Assessment of diaphragmatic function through surface electromyography in healthy individuais. A cross-section observational study

Introduction: Diaphragmatic surface electromyography is a procedure designed to assess the diaphragm. The physiological values of the electrical activity may have potential use in rehabilitation, sports training, ventilatory support withdrawal in critical care units and follow-up of respiratory disease. Objective: To assess and describe the diaphragmatic function through surface electromyography in a population of individuals during spontaneous and forced breathing. Methods: Observational, exploratory cross-sectional study including subjects with no comorbidities. Diaphragmatic surface EMG was performed measuring the mean quadratic root during tidal volume and vital capacity breathing. The body composition of the participants was also assessed. Results: 28 males and 22 females were included in the study. The mean quadratic root of the tidal volume for two minutes was 13.94 nV for females and 13.31 nV for males. The vital capacity was 23.24 nV for males and 22.4 nV for females. A correlation was identified between the mean quadratic root, weight, and body surface. Conclusions: Mean quadratic root values of tidal volume in two minutes in healthy females and males have been documented. The mean quadratic root values are correlated with the physiological and functional characteristics of the participants.

Introducción: La electromiografía de superficie diafragmática es un procedimiento para la evaluación diafragmática. Los valores fisiológicos de la actividad eléctrica tendrían aplicaciones potenciales en rehabilitación, entrenamiento deportivo, en el retiro ventilatorio en unidades de cuidado crítico y en el seguimiento a patologías respiratorias. Objetivo: Evaluar y describir la función diafragmática a través de electromiografía de superficie diafragmática en una población de sujetos durante la respiración espontánea y la respiración forzada. Métodos: Estudio observacional exploratorio de corte transversal en el que se incluyeron sujetos sin comorbilidades. Se realizó electromiografía de superficie diafragmática midiendo la raíz cuadrática media durante respiraciones de volumen corriente y capacidad vital. Adicionalmente, se valoró la composición corporal de los participantes. Resultados: Se incluyeron 28 hombres y 22 mujeres. La raíz cuadrática media de volumen corriente por dos minutos fue de 13,94 µV para mujeres y 13,31 µV para hombres, mientras que la capacidad vital fue 23,24 µV para hombres y 22,4 µV para mujeres. Se encontró una correlación entre la raíz cuadrática media, el peso y la superficie corporal. Conclusiones: Se han documentado los valores de la raíz cuadrática media de volumen corriente por dos minutos en mujeres y hombres sanos. Los valores de la raíz cuadrática media se correlacionan con características fisiológicas y funcionales de los participantes.

Is it Mandatory to do a 24 hour ABPM in all Patients with Moderate to Severe Obstructive Sleep Apnoea?

Background Obstructive sleep apnoea (OSA) has been described as a risk factor for arterial hypertension (HT). One of the proposed mechanisms linking these conditions is non dipping (ND) pattern in nocturnal blood pressure, however evidence is variable and based on specific populations with underlying conditions. Data for OSA and ND in subjects residing at high altitude are currently unavailable. Objective Identify the prevalence and association of moderate to severe OSA with HT and ND pattern in hypertensive and non-hypertensive otherwise healthy middle-aged individuals in residing at high altitude (Bogotá:2640 mt) Methods Adult individuals with diagnosis of moderate to severe OSA underwent 24 hour- ambulatory blood pressure monitoring (ABPM) between 2015 and 2017. Univariable and multivariable logistic regression analysis were performed to identify predictors of HT and ND pattern. Results Ninety-three (93) individuals (male 62.4% and median age 55) were included in the final analysis. Overall, 30.1% showed a ND pattern in ABPM and 14.9% had diurnal and nocturnal hypertension. Severe OSA (higher apnea-hiponea index [AHI]) was associated with HT (p = 0.006), but not with ND patterns (p = 0.54) in multivariable regression. Smoking status and lowest oxygen saturation during respiratory events where independently associated with ND pattern (p = 0.04), whereas age (p = 0.001) was associated with HT. Conclusions In our sample, one in three individuals with moderate to severe OSA have non dipping patterns suggesting lack of straight association between OSA and ND. Older individuals who have higher AHI are more likely to have HT, and those who smoke have a higher risk of ND. These findings add aditional information to the multiple mechanisms involved in the relationship between OSA and ND pattern, and questions the routine use of 24-hour ABPM, particullary in our region, with limited resources and healthcare acces. However, further work with more robust methodology is needed to draw conclusions.

Effectiveness of a multidrug therapy consisting of Ivermectin, Azithromycin, Montelukast, and Acetylsalicylic acid to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico.

OBJECTIVE: There is an urgent need for effective treatments to prevent or attenuate lung and systemic inflammation, endotheliitis, and thrombosis related to COVID-19. This study aimed to assess the effectiveness of a multidrug-therapy consisting of Ivermectin, Azithromycin, Montelukast, and Acetylsalicylic acid ("TNR4" therapy) to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico. DESIGN AND METHODS: A comparative effectiveness study was performed among 768 confirmed SARS-CoV-2 cases aged 18-80 years, who received ambulatory care at the Ministry of Health of Tlaxcala. A total of 481 cases received the TNR4 therapy, while 287 received another treatment (comparison group). All participants received home visits and/or phone calls for clinical evaluation during the 14 days after enrollment. RESULTS: Nearly 85% of cases who received the TNR4 recovered within 14 days compared to 59% in the comparison group. The likelihood of recovery within 14 days was 3.4 times greater among the TNR4 group than in the comparison group. Patients treated with TNR4 had a 75% and 81% lower risk of being hospitalized or death, respectively, than the comparison group. CONCLUSIONS: TNR4 therapy improved recovery and prevented the risk of hospitalization and death among ambulatory COVID-19 cases.

Analysis of the complete organellar genomes of the rockweed Fucus spiralis (Fucaceae, Phaeophyceae) supports its infraspecific recognition as Fucus vesiculosus var. spiralis.

Fucus spiralis L. is a broadly distributed monoecious intertidal seaweed. The specific status of F. spiralis however is debatable. Here, we contribute to the bioinformatics and systematics of F. spiralis by analysing the complete mitochondrial and plastid genomes of a specimen from California, U.S.A. The F. spiralis mitogenome is 36,396 base pairs (bp) in length and contains 67 genes, and the plastid genome is 125,066 bp in length and contains 171 genes. The F. spiralis genomes are 99.7% and 99.8% similar in nucleotide sequence to F. vesiculosus, and support the revised classification of F. spiralis to Fucus vesiculosus var. spiralis.

Isquemia talámica bilateral secundaria a trombosis venosa cerebral: tratamiento endovascular, presentación de un caso / Bilateral thalamic stroke due to cerebral vein thrombosis: endovascular treatment, case report

RESUMEN La trombosis venosa cerebral (TVC) es una entidad poco frecuente y potencialmente devastadora que se presenta con mayor frecuencia en adultos jóvenes, especialmente en mujeres. La TVC representa el 0,5 % a 1 % de todos los ACV, su amplio espectro clínico la convierte en un desafío diagnóstico, especialmente en aquellos casos de mujeres jóvenes sin factores protrombóticos conocidos que debutan con cefalea como único síntoma. La TVC puede ocasionar isquemia o infartos talámicos y gangliobasales bilaterales con delirio y deterioro del estado de conciencia, en especial cuando hay compromiso del sistema venoso profundo. El diagnóstico se confirma con resonancia magnética cerebral (RM) y venografía por resonancia. La anticoagulación sigue siendo la piedra angular del tratamiento; sin embargo, los pacientes que no responden a terapia médica intensiva pueden beneficiarse de la trombectomía endovascular mecánica (TEM). A continuación presentamos el caso clínico de una paciente de 29 años con una isquemia talámica y gangliobasal bilateral secundaria a trombosis venosa cerebral que fue llevada a trombectomía endovascular mecánica.

SUMMARY Thrombosis of the dural sinus and/or cerebral veins (CVT) is a rare but potentially devastating type of stroke that tends to occur in young adults, especially women. CVT represents about 0.5% of all strokes and can be challenging to diagnose because headache, rather than focal neurologic symptoms, is the prominent feature. However, some patients (especially those with deep cerebral venous occlusion) may present with bilateral thalamic or basal infarction and often will have decreased level of consciousness and rapid neurologic deterioration. The diagnosis of CVT is confirmed with MRI and magnetic resonance venogram (MRV). The mainstay of acute management is anticoagulation. However, some patients do not respond to medical therapy and these might benefit from endovascular mechanical thrombectomy. We present the case of a 29 year old female patient with bilateral thalamic and gangliobasal ischemia secondary to CVT, who was treated with anticoagulation and endovascular mechanical thombectomy.

Caídas frecuentes y neuroimágenes en paciente con parálisis supranuclearprogresiva. Presentación de caso y revisión de la literatura / Frequent falls neuroimaging in a patient with progressive supranuclear palsy

Las caídas en los adultos mayores son comunes, peligrosas y frecuentemente incapacitantes. Con frecuenciason multifactoriales y requieren un amplio abordaje diagnóstico. Las demencias, la enfermedad de Parkinsonidiopática (EP), la enfermedad cerebrovascular y las neuropatías se encuentran entre las condiciones neurológicasque con mayor frecuencia se asocian a caídas. Sin embargo, cuando estas se presentan con recurrenciaen el contexto de un síndrome parkinsoniano, particularmente al inicio de la enfermedad, deben sugerir eldiagnóstico de una parálisis supranuclear progresiva (PSP). Esta entidad es de diagnóstico esencialmente clínico;sin embargo, dado su pronóstico sombrío, se realizan imágenes por resonancia magnética (IRM) de cerebro atodos los pacientes para excluir otros diagnósticos alternativos y buscar hallazgos característicos de PSP. Estosson, principalmente, atrofia del mesencéfalo, borramiento de la sustancia nigra, atrofia del putamen y atrofiacon aumento de la señal del globo pálido.Se presenta a continuación el caso de un paciente adulto mayor que presentaba demencia y parkinsonismorefractario a levodopa, con caídas frecuentes, en quien la realización de una resonancia magnética sirvió paraaclarar el diagnóstico al evidenciar los hallazgos típicos de PSP. Además, se hace una breve revisión de losprincipales hallazgos con imágenes, de demencias parkinsonianas, y la prevención de caídas en estos pacientes.

Falls in the elderly are common, dangerous and often disabling. They are often multifactorial and require extensive diagnostic approach. Dementia, Idiopathic Parkinson's Disease, cerebrovascular disease and neuropathies are among the most frequent neurological condictions associated with falls. However, if a patient has had early instability and recurrent falls associated with a Parkinsonian syndrome, particularly at the beginning of the disease, it should suggest the diagnosis of Progressive Supranuclear Palsy (PSP). PSP is essentially a clinical diagnosis, however, given the bleak prognosis, Magnetic Resonance Imaging (MRI) of the brain is performed in all patients to exclude alternative diagnoses and to look for supporting features of PSP. These include signal increase and atrophy of the midbrain, thinning or smudging of the substantia nigra, atrophy of the putamen, atrophy and signal increase of globus pallidus.We present the case of an adult patient who had dementia and parkinsonism refractory to levodopa with frequent falls in whom typical findings of PSP were documented in MRI. In addition, a brief review of the main findings in Parkinsonian Dementias images and fall prevention in these patients.

Apoplejía tumoral pituitaria / Pituitary tumor apoplexy

La apoplejía tumoral pituitaria es un síndrome infrecuente que resulta del infarto y/o hemorragia espontánea de un adenoma pituitario preexistente. Ya que el evento primario involucra el adenoma, este síndrome debe ser nombrado como apoplejía tumoral pituitaria y no como apoplejía pituitaria. El aumento súbito en la presión de los contenidos de la silla turca da como resultado una cefalea de inicio agudo (puede ser incluso una "cefalea en trueno") de intensidad severa, alteraciones visuales y compromiso en la función pituitaria. El diagnóstico se basa en una alta sospecha clínica, imagen por resonancia magnética y medición de hormonas hipofisiarias en sangre. El tratamiento se basa en medidas de soporte (líquidos intravenosos y corticoides) y en casos sin buena respuesta o con deterioro neurológico, descompresión de silla turca. A continuación presentamos el caso de un adenoma previamente no diagnosticado que debutó como apolejía tumoral pituitaria. (Acta Med Colomb 2015; 40: 249-253).

Pituitary tumor apoplexy is an infrequent condition resulting from infarction and/or spontaneous bleeding from a pre-existing pituitary adenoma. This entity requires the prior existence of an adenoma in order to be named as pituitary tumor apoplexy, otherwise, it should be named pituitary apoplexy. The sudden increase in pressure of the sella turcica's contents results in a clinical syndrome characterized by headache (which can be "thunderclap headache"), visual disturbances and hypopituitarism. Diagnosis is not always straight forward and requires high clinical suspicion in addition to magnetic resonance imaging and measurement of serum pituitary hormones. Treatment is mainly based on supportive measures (intravenous fluids and steroids) and surgical decompression in those cases with no response to medical treatment and progressive neurological impairment. We report the case of a patient with a previously unknown pituitary adenoma presenting as a tumor apoplexy. (Acta Med Colomb 2015; 40: 249-253).

Teaching case: a man with a progressive gait impairment and visual compromise.

Primary progressive multiple sclerosis can present with a wide variety of symptoms. We report a case of a 52-year-old man presenting with visual symptoms and gait impairment in whom a diagnosis of a primary progressive multiple sclerosis was established. Symptomatic treatment with dalfampridine was started but did not result in a considerable improvement. Gait disorders in multiple sclerosis are common and can have a considerable effect over the patient׳s quality of life. Dalfampridine is the first drug approved for the symptomatic treatment of gait in MS, although only a 40% of patients show an objective response to this medication. Primary progressive multiple sclerosis represents a therapeutic challenge. Currently, there are no disease modifying treatments approved but there are several medications undergoing assessment for this indication. Further research in the underlying pathophysiology of PPMS will help us develope more successful disease-modifying treatments. Meanwhile, a symptomatic approach should be offered in order to improve the patient׳s quality of life.

Controversias en Neurología: Esclerosis Múltiple / Controversies in Neurology: Multiple Sclerosis

La esclerosis múltiple es la condición desmielinizante que afecta con mayor frecuencia el sistema nervioso central (SNC). Se considera una enfermedad de alto costo y una de las principales causas de discapacidad neurológica en adultos jóvenes. A pesar de los avances logrados en su diagnóstico y tratamiento, algunos aspectos continúan siendo controversiales. En este manuscrito se discuten 15 puntos polémicos, reconocidos en la práctica clínica diaria y la investigación de sujetos con EM. Para analizar el contexto de cada controversia con la mejor evidencia disponible, se realizó una revisión sistemática de la literatura disponible en MEDLINE, Embase, Cochrane y LILACS. Los temas incluyen la interrupción del tratamiento inmunomodulador, la utilidad de las bandas oligoclonales, el cambio a fármacos de segunda línea, las indicaciones de seguimiento con resonancia magnética, la plasmaféresis, el síndrome radiológico aislado, el manejo ambulatorio de las recaídas, la duración óptima de los ciclos de corticoides intravenosos, el beneficios de la tomografía de coherencia óptica, la deficiencia de vitamina D, el manejo de la EM secundariamente progresiva, los nuevos medicamentos orales y la seguridad del uso de interferón durante el embarazo. En el marco de cada controversia, se plantean recomendaciones específicas y conclusiones que pueden ser de utilidad para futuras investigaciones.

Multiple sclerosis (MS) is the most common demyelinating disorder of the central nervous system, and contributes greatly to health care costs and disability in young adults. Despite advances in diagnostic techniques and treatment, several important issues remain controversial. We addressed fifteen specific controversies that arise at the bedside and affect clinical practice, education and research in MS. We reviewed these issues followed by some opinions as to how use the best available evidence in a way that support clinical decisions. Topics discussed include utility of oligoclonal IgG bands in the diagnosis and prognosis of multiple sclerosis, cost-effectiveness of disease-modifying therapies, change from first- to second-line treatment, indications for follow-up MR imaging, plasma exchange, radiologically isolated syndrome, discontinuation of immunomodulatory therapies, home administration of intravenous methylprednisolone, duration of corticosteroids treatment, role of optical coherence tomography, vitamin D deficiency and supplementation, management of secondary progressive multiple sclerosis, emerging therapies and interferon during pregnancy. A systematic review of the literature was conducted using MEDLINE, Embase, Cochrane and the Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) databases. Answers to the targeted questions were formulated and specific recommendations were made with the hope to stimulate future research.