Fake imported tropical diseases: A retrospective study.

OBJECTIVE: When we evaluate a patient with a suspected imported disease we cannot forget to include any autochthonous causes that may mimic imported pathologies to avoid misdiagnosis and therapeutic delay. METHODS: A descriptive longitudinal retrospective study was designed with patients in whom an imported disease was suspected but who were finally diagnosed with autochthonous processes. The patients were selected from two internal medicine practices specializing in tropical diseases between 2008-2017 in Spain. RESULTS: We report 16 patients, 11 (68.7%) were males, and the mean age was 43.4 ± 13.7 years old. Thirteen patients (81.2%) were travellers. Half of the patients were from Latin America, 7 (43.5%) were from Africa, and 1 (6.2%) was from Asia. The time from trip to evaluation ranged between 1 week and 20 years (median, 4 weeks), and the mean time from evaluation to diagnosis was 58.4 ± 100.9 days. There were 5 (31.2%) cases of autochthonous infection, 5 (31.2%) cases of cancer, 2 (12.5%) cases of inflammatory disease, and 2 (12.5%) cases of vascular disease. CONCLUSIONS: Travel or migration by a patient can sometimes be a confusing factor if an imported disease is suspected and may cause delays in the diagnosis and treatment of an autochthonous disease. We highlight that 1/3 of the patients with autochthonous diseases in this study had cancer. The evaluation of imported diseases requires a comprehensive approach by the internist, especially if he specializes in infectious and/or tropical diseases and is, therefore, the best qualified to make an accurate diagnosis.

Virus Zika: manifestaciones cutáneas en 3 pacientes / Zika Virus: Cutaneous Manifestations in 3 Patients

La infección por el virus Zika debe sospecharse en viajeros o inmigrantes con clínica de viriasis (exantema, fiebre, artralgias, artritis, conjuntivitis, cefalea, etc.) y una historia epidemiológica compatible. Aunque las manifestaciones cutáneas se encuentran entre las más frecuentes no son específicas y su iconografía es escasa. Presentamos 3 casos, 2 viajeros y un inmigrante que comienzan con un exantema por virus Zika. Alcanzar el diagnóstico de forma rápida optimiza el manejo de estos pacientes, mejora el control de los casos graves y permite minimizar una posible transmisión autóctona dado el riesgo que supone la presencia del Aedes albopictus como potencial vector transmisor de esta enfermedad en el litoral mediterráneo español

Zika virus infection should be suspected in travelers or immigrants with the signs or symptoms of a viral infection (rash, fever, joint pains, conjunctivitis, headache, etc.) and a compatible epidemiological history. Although cutaneous manifestations are among the most common clinical signs of Zika, they are not specific and very few images are available. We present 3 patients (2 travelers and 1 immigrant) in whom a rash was the presenting manifestation of Zika virus infection. Prompt diagnosis optimizes outcomes in these patients, improves the management of severe disease, and minimizes the risk of local transmission by Aedes albopictus, now a potential local vector for the virus due to its presence in areas along Spain's Mediterranean coast

Zika Virus: Cutaneous Manifestations in 3 Patients. / Virus Zika: manifestaciones cutáneas en 3 pacientes.

Zika virus infection should be suspected in travelers or immigrants with the signs or symptoms of a viral infection (rash, fever, joint pains, conjunctivitis, headache, etc.) and a compatible epidemiological history. Although cutaneous manifestations are among the most common clinical signs of Zika, they are not specific and very few images are available. We present 3 patients (2 travelers and 1 immigrant) in whom a rash was the presenting manifestation of Zika virus infection. Prompt diagnosis optimizes outcomes in these patients, improves the management of severe disease, and minimizes the risk of local transmission by Aedes albopictus, now a potential local vector for the virus due to its presence in areas along Spain's Mediterranean coast.

Is cystic echinoccocosis re-emerging in western Spain?

Cystic echinococcosis (CE) remains an important health problem in many areas of the world, including the Mediterranean region. We performed a retrospective study of cases reported from 1998 to 2012 in order to review and update the epidemiology of this disease in a highly endemic area situated in western Spain. A total of 471 patients were diagnosed with hydatid disease. Of these cases, 55·8% were male, with an average age of 62·3 ± 19·5 years. More importantly, 1·5% of patients were children, and 20·5% were aged <45 years. An active therapeutic approach was implemented for 92·6% of the CE patients with primary diagnoses; however, a 'watch and wait' strategy was used in 59·3% of all secondary CE diagnoses. The incidence rate of hydatid disease was significantly higher compared to the incidence described in the Notifiable Disease System in this area. Furthermore, a significant decrease in hydatid incidence during the years included in the study was observed (ß = -0·4357, P < 0·001). CE incidence has diminished in recent years, although active transmission remains in paediatric cases. Additionally, CE incidence remains high in our region despite public health plans for its control. The documented incidence of CE disease clearly underestimates the real numbers.

Imported transmissible diseases in minors coming to Spain from low-income areas.

We prospectively studied the prevalence of imported transmissible diseases in 373 immigrant children and adolescents coming from Sub-Saharan Africa, North Africa and Latin America to Salamanca, Spain. The most frequent transmissible diseases in this group were latent tuberculosis (12.7%), chronic hepatitis B virus infection (4.2%), hepatitis C virus infection (2.3%), syphilis (1.5%) and human T-lymphotropic virus type 1 or 2 infections (1.4%). A total of 24.2% of patients had serologic profiles suggesting past hepatitis B virus infection. Anti-human immunodeficiency virus antibodies were not detected in any subject. Largely asymptomatic immigrant children show a high prevalence of communicable diseases. Thus, infectious disease screenings are highly advisable in immigrant children coming from low-income countries.

Comparación del desempeño neuropsicológico según la edad de inicio en sujetos con enfermedad de Parkinson y parkinsonismo / Comparison of neuropsychological performance according to the age of onset in subjects with parkinson´s disease and parkinsonism

Introducción. La enfermedad de Parkinson (EP) es el trastorno neurodegenerativo más común después de la enfermedad de Alzheimer, y se caracteriza por temblor, bradicinesia, rigidez e inestabilidad postural. El trastorno cognitivo más común es disfunción ejecutiva, aunque también se han informado déficit globales asociados al inicio tardío de la enfermedad. Objetivos. Describir y comparar el desempeño cognitivo en tres grupos con EP y uno con parkinsonismo. Pacientes y métodos. A 175 pacientes con EP idiopática y parkinsonismo se les realizó una valoración neurológica y neuropsicológica. El análisis de datos se hizo comparando resultados de las pruebas para cuatro grupos: tres con EP (edad de inicio: juvenil, del adulto y tardía) y uno con parkinsonismo, y controlando por edad, escolaridad y tiempo de evolución. Resultados. En el grupo conEP juvenil se encontró alteración en el número de intrusiones en memoria verbal; en los de EP del adulto y EP tardía, se encontró alteración en el tiempo en ejecución continua visual. Comparados entre sí los grupos y controlando por edad, las diferencias desaparecieron. El grupo con parkinsonismo obtuvo resultados inferiores a todos los grupos con EP para la mayoría de variables cognitivas y funcionales. Conclusiones. La EP idiopática no sería causante de deterioro cognitivo múltiple, sino de una alteración específica, principalmente en velocidad de procesamiento y evocación de la información. La edad de inicio no sería un factor decisivo en el grado de deterioro del funcionamiento cognitivo; sólo existe un deterioro cognitivo importante en el grupo con parkinsonismo (AU)

Introduction. Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease, and it is characterised by tremor, bradykinesia, rigidity and postural instability. The most frequent cognitive disorder is executive dysfunction, although global deficits associated to late onset of the disease have also been reported. Aims. To describe and to compare cognitive performance in three groups with PD and one with Parkinsonism. Patients and methods. A neurological and neuropsychological evaluation was carried out on 175 patients with idiopathic PD and Parkinsonism. The data analysis was performed by comparing the results of the tests carried out on the four groups: three with PD (age of onset: juvenile, adult and late) and one with Parkinsonism, while controlling for age, schooling and time of progression. Results. In the juvenile PD group, alterations were observed in the number of intrusions in verbal memory; in the adult PD and late PD groups, there were alterations in time in continuous visual execution. These differences disappeared when the groups were compared to each other while also controlling for age. The Parkinsonism group obtained results that were lower than those of all the groups with PD for most of the cognitive and functional variables. Conclusions. Idiopathic PD would not be the cause of multiple cognitive impairment, but of a specific alteration, mainly involving the speed of processing and information recall. Age of onset would not be a decisive factor in the degree of impairment of cognitive functioning; important cognitive impairment was only present in the group with Parkinsonism (AU)

[Comparison of neuropsychological performance according to the age of onset in subjects with Parkinson's disease and Parkinsonism]. / Comparación del desempeño neuropsicológico según la edad de inicio en sujetos con enfermedad de Parkinson y parkinsonismo.

INTRODUCTION: Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease, and it is characterised by tremor, bradykinesia, rigidity and postural instability. The most frequent cognitive disorder is executive dysfunction, although global deficits associated to late onset of the disease have also been reported. AIMS: To describe and to compare cognitive performance in three groups with PD and one with Parkinsonism. PATIENTS AND METHODS: A neurological and neuropsychological evaluation was carried out on 175 patients with idiopathic PD and Parkinsonism. The data analysis was performed by comparing the results of the tests carried out on the four groups: three with PD (age of onset: juvenile, adult and late) and one with Parkinsonism, while controlling for age, schooling and time of progression. RESULTS: In the juvenile PD group, alterations were observed in the number of intrusions in verbal memory; in the adult PD and late PD groups, there were alterations in time in continuous visual execution. These differences disappeared when the groups were compared to each other while also controlling for age. The Parkinsonism group obtained results that were lower than those of all the groups with PD for most of the cognitive and functional variables. CONCLUSIONS: Idiopathic PD would not be the cause of multiple cognitive impairment, but of a specific alteration, mainly involving the speed of processing and information recall. Age of onset would not be a decisive factor in the degree of impairment of cognitive functioning; important cognitive impairment was only present in the group with Parkinsonism.

[Analysis of intrusive errors in a memory test as possible pre-clinical marker of familial Alzheimer disease, in E280A presenilin-1 mutation carrier]. / Analisis de las intrusiones en una prueba de memoria como posible marcador preclinico de enfermedad de Alzheimer en portadores de la mutacion E280A de la presenilina-1.

INTRODUCTION: Intrusive errors in verbal memory tests could be considered as a preclinical marker of familial Alzheimer disease (AD). AIMS. To analyze and to compare the number and types of intrusive errors in the CERAD verbal memory test, administered to a genealogy of affected by familial AD, with E280A presenilin-1 mutation. PATIENTS AND METHODS: Sample was constituted by 30 asymptomatic non-carriers (ANC), 39 non-demented carriers (NDC) and 21 demented carriers (DC). CERAD verbal memory test was administered to the sample. Comparisons, with non parametric Kruskal-Wallis' analysis, were done. RESULTS: NDC participants presented more intrusive errors than ANC group in the first and second trials and in the delay recall of the memory task; also they had more intrusive errors than the DC patients in intrusive errors of the first trial and delay recall of the same task. The ANC and DC groups had significantly more intrusions only in third trial. CONCLUSION: Intrusive errors could be considered as a cognitive preclinical marker for familial AD.

Análisis de las intrusiones en una prueba de memoria como posible marcador preclínico de enfermedad de Alzheimer en portadores de la mutación E280A de la presenilina-1 / Analysis of intrusive errors in a memory test as possible pre-clinical marker of familial alzheimer disease, in E280A presenilin-1 mutation carrier

Introducción. Las intrusiones en tareas de memoria podrían ser uno de los marcadores preclínicos en la enfermedad de Alzheimer (EA) familiar. Objetivos. Analizar y comparar la cantidad y el tipo de intrusiones en la prueba de memoria de una lista de palabras del CERAD de una genealogía extensa afectada por EA familiar, con mutación E280A. Pacientes y métodos. La muestra se dividió en tres grupos: 30 participantes no portadores asintomáticos (NP), 39 portadores sin demencia (PSD) y 21 portadores con demencia (PD). Se administró la prueba de memoria verbal del CERAD a los tres grupos y se hicieron comparaciones con el procedimiento no paramétrico de Kruskal-Wallis. Resultados. Los PSD presentaron más intrusionesque el grupo de NP en el primer y segundo ensayos y en la evocación diferida de la prueba de memoria; también tuvieron más intrusiones que los PD en el primer ensayo y en la evocación diferida de la misma tarea. Los PD sólo tuvieron significativamente más intrusiones que los NP en el tercer ensayo de la prueba de memoria. Conclusión. Las intrusiones podrían ser uno de los marcadores neuropsicológicos preclínicos de la alteración de la memoria en los PSD de la mutación E280A para EA familiar

Introduction. Intrusive errors in verbal memory tests could be considered as a preclinical marker of familialAlzheimer disease (AD). Aims. To analyze and to compare the number and types of intrusive errors in the CERAD verbal memory test, administered to a genealogy of affected by familial AD, with E280A presenilin-1 mutation. Patients and methods. Sample was constituted by 30 asymptomatic non-carriers (ANC), 39 non-demented carriers (NDC) and 21 demented carriers (DC). CERAD verbal memory test was administered to the sample. Comparisons, with non parametric Kruskal-Wallis’ analysis, were done. Results. NDC participants presented more intrusive errors than ANC group in the first and second trials and in the delay recall of the memory task; also they had more intrusive errors than the DC patients in intrusive errors of the first trial and delay recall of the same task. The ANC and DC groups had significantly more intrusions only in third trial. Conclusion. Intrusive errors could be considered as a cognitive preclinical marker for familial AD

Resolución de lesión ósea en paciente con histiocitosis X pulmonar / No disponible

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[Cognitive effects of combined memory and psychomotor training in elderly adults]. / Efectos cognitivos de un entrenamiento combinado de memoria y psicomotricidad en adultos mayores.

INTRODUCTION: As part of the normal ageing process, cognitive deterioration clearly takes place in memory, attention and the information processing speed (IPS). Among the intervention strategies commonly used, combined programmes like those involving memory and psychomotor skills have the greatest beneficial effects on cognition in the short and long term. AIM: To evaluate the effects of a combined memory and psychomotor training programme entitled 'Independence in Older age' (SIMA) on the cognitive performance of a population sample of healthy elderly adults. SUBJECTS AND METHODS: A cross-sectional study was conducted on 95 elderly adults (49 in the intervention group and 46 in the control group) before and after a 20-session training programme. Both intergroup (intervention group versus control group) and intragroup (each group individually) cognitive performance was analysed. The two groups were paired by age, sex and schooling. RESULTS: The intergroup analysis following the training showed statistically and clinically significant differences in two IPS variables: conflict and interference in the colour-word test, which had a size effect of -1.31 and -1.38, respectively; the performance of the group of trained elderly adults was better than that of the controls. Likewise, in the intragroup analysis significant differences were found in these two variables in the group that received the intervention, with a size effect of -1.27 and -1.15. CONCLUSION: Findings show positive effects of combined SIMA memory and psychomotor training, especially in selective attention and the IPS with a healthy elderly adult population.

Demencia semántica: descripción de un caso / Semantic dementia: a case report

No disponible

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[Performance of carriers and non-carriers of the E280A mutation for familial Alzheimer's disease in a naming test]. / Desempeño de portadores y no portadores de la mutación E280A para enfermedad de Alzheimer familiar en una prueba de denominación.

INTRODUCTION: Early preclinical diagnosis is the greatest challenge faced by researchers into dementia. Cognitive, neuroanatomical, neurophysiological and genetic markers have been reported. One of the preclinical cognitive markers is anomia and it is often assessed using visual naming tests. AIMS: The aim of this study was to analyse the type of mistakes made in a visual naming test in a group of carriers and non-carriers of the E280A PS1 mutation. PATIENTS AND METHODS: The sample was made up of 91 participants who were genotyped for the E280A PS1 mutation and divided into three groups: non-carriers (n = 30), asymptomatic carriers (n = 39) and sick carriers (n = 22). Selection was performed using the Minimental and the Fast and EDG scales and mistakes in the CERAD naming test were classified. The types of mistakes taken into account were: no answer, visual, semantic, phonological, the whole for the part, and not related. RESULTS: There is a significant difference in the number of semantic errors between non-carriers and asymptomatic carriers; on comparing the three groups, no statistically significant differences were found in visual mistakes. CONCLUSIONS: Visual mistakes are a general characteristic, even in healthy subjects and, therefore, these errors did not provide any information that could be used to classify patients with or without dementia. Semantic mistakes can be considered as being a preclinical sign in familial Alzheimer's disease (FAD). Both visual and auditory naming tests must be applied when evaluating patients with FAD.

Desempeño de portadores y no portadores de la mutación E280A para la enfermedad de Alzheimer familiar en una prueba de denominación / Performance of carriers and non-carriers of the e280a mutation for familial alzheimer's disease in a naming test

Introducción. El diagnóstico precoz y el preclínico son los mayores retos de la investigación en demencias. Se han descrito marcadores cognitivos, neuroanatómicos, neurofisiológicos y genéticos. La anomia es uno de los marcadores cognitivos preclínicos; frecuentemente, se evalúa mediante pruebas de denominación por presentación visual. Objetivo. Analizar el tipo de errores en una prueba de denominación por presentación visual en un grupo de portadores y no portadores de la mutación E280A de la presenilina-1 (PS1). Pacientes y métodos. La muestra se conformó con 91 participantes genoti pificados para la mutación E280A de la PS1 dividida en tres grupos: no portadores (n = 30), portadores asintomáticos (n = 39) y portadores enfermos (n = 22). Para la selección, se utilizó el minimental y las escalas FAST y EDG; se clasificaron los errores de la prueba de denominación del CERAD. Los tipos de errores que se consideraron fueron: no respuesta, visuales, semánticos, fonológicos, todo por la parte y no relacionados. Resultados. Entre los no portadores y los portadores asintomáticos hay una diferencia significativa en el número de errores semánticos; comparando los tres grupos, no se encontraron diferencias estadísticamente significativas en errores visuales. Conclusiones. Los errores visuales se presentan como una característica general, incluso en personas sanas; por tanto, estos errores no aportan información para clasificar los pacientes con o sin demencia. Los errores semánticos se pueden considerar como un signo preclínico en la EAF. Cuando se evalúen pacientes con EAF se deben aplicar pruebas de denominación, tanto por presentación visual como por presentación auditiva (AU)

Introduction. Early preclinical diagnosis is the greatest challenge faced by researchers into dementia. Cognitive, neuroanatomical, neurophysiological and genetic markers have been reported. One of the preclinical cognitive markers is anomia and it is often assessed using visual naming tests. Aims. The aim of this study was to analyse the type of mistakes made in a visual naming test in a group of carriers and non-carriers of the E280A PS1 mutation. Patients and methods. The sample was made up of 91 participants who were genotyped for the E280A PS1 mutation and divided into three groups: non-carriers (n = 30), asymptomatic carriers (n = 39) and sick carriers (n = 22). Selection was performed using the Minimental and the FAST and EDG scales and mistakes in the CERAD naming test were classified. The types of mistakes taken into account were: no answer, visual, semantic, phonological, the whole for the part, and not related. Results. There is a significant difference in the number of semantic errors between non-carriers and asymptomatic carriers; on comparing the three groups, no statistically significant differences were found in visual mistakes. Conclusions. Visual mistakes are a general characteristic, even in healthy subjects and, therefore, these errors did not provide any information that could be used to classify patients with or without dementia. Semantic mistakes can be considered as being a preclinical sign in familial Alzheimer’s disease (FAD). Both visual and auditory naming tests must be applied when evaluating patients with FAD (AU)

[Pneuropsychological disorders after occupational exposure to mercury vapors in El Bagre (Antioquia, Colombia)]. / Alteraciones neuropsicológicas por exposición ocupacional a vapores de mercurio en El Bagre (Antioquia, Colombia).

INTRODUCTION: The department of Antioquia in Columbia is the main producer of gold in Columbia. In the gold-producing regions the population is exposed to high levels of mercury used in the processes of extraction and purification. Studies done in Columbia on neurotoxicity underline the hazards of mercury from the environmental and occupational-health point of view, but the effect of long-term exposure on cognitive function has not been studied. OBJECTIVE: To determine whether the miners of El Bagre (Antioquia, Columbia) have neuropsychological and/or behavior disorders as a result of occupational exposure to toxic mercury vapor. PATIENTS AND METHODS: The sample was made up of 22 right-handed men, residents of El Bagre, aged between 20 and 45 years old who had been exposed to mercury vapor for at least three years. The control group consisted of 22 men who lived in the non-mining regions of the department and had not been exposed to mercury, paired with the cases considered for age and educational status. Neuropsychological assessment, a medical examination and behavioral performance tests were applied to all the men (in both groups). RESULTS: In the study group alterations were seen and classified as: intellectual damage (mainly alteration of executive function and constructional praxis); emotional changes (symptoms of depression and anxiety) and neurological changes (amnesia, insomnia and tremor of the tongue). No changes were found in the control group. CONCLUSION: Exposure to mercury causes specific neuropsychological and behavior disorders in the absence of clinically detectable physical or physiological damage.

Alteraciones neuropsicológicas por exposición ocupacionala vapores de mercurio en El Bagre (Antioquia, Colombia) / Neuropsychological disorders due to occupational exposure to mercury vapor in El Bagre (Antioquia, Columbia)

Introducción. El departamento de Antioquia es el primer productor de oro en Colombia; en sus zonas auríferas la población está expuesta a altos niveles de mercurio, metal utilizado en los procesos de extracción y purificación. Estudios realizados en Colombia en materia de neurotoxicidad destacan el peligro del mercurio desde el punto de vista ambiental y en salud ocupacional, pero no se han estudiado los efectos de la exposición crónica sobre las funciones cognitivas. Objetivo. Determinar si en los mineros de la región antioqueña de El Bagre se presentan alteraciones neuropsicológicas y/o comportamentales como consecuencia de la exposición ocupacional a vapores tóxicos de mercurio. Pacientes y métodos. La muestra la componen 22 varones, residentes en El Bagre, con edades entre 20 y 45 años, diestros y con un tiempo mínimo de exposición al mercurio de tres años. El grupo control está formado por 22 varones no expuestos, residentes en una región sin actividad minera del departamento y pareados con los casos por edad y escolaridad. A los individuos de ambos grupos se les realizó una evaluación neuropsicológica, un examen médico y se les aplicaron escalas comportamentales. Resultados. En el grupo de casos se encontraron alteraciones que pueden agruparse como: daño intelectual (alteración en la función ejecutiva y las praxias construccionales, principalmente); alteración emocional (síntomas de depresión y ansiedad) y alteraciones neurológicas (amnesia, insomnio y temblor lingual). En el grupo control, por el contrario, no se hallaron alteraciones. Conclusión. La exposición al mercurio genera alteraciones neuropsicológicas y comportamentales específicas en ausencia de daño físico y fisiológico detectable clínicamente (AU)