illicit drug abuse continues to be a significant risk factor for HIV transmission worldwide. Whether HIV-related CNS disease is more prevalent or more severe in this risk group has long been debated. Drugs of abuse can of themselves cause immune suppression, blood-brain barrier breakdown, microglial activation, and neuronal injury. This review presents evidence that HIV associated CNS disorders are indeed accentuated in drug abusers. However, the advent of effective therapy has added a new dimension, which must be taken into consideration. Treated individuals are surviving much longer and HIV encephalitis and HIV-associated dementia have become much less common. However, more subtle forms of CNS damage are emerging. Examination of the brains of individuals who have been treated long term with highly active antiretroviral therapy (HAART) reveals a surprising degree of microglial activation, comparable at times to that seen formerly in milder cases of HIV encephalitis. In addition, these individuals show evidence of increased deposition of neurodegenerative proteins, particularly hyperphosphorylated tau. Similar observations have been made in young opiate abusers who are HIV negative. Taken together, these results suggest that neuroinflammation and neurodegeneration, which are clinically silent at present, may cause problems in the future in HAART-treated subjects.

Does drug abuse influence the microglial response in AIDS and HIV encephalitis?

OBJECTIVES: To investigate the pathological evidence for a possible interaction between drugs of abuse and HIV infection in terms of microglial responses in early and late HIV/AIDS, and to discuss the possible long-term consequences of microglial activation in chronic HIV infection. DESIGN: This brain pathology study compared age and sex-matched control patients with HIV-negative intravenous drug users, and with HIV-positive drug users both in the presymptomatic stage and with AIDS. A further group of non-drug-using AIDS patients was included. All the AIDS patients had HIV encephalitis (HIVE) but no other significant HIV-associated brain pathology. METHODS: Microglia/macrophages were identified in the grey and white matter of the frontal and temporal lobes and the thalamus, using antibodies to CD68 and MHCII. Objective quantitation was used to compare subjects in the different groups. RESULTS: AIDS patients showed a significant increase in activated microglia/macrophages in both the grey and white matter of all areas compared with non-AIDS patients. Drug users with HIVE tended to have more activated microglia than non-drug-using comparison groups, but this difference was not found in all brain areas studied. CONCLUSION: Drug misuse appears to enhance the microglial activation resulting from HIV infection in some individuals. Other factors such as the severity of HIVE, or systemic immune factors, are also likely to affect the degree of microglial activation. The implications for drug-using patients who survive long term with HIV/AIDS are discussed, particularly in relation to premature neurodegeneration.

Depresion en la enfermedad de Alzheimer / Depression in Alzheimer disease

No cabe duda de que una de las cuestiones que hoy preocupa a los clínicos que trabajan con personas mayores es la distinción entre los síntomas propios de un trastorno depresivo y aquellos que reflejan el inicio de un proceso neurodegenerativo o la aparición conjunta de ambos desórdenes. Esto es una cuestión aún no resuelta y que nos hace plantear la necesidad de revisar de forma crítica las hipótesis y los factores que se han planteado sobre la aparición de síntomas depresivos en personas con enfermedad de Alzheimer (biológicos, psicológicos, y ambientales o socioculturales), valorar los datos epidemiológicos que contrastan ambos síndromes, las características que permiten hacer un diagnóstico diferencial y los instrumentos de evaluación que se emplean. Nos planteamos la necesidad de establecer criterios internacionales y desarrollar pruebas de valoración de la depresión que sean los suficientemente sensibles a las características de este tipo de población, puesto que en la actualidad no disponemos de marcadores biológicos que permitan aclarar mejor dicha distinción

Cáncer Gástrico temprano en varias Instituciones de Medellín / Early gastric cancer in several institutions in Medellín 1994-2000

Este estudio analizó la evolución postoperatoria de 31 pacientes con diagnóstico confirmado de cáncer gástrico temprano (CGT) en seis diferentes instituciones hospitalarias de Medellín, entre Enero de 1994 y Diciembre de 2000. La edad promedio fue de 57.6 años, y predominancia del sexo femenino (61.3 por ciento) sin ser estadísticamente significativa. El 54.8 por ciento de las lesiones fueron adenocarcinomas bien diferenciados, con tipo morfológico superficial (29 por ciento), tamaño promedio de 1.98 cm. e invasión hasta la submucosa en el 61.3 por ciento de los casos. Solo dos pacientes tuvieron compromiso ganglionar asociado...

Encefalitis herpética en niños: aspectos epidemiológicos, clínicos, paraclínicos y utilidad de la reacción en cadena de la polimerasa (PCR) en líquido cefalorraquídeo / Herpetic encephalitis in children: epidemiological facts and PCR performance in CSF diagnosis

El objetivo del estudio fue determinar la incidencia y las características clínicas, de EH en niños menores de 12 años, en una población infantil de Medellin. Establecer la utilidad de la PCR para el HSV en líquido cefalorraquídeo (LCR), en relación a la biopsia del cerebro. Se atendieron ocho niños con EH, en cinco se confirmó el diagnóstico mediante biopsia cerebral. La mayor frecuencia correspondió a menores de un año. La PCR en LCR tuvo una sensibilidad del 80/100, una especificidad del 90/100, un valor predictivo negativo del 90/100. La exactitud de la prueba fue del 86.7/100. Las características clínicas y paraclínicas de nuestros pacientes, salvo una incidencia un poco más alta, son similares a las informadas en la literatura mundial. La utilidad hallada para la PCR en LCR en este estudio (86.7/100) es semejante a la informada por otros estudios