Trends in stroke mortality in La Rioja (Spain) from 1999 to 2022.

INTRODUCTION: Stroke mortality has declined in recent decades, but there appears to be a slowdown in the decline in recent years. We analyze the trends in stroke mortality in La Rioja (Spain) for the period 1999-2022. METHODS: We evaluated stroke mortality using statistical data from the mortality registry of La Rioja (Spain). We adjusted the rates by age and sex and analyzed both overall strokes and subtypes: hemorrhagic and ischemic. To analyze the trend in mortality rates we constructed joinpoint regression models, with associated annual percentage change (APC) RESULTS: Age-standardized stroke mortality declined between 1999 and 2022: females from 98.0 to 29.2 per 100 000; males, from 131.6 to 44.8 per 100 000. We found a decrease in overall stroke mortality in all age groups, except those under 65 years old. Ischemic stroke mortality showed declines in the first decade (APC: 7.3%, CI95%: 4.1-19.1%) and increases in the second decade (APC: 1.6%, CI95%: -1.6-11.7%) among men. In women, the rates declined between 2018 and 2022(APC: -6.6%, CI95%: -5.1-30.6%) after an increase between 2015 and 2017 (APC: 23.5%, CI95%: -20.2-38.3%). For hemorrhagic stroke, we found a consistent rate of decline throughout the entire time period in men (APC: 2.4%, CI95%: 0.9 a 4.0%). In women, rates increased during the period 1999-2009(APC: 1.9%, CI95%: -2.1-22.8%) and decreased 2010-2022 (APC: 6.5%, CI95%: 4.0-25.6%). CONCLUSIONS: Stroke mortality rates have decreased, more so for haemorrhagic than ischaemic strokes.

Bloqueo anestésico del nervio occipital mayor en el tratamiento de las cefaleas. Revisión de la evidencia / Greater occipital nerve block in the treatment of headaches. Review of evidence

Introducción Los bloqueos anestésicos de nervios pericraneales han constituido un tratamiento habitual de múltiples cefaleas. El más utilizado en la práctica clínica habitual y que cuenta con mayor evidencia que avale su efectividad es el bloqueo del nervio occipital mayor. Métodos búsqueda en Pubmed de Meta-Analysis/Systematic Review de los últimos 10 años, seleccionando para su revisión aquellos metaanálisis, y en su defecto revisiones sistemáticas, acerca del bloqueo del nervio occipital mayor en el tratamiento de las cefaleas. Resultados Se obtuvieron 95 trabajos, 13 incluyeron los criterios de inclusión. Conclusión El bloqueo del occipital mayor es una técnica eficaz y segura, fácil de realizar, y que ha mostrado su utilidad en migraña, cefalea en racimos, cefalea cervicogénica y pospunción lumbar. No obstante, hacen falta más estudios que aclaren su eficacia a largo plazo, su lugar en el tratamiento habitual, la posible diferencia entre diversos anestésicos, la posología más conveniente y el papel del uso concomitante de corticoides (AU)

Introduction Peripheral nerve blocks have been a common treatment for multiple headaches. By far, the greater occipital nerve block is the most used and with the stronger body of evidence in routine clinical practice. Methods We searched Pubmed Meta-Analysis/Systematic Review, in the last 10 years. Of these results, meta-analyses, and in the absence of these systematic reviews, assessing Greater Occipital Nerve Block in headache has been selected for review. Results We identified 95 studies in Pubmed, 13 that met the inclusion criteria. Conclusion Greater occipital block is an effective and safe technique, easy to perform and which has shown its usefulness in migraine, cluster headache, cervicogenic headache and Post-dural puncture headache. However, more studies are needed to clarify its long-term efficacy, its place in clinical treatment, the possible difference between different anaesthetics, the most convenient dosage and the role of concomitant use of corticosteroids (AU)

[Greater occipital nerve block in the treatment of headaches. Review of evidence]. / Bloqueo anestésico del nervio occipital mayor en el tratamiento de las cefaleas. Revisión de la evidencia.

INTRODUCTION: Peripheral nerve blocks have been a common treatment for multiple headaches. By far, the greater occipital nerve block is the most used and with the stronger body of evidence in routine clinical practice. METHODS: We searched Pubmed Meta-Analysis/Systematic Review, in the last 10 years. Of these results, meta-analyses, and in the absence of these systematic reviews, assessing Greater Occipital Nerve Block in headache has been selected for review. RESULTS: We identified 95 studies in Pubmed, 13 that met the inclusion criteria. CONCLUSION: Greater occipital block is an effective and safe technique, easy to perform and which has shown its usefulness in migraine, cluster headache, cervicogenic headache and Post-dural puncture headache. However, more studies are needed to clarify its long-term efficacy, its place in clinical treatment, the possible difference between different anaesthetics, the most convenient dosage and the role of concomitant use of corticosteroids.

Biomonitoring of Mycotoxins in Plasma of Patients with Alzheimer's and Parkinson's Disease.

Exposure to environmental contaminants might play an important role in neurodegenerative disease pathogenesis, such as Parkinson´s disease (PD) and Alzheimer´s disease (AD). For the first time in Spain, the plasmatic levels of 19 mycotoxins from patients diagnosed with a neurodegenerative disease (44 PD and 24 AD) and from their healthy companions (25) from La Rioja region were analyzed. The studied mycotoxins were aflatoxins B1, B2, G1, G2 and M1, T-2 and HT-2, ochratoxins A (OTA) and B (OTB), zearalenone, sterigmatocystin (STER), nivalenol, deoxynivalenol, 3-acetyldeoxynivalenol, 15-acetyldeoxynivalenol, deepoxy-deoxynivalenol, neosolaniol, diacetoxyscirpenol and fusarenon-X. Samples were analyzed by LC-MS/MS before and after treatment with ß-glucuronidase/arylsulfatase in order to detect potential metabolites. Only OTA, OTB and STER were detected in the samples. OTA was present before (77% of the samples) and after (89%) the enzymatic treatment, while OTB was only detectable before (13%). Statistically significant differences in OTA between healthy companions and patients were observed but the observed differences might seem more related to gender (OTA levels higher in men, p-value = 0.0014) than the disease itself. STER appeared only after enzymatic treatment (88%). Statistical analysis on STER, showed distributions always different between healthy controls and patients (patients' group > controls, p-value < 0.0001). Surprisingly, STER levels weakly correlated positively with age in women (rho = 0.3384), while OTA correlation showed a decrease of levels with age especially in the men with PD (rho = -0.4643).

Education and information needs for physicians about rare diseases in Spain.

BACKGROUND: Rare diseases are a priority objective for public health systems. Given its complexity, late and misdiagnoses occur very often which causes mental and physical burden for patients and family. This would be caused, in part, for unprepared clinicians in this field. The aim of this study was to report the training needs and the perceived shortcomings of Spanish physicians of the public health system in the diagnosis, treatment and monitoring of patients with rare diseases. METHODS: We used a descriptive cross-sectional study through an "ad hoc" survey of 26 questions was completed by 132 primary care physicians and 37 specialists during April and May 2018. RESULTS: Less than a third of the physicians had received training in rare disease during their undergraduate or postgraduate years, and for hospital professionals, they received more training in the postgraduate period. CONCLUSION: Primary care physicians and specialists showed low training level in rare diseases. An academical and continuous program on rare disease, as well as, multidisciplinary units and high quality practice guidelines are necessary to help to prevention and support clinical decisions and improve quality of care of patients and families.

Riesgo de infección por SARS-CoV-2 y resultados clínicos en pacientes con esclerosis múltiple en la Rioja (España) / Risk of SARS-CoV-2 infection and clinical outcomes in multiple sclerosis patients in La Rioja (Spain)

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El holobionte enfermo, el ejemplo de la esclerosis múltiple / Disease of the holobiont, the example of multiple sclerosis

En los últimos años se ha producido una revolución en torno al papel de la microbiota en diferentes enfermedades, la mayoría dentro del espectro de las inflamatorias y autoinmunes, asociado al desarrollo de la metagenómica y al concepto de holobionte, entendido como el conjunto formado por los organismos superiores y su microbiota. Concretamente, en la esclerosis múltiple, existe múltiple evidencia acerca del papel de la microbiota en la encefalomielitis autoinmune experimental, modelo animal de la enfermedad y se han publicado en los últimos años diversos artículos acerca de las diferencias en la microbiota intestinal entre pacientes enfermos de esclerosis múltiple y sujetos control. En este artículo revisamos el concepto de holobionte y las funciones de la microbiota dentro del mismo, así como la evidencia acumulada en el papel de la microbiota en la encefalomielitis autoinmune experimental y en la esclerosis múltiple. A día de hoy, existe una amplia evidencia científica del papel de la microbiota en la génesis, prevención y tratamiento de la encefalomielitis autoinmune experimental en base fundamentalmente a tres pilares inmunológicos, el equilibrio Th1-Th17/Th2, las células Treg y la inmunidad humoral. Así mismo está bien documentado que existen diferencias en la microbiota de pacientes con EM que se asocian a una diferente expresión de genes relacionados con la inflamación

In recent years there has been a revolution regarding the role of the microbiota in different diseases, most of them within the spectrum of inflammatory and autoimmune diseases, associated with the development of metagenomics and the concept of holobiont, a large organism together with its microbiota. Specifically, in Multiple Sclerosis, multiple evidence points to the role of the microbiota in experimental autoimmune encephalomyelitis, animal model of the disease, and several articles have been published in recent years about differences in intestinal microbiota among patients with multiple sclerosis and control subjects. We review in this article the concept of holobiont and the gut microbiota functions, as well as the evidence accumulated about the role of the microbiota in experimental autoimmune encephalomyelitis and multiple sclerosis. Nowadays, there is a lot of evidence showing the role of the microbiota in the genesis, prevention and treatment of experimental autoimmune encephalomyelitis based mainly on three immunological pillars, the Th1-Th17 / Th2 balance, the Treg cells and the humoral immunity. It is also well documented that there are differences in the microbiota of patients with MS that are associated with a different expression of genes related to inflammation

Disease of the holobiont, the example of multiple sclerosis. / El holobionte enfermo, el ejemplo de la esclerosis múltiple.

In recent years there has been a revolution regarding the role of the microbiota in different diseases, most of them within the spectrum of inflammatory and autoimmune diseases, associated with the development of metagenomics and the concept of holobiont, a large organism together with its microbiota. Specifically, in Multiple Sclerosis, multiple evidence points to the role of the microbiota in experimental autoimmune encephalomyelitis, animal model of the disease, and several articles have been published in recent years about differences in intestinal microbiota among patients with multiple sclerosis and control subjects. We review in this article the concept of holobiont and the gut microbiota functions, as well as the evidence accumulated about the role of the microbiota in experimental autoimmune encephalomyelitis and multiple sclerosis. Nowadays, there is a lot of evidence showing the role of the microbiota in the genesis, prevention and treatment of experimental autoimmune encephalomyelitis based mainly on three immunological pillars, the Th1-Th17 / Th2 balance, the Treg cells and the humoral immunity. It is also well documented that there are differences in the microbiota of patients with MS that are associated with a different expression of genes related to inflammation.

Toxina botulínica en la neuralgia del trigémino / Botulinum toxin in trigeminal neuralgia

Introducción: La neuralgia del trigémino es uno de los síndromes de dolor facial más incapacitantes, con un importante impacto sobre la calidad de vida. Su tratamiento inicialmente es farmacológico, pero a menudo se presentan casos de farmacorresistencia que obligan a buscar nuevas estrategias, entre las que se han utilizado diversos tratamientos intervencionistas. En los últimos años ha surgido una nueva estrategia terapéutica consistente en el uso de toxina botulínica, con resultados prometedores. Desarrollo: Se han revisado los casos clínicos y las series de casos, los estudios abiertos y los ensayos clínicos aleatorizados publicados sobre el uso de la toxina botulínica en el tratamiento de la neuralgia del trigémino farmacorresistente. Conclusiones: La administración de toxina botulínica ha mostrado ser una estrategia terapéutica segura y efectiva en pacientes con neuralgia del trigémino farmacorresistente idiopática, pero quedan por responder numerosas cuestiones que terminen de situar su papel dentro de la terapéutica de esta enfermedad (AU)

Introduction: Trigeminal neuralgia is one of the most disabling facial pain syndromes, with a significant impact on patients’ quality of life. Pharmacotherapy is the first choice for treatment but cases of drug resistance often require new strategies, among which various interventional treatments have been used. In recent years a new therapeutic strategy consisting of botulinum toxin has emerged, with promising results. Development: We reviewed clinical cases and case series, open-label studies and randomized clinical trials examining the use of botulinum toxin for drug-refractory trigeminal neuralgia published in the literature. Conclusions: The administration of botulinum toxin has proven to be a safe and effective therapeutic strategy in patients with drug-refractory idiopathic trigeminal neuralgia, but many questions remain unanswered as to the precise role of botulinum toxin in the treatment of this disease (AU)

Botulinum toxin in trigeminal neuralgia. / Toxina botulínica en la neuralgia del trigémino.

INTRODUCTION: Trigeminal neuralgia is one of the most disabling facial pain syndromes, with a significant impact on patients' quality of life. Pharmacotherapy is the first choice for treatment but cases of drug resistance often require new strategies, among which various interventional treatments have been used. In recent years a new therapeutic strategy consisting of botulinum toxin has emerged, with promising results. DEVELOPMENT: We reviewed clinical cases and case series, open-label studies and randomized clinical trials examining the use of botulinum toxin for drug-refractory trigeminal neuralgia published in the literature. CONCLUSIONS: The administration of botulinum toxin has proven to be a safe and effective therapeutic strategy in patients with drug-refractory idiopathic trigeminal neuralgia, but many questions remain unanswered as to the precise role of botulinum toxin in the treatment of this disease.