Clinical and anatomic description of patients with arteriovenous malformation treated with endovascular therapy in a Mexican population.

OBJECTIVE: Arteriovenous malformations (AVMs) are benign congenital lesions. The estimated prevalence is 10-18 per 100,000 individuals, with an incidence rate of 1.1-1.4 per 100,000 person-year; only 12% of AVMs present symptoms during life. It is important to study different characteristics associated with AVMs because these patients require multidisciplinary treatment. METHODS: A descriptive, observational, longitudinal, and retrospective study was carried out from January 15, 2016 to October 19, 2021. Convenience sampling was used on patients diagnosed with arteriovenous malformation. Sociodemographic data was obtained, such as: sex, age, site, predominant symptoms, clinical debut, type of malformation, data associated with post therapy evolution, type of embolizing agent used, associated complications, Rankin scale, and death. RESULTS: Data from 535 procedures was collected, we calculated an incidence of 4.4 cases per million inhabitants. Ninety procedures in 56 patients that used endovascular therapy were obtained with a female-male ratio of 0.75 and an age distribution of 35±14 (SD). A 36.3±11.5 (SD) mm diameter was registered. There was a 33% success rate for endovascular surgery. CONCLUSIONS: The multidisciplinary treatment of AVMs is made up of three pillar techniques: microsurgical resection, embolization, and radio-neurosurgery. It is extremely important to make an appropriate decision, with an emphasis on achieving better functional outcomes for the patient. Although neurological endovascular therapy was initially used as an adjuvant treatment for neurosurgery and radio-neurosurgery, it has been used more and more frequently as the first line of treatment.

Case of anterolateral migration of herniated cervical disc fragment mimicking a spinal meningioma.

BACKGROUND: Before the introduction of high-resolution MR, few disc fragments were misdiagnosed as meningiomas. CASE DESCRIPTION: A 63-year-old female presented with a 6-month history of mild to moderate pain in the left arm, weakness 4/5 in the left arm C5-C6 distribution, and a loss of the left biceps reflex response. Although the MR study was read as showing a C5-C6 level probable spinal meningioma, this proved to be a sequestrated disc fragment at surgery. CONCLUSION: Rarely, cervical disc herniations may be misdiagnosed on MR studies as spinal meningiomas.

Minimally invasive management for a giant lumbar intervertebral disc herniation: A case report, and literature review.

INTRODUCTION AND IMPORTANCE: Low back pain and lower limb radiculopathy are some of the most common diagnoses in our neurosurgery department. Giant lumbar intervertebral disc herniation, are not a common find in our daily practice. Management for this kind of pathology is controversial. The quest for the best surgical approach is still a matter of debate. This case report intends to demonstrate the advantages of minimally invasive procedures. CASE PRESENTATION: 40-year-old female, diagnosed with giant lumbar L5-S1 disc herniation with localized lower back electric-type pain, 5/10 intensity in the visual analog scale (VAS) and an Oswestry Disability Index (ODI) score of 76 points, underwent minimally invasive surgery (MIS) with tubular retractor system. 6-month post-op, the patient referred no pain, and an ODI score of 4 points was obtained. CLINICAL DISCUSSION: There is no clear classification, regarding the lumbar intervertebral disc herniated content. We didn't find any clear indications or contraindications regarding the relationship of the size of herniated disc content and surgical approach (MIS vs Open). We perform on average 175 spine cases per year and educational commitment with spine pathology is demonstrated with our spine fellowship since 3 years ago. CONCLUSION: We believe giant extruded regardless of migration, single-level intervertebral disc herniation, could be effectively and safely treated by MIS.

Marihuana en México, ¿droga recreativa o medicina? / Marijuana in Mexico, recreational drug or medicine?

El tema que discutimos tiene una relevancia que alcanza todos los ámbitos de la sociedad actual, debido a que incluye factores sociales, políticos, económicos y de salud; sin embargo, es de mencionar la situación risible que ocurre en relación con el consumo de marihuana en México, dado que los artículos 477 y 479 de la Ley General de Salud determinan su posible portación y consumo personal a la cantidad de 5 g del estupefaciente. Dicho en otras palabras, el uso con fines médicos se encuentra aún penalizado e inclusive mal visto dentro de la práctica, mientras que la finalidad recreativa sobre la posesión y el uso tanto de la marihuana como de algún derivado del tetrahidrocannabinol (THC) son contemplados dentro de la ley explícitamente. Esto ha quedado ejemplificado claramente el pasado 24 de noviembre de 2015, fecha en la cual, a pesar de la ley ya existente, el Pleno de la Suprema Corte de Justicia de la Nación concedió a cuatro personas el derecho a la «... producción, uso y autoconsumo del estupefaciente cannabis y el psicotrópico "THC" para fines "lúdicos"¼; al compararlo con los casos actuales que han obtenido la autorización pertinente del gobierno para el uso médico, son muchos menos. Si bien el 19 de junio de 2017 se aprobó el uso medicinal de la marihuana en productos con un contenido neto de THC < 1%, la Cofepris (Comisión Federal para la Protección contra Riesgos Sanitarios) dio a conocer los reglamentos en materia de control sanitario del cannabis y sus derivados hasta finales de 2018; tal hecho, dejó a merced de la obtención de un permiso para la importación de medicamentos a base del psicoactivo provenientes del extranjero acorde a lo escrito en el artículo 290. Asimismo destaca que los permisos solo pueden ser otorgados tras la ordenanza de un juez, situación que hasta la fecha continúa como «difícil¼, ya que tras recibir aproximadamente 534 solicitudes, solo 9 se habían autorizado a 5 de septiembre de 2018, esto según el portal del propio gobierno de México.

The issue we are discussing is relevant to all areas of today's society, as it includes social, political, economic and health factors; however, it is worth mentioning the laughable situation that occurs in relation to the consumption of marijuana in Mexico, given that articles 477 and 479 of the General Health Law determine its possible possession and personal consumption to the amount of 5 g of the drug. In other words, use for medical purposes is still criminalised and even frowned upon in practice, while the recreational purpose of possession and use of both marijuana and a derivative of tetrahydrocannabinol (THC) is explicitly contemplated in the law.This was clearly exemplified on 24 November 2015, when, despite the existing law, the Plenary of the Supreme Court of Justice of the Nation granted four people the right to "... production, use and self-consumption of the narcotic drug cannabis and the psychotropic "THC" for "recreational" purposes"; when compared to the current cases that have obtained the relevant government authorisation for medical use, there are far fewer. Although the medical use of marijuana in products with a net THC content < 1% was approved on 19 June 2017, the Cofepris (Comisión Federal para la Protección contra Riesgos Sanitarios) released the regulations on the sanitary control of cannabis and its derivatives until the end of 2018; this fact left the importation of medicines based on the psychoactive drug from abroad subject to obtaining a permit in accordance with the provisions of article 290. It also points out that permits can only be granted following a judge's order, a situation that to date continues to be "difficult", as after receiving approximately 534 applications, only 9 had been authorised as of 5 September 2018, according to the Mexican government's own website.

Detection and molecular characterization of respiratory viruses that cause acute respiratory infection in the adult population.

INTRODUCTION: Acute respiratory infections are one of the main causes of morbidity and mortality in older adults and patients with chronic diseases. Among the responsible etiological agents are human respiratory viruses, such as: respiratory syncytial virus, parainfluenza virus and metapneumovirus. OBJECTIVE: To carry out a differential diagnostic study of respiratory viruses circulating and co-circulating in an adult population. METHODS: A pilot study was conducted in patients older than 18 years, who presented signs and symptoms suggestive of acute respiratory infection and whose clinical picture did not exceed 15 days of evolution; end-point polymerase chain reaction assays were performed with the use of specific oligonucleotides for molecular diagnosis. RESULTS: 72 specimens of patients with an age of 51.33 ± 19.33 years, with a predominance of females (4.5:1); original inhabitants of Mexico City; only 22 were positive for respiratory viruses, being mostly metapneumovirus infections. CONCLUSIONS: The knowledge of the circulating viral strains in the population will allow to determine changes that can declare an epidemiological alert leading to the best decision making for the benefit of the patients.

[Detección y caracterización molecular de virus respiratorios causantes de infección respiratoria aguda en población adulta].

INTRODUCTION: Acute respiratory infections are one of the main causes of morbidity and mortality in older adults and patients with chronic diseases. Among the responsible etiological agents are human respiratory viruses, such as: respiratory syncytial virus, parainfluenza virus and metapneumovirus. OBJECTIVE: To carry out a differential diagnostic study of respiratory viruses circulating and co-circulating in an adult population. METHODS: A pilot study was conducted in patients older than 18 years, who presented signs and symptoms suggestive of acute respiratory infection and whose clinical picture did not exceed 15 days of evolution; end-point polymerase chain reaction assays were performed with the use of specific oligonucleotides for molecular diagnosis. RESULTS: 72 specimens of patients with an age of 51.33 ± 19.33 years, with a predominance of females (4.5:1); original inhabitants of Mexico City; only 22 were positive for respiratory viruses, being mostly metapneumovirus infections. CONCLUSIONS: The knowledge of the circulating viral strains in the population will allow to determine changes that can declare an epidemiological alert leading to the best decision making for the benefit of the patients.

INTRODUCCIÓN: Las infecciones respiratorias agudas son una de las principales causas de morbimortalidad en adultos mayores y pacientes con enfermedades crónicas. Dentro de los agentes etiológicos responsables se encuentran los virus respiratorios humanos, tales como: virus sincitial respiratorio, virus parainfluenza y metapneumovirus. OBJETIVO: Realizar un estudio de diagnóstico diferencial de virus respiratorios que circulan y cocirculan en una población adulta. MÉTODO: Se realizó un estudio tipo piloto en pacientes mayores de 18 años, que presentaron signos y síntomas sugestivos de infección respiratoria aguda y cuyo cuadro clínico no sobrepasara los 15 días de evolución; se realizaron ensayos de reacción en cadena de la polimerasa de punto final con el uso de oligonucleótidos específicos para el diagnóstico molecular. RESULTADOS: Se tipificaron 72 especímenes de pacientes con una edad de 51.33 ± 19.33 años, con predominio del sexo femenino (4.5:1); originarios en su totalidad de la Ciudad de México; solo 22 fueron positivos para virus respiratorios, siendo en su mayoría infecciones por metapneumovirus. CONCLUSIONES: El conocimiento de las cepas virales circulantes en la población permitirá determinar cambios que puedan declarar una alerta epidemiológica llevando a la mejor toma de decisiones en beneficio de los pacientes.

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

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

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

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

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

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

Detección y caracterización molecular de virus respiratorios causantes de infección respiratoria aguda en población adulta / Detection and molecular characterization of respiratory viruses that cause acute respiratory infection in the adult population

Resumen Introducción: Las infecciones respiratorias agudas son una de las principales causas de morbimortalidad en adultos mayores y pacientes con enfermedades crónicas. Dentro de los agentes etiológicos responsables se encuentran los virus respiratorios humanos, tales como: virus sincitial respiratorio, virus parainfluenza y metapneumovirus. Objetivo: Realizar un estudio de diagnóstico diferencial de virus respiratorios que circulan y cocirculan en una población adulta. Método: Se realizó un estudio tipo piloto en pacientes mayores de 18 años, que presentaron signos y síntomas sugestivos de infección respiratoria aguda y cuyo cuadro clínico no sobrepasara los 15 días de evolución; se realizaron ensayos de reacción en cadena de la polimerasa de punto final con el uso de oligonucleótidos específicos para el diagnóstico molecular. Resultados: Se tipificaron 72 especímenes de pacientes con una edad de 51.33 ± 19.33 años, con predominio del sexo femenino (4.5:1); originarios en su totalidad de la Ciudad de México; solo 22 fueron positivos para virus respiratorios, siendo en su mayoría infecciones por metapneumovirus. Conclusiones: El conocimiento de las cepas virales circulantes en la población permitirá determinar cambios que puedan declarar una alerta epidemiológica llevando a la mejor toma de decisiones en beneficio de los pacientes.

Abstract Introduction: Acute respiratory infections are one of the main causes of morbidity and mortality in older adults and patients with chronic diseases. Among the responsible etiological agents are human respiratory viruses, such as: respiratory syncytial virus, parainfluenza virus and metapneumovirus. Objective: To carry out a differential diagnostic study of respiratory viruses circulating and co-circulating in an adult population. Methods: A pilot study was conducted in patients older than 18 years, who presented signs and symptoms suggestive of acute respiratory infection and whose clinical picture did not exceed 15 days of evolution; end-point polymerase chain reaction assays were performed with the use of specific oligonucleotides for molecular diagnosis. Results: 72 specimens of patients with an age of 51.33 ± 19.33 years, with a predominance of females (4.5:1); original inhabitants of Mexico City; only 22 were positive for respiratory viruses, being mostly metapneumovirus infections. Conclusions: The knowledge of the circulating viral strains in the population will allow to determine changes that can declare an epidemiological alert leading to the best decision making for the benefit of the patients.

[Implicaciones psiquiátricas y neurológicas en la literatura shakespeariana. Breve análisis].

William Shakespeare (1564-1616) is with no doubt one of the most prolific literary artists of all times; in addition to being an eminent playwright, his works reflect arguments that express medical knowledge, allude to concise descriptions that are relevant to medical practice of that time, and even to current medicine. He wrote between 35 and 38 plays, six lyric works and 154 sonnets (approximately) where finding little more than 700 references to medicine of those days is possible. For this reason, different scholars have analyzed the medical concepts within the Shakespearean literature; some agree that these may be the result of studies of his own, while others suggest that Shakespeare repeated the medical knowledge of some "men of wisdom" of his time. It should be mentioned that the author's contemporary London society lived in an overpopulated, nauseating, sexually promiscuous city that was plagued by pests and waste and continually besieged by epidemics whose treatments many times caused greater evil than benefit (for example, lead-based make-up). Some biographers credit syphilis, alcohol, and depression as the source of Shakespeare's creative production. Despite the myriad of authors who have analyzed the insinuations about medicine in Shakespeare's dramatic accounts, Sigmund Freud (1856-1939) is perhaps the most important; throughout his career he carried out a substantial analysis of the English playwright's works owing to his passion for literature and for this author.

William Shakespeare (1564-1616) es sin duda uno de los artistas literarios más prolíficos de todos los tiempos. Además de ser un dramaturgo eminente, en sus obras podemos encontrar descripciones relativas a la práctica médica de la época e incluso de la medicina actual. Escribió entre 35 y 38 piezas teatrales, seis obras líricas y 154 sonetos (aproximadamente), en los que es posible encontrar poco más de 700 referencias a la medicina de su tiempo. Por tal motivo, diversos estudiosos han analizado los conceptos médicos en la literatura shakesperiana; algunos coinciden en que puede ser el resultado de su estudio, mientras que otros indican que Shakespeare repitió el conocimiento médico de algunos "hombres de saber" de su tiempo. Cabe mencionar que la sociedad londinense contemporánea al autor vivía en una ciudad sobrepoblada, nauseabunda, sexualmente promiscua y atestada de plagas y desechos, que continuamente era asediada por epidemias, cuyos tratamientos muchas veces ocasionaban un mal mayor a su beneficio (por ejemplo, el maquillaje de plomo). Algunos biógrafos dan crédito a la sífilis, el alcohol y la depresión como origen de la producción creativa de Shakespeare. Aun cuando un sinfín de autores se han dado a la tarea de examinar las alusiones sobre medicina en los relatos dramáticos de Shakespeare, Sigmund Freud (1856-1939) fue quizás el más importante; a lo largo de su carrera elaboró un análisis sustancial de las obras del dramaturgo inglés debido a su pasión por la literatura y hacia este artista.

From Romanticism and fiction to reality: Dippel, Galvani, Aldini and "the Modern Prometheus". Brief history of nervous impulse / Del romanticismo y la ficción a la realidad: Dippel, Galvani, Aldini y «el moderno Prometeo¼. Breve historia del impulso nervioso.

Mary Wollstonecraft Godwin, better known as Mary Shelley, and her romantic vision of the world gave life to an endless progeny of literacy stories; also originated the myth of the mortal creator who generate life from science. Unexpectedly the history has been considered as a myth, due to acts grounded in facts of certain "truthful;" such were galvanism and the study of the electrical potential in living beings by the two Italian physicians: Luigi Galvani and Giovanni Aldini. Also, is possible to proclaim direct influence on the work by the European folklore surrounding the theologian, alchemist Johann Konrad Dippel and physician who habited the Frankenstein's Castle from his birth, and further developing the "life elixir." The similarities between the novel and the life of the three historical figures suggests that Mary Shelley, belonging to a socially graceful and educated class, was aware of the scientific dispute over the understanding of electricity. Shelley's creative world, full of gothic and romantic hues, shows direct influence of alchemy speaking of the "spark of life" as well as works published by Galvani and Aldini.

Mary Wollstonecraft Godwin (1797-1851), mejor conocida como Mary Shelley, con su visión romántica del mundo dio vida a una progenie interminable de historias en la literatura, y su escrito originó el mito del creador mortal que da vida a partir de la ciencia. Aunque parezca sorprendente, la historia ha llegado a considerarse un mito debido a los actos fundamentados en hechos de cierta forma «verídicos¼ que ayudaron a su origen, como fueron el galvanismo y el estudio del potencial eléctrico en los seres vivos llevados a cabo por dos italianos: Luigi Galvani y Giovanni Aldini. De igual manera, es posible aseverar la influencia directa sobre la obra por parte del folklore europeo de la época que rodeaba al teólogo, alquimista y médico Johann Konrad Dippel, quien hábitó el Castillo Frankenstein desde su nacimiento y además desarrollo el «elixir de la vida¼. La similitud que existe entre la novela y la vida de los tres personajes históricos hace pensar que la autora Mary Shelley, al pertenecer a una clase socialmente agraciada y educada, tuvo conocimiento de la disputa científica por el entendimiento de la energía eléctrica. El mundo creativo de Shelley, lleno de matices góticos y románticos, demuestra influencia directa de la alquimia al hablar de la «chispa de la vida¼, así como de los trabajos publicados por Galvani y Aldini.

Efficacy of botulinum toxin therapy in treatment of myofascial pain.

The present study aimed to assess the efficacy of using botulinum toxin (BTX) in temporomandibular joint disorders, particularly pertaining to myofascial pain from masseter and temporal muscles. The study included 11 patients who were diagnosed with masseter and temporalis myofascial pain. Visual analog scale for pain and pressure algometry were conducted initially, after 1 month of conservative therapy (control group), and after 1 month of BTX type A injections (study group). Data were statistically analyzed (analysis of variance and Wilcoxon's test) to determine intergroup differences. Both conservative therapy and BTX injections showed reduction in pain scores and increase in pain threshold compared with baseline, and statistically significant differences were noted between both groups. Thus, BTX injections appear to be effective in management of chronic myofascial pain targeting masseter and temporalis muscles.

¿Fueron los aztecas quienes primero representaron la enfermedad de Parkinson? / No disponible

No disponible