Primary headache disorders in Latin America and the Caribbean: A meta-analysis of population-based studies.

BACKGROUND: In this manuscript, we aim to systematically estimate the pooled prevalence and incidence of primary headaches and its subtypes (migraine, tension-type headache, and chronic headaches) in Latin America and the Caribbean, describing its epidemiological profile and associated factors. METHODS: We systematically searched PubMed/MEDLINE, Scopus, and LILACS (From conception to March 2021), for populational studies reporting the epidemiology of primary headaches and their associated factors in Latin America and the Caribbean. The data extraction was conducted independently. We performed random-effect model meta-analysis of prevalence (overall primary headaches and by subtypes) and associated factors, assessed potential sources of heterogeneity, the risk of bias, publication bias, and the evidence certainty (GRADE methodology). RESULTS: We included 32 populational studies (38 subpopulations, n = 63,813). The prevalence of primary headaches was 41.4% (95% CI 31.1-52.2%; n = 54,357), 15% for migraine (95% CI 12.0-18.3; n = 53,658 individuals), 20.6% for tension-type headache (95% CI 12.4-30.2; n = 25,840), and 6% for chronic headaches (95% CI 3.3-9.6; n = 21,720), with high between-study heterogeneity. No incidence data was found. Female sex, white ethnicity, high BMI, comorbid mental health disorders, and low-back pain were associated with higher prevalence of primary headaches. The prevalence was less in rural areas. CONCLUSION: In Latin America and the Caribbean, primary headaches are highly prevalent affecting young females disproportionally. The prevalence of chronic headaches is higher than in other systematic global and regional estimations. The presence of comorbidities as modifiable risk factors should encourage their integration as targets for community-based preventive and therapeutic interventions. PROTOCOL REGISTRATION NUMBER: CRD42018105116.

Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies.

OBJECTIVE: This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. METHODS: Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. RESULTS: Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. SIGNIFICANCE: The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.

Clinical practice guidelines for the diagnosis and management of Duchenne muscular dystrophy: a scoping review.

Introduction: Our objective was to identify recent CPGs for the diagnosis and management of DMD and summarize their characteristics and reliability. Methods: We conducted a scoping review of CPGs using MEDLINE, the Turning Research Into Practice (TRIP) database, Google Scholar, guidelines created by organizations, and other repositories to identify CPGs published in the last 5 years. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses for scoping reviews. To assess the reliability of the CPGs, we used all the domains included in the Appraisal of Guidelines Research and Evaluation II. Results: We selected three CPGs published or updated between 2015 and 2020. All the guidelines showed good or adequate methodological rigor but presented pitfalls in stakeholder involvement and applicability domains. Recommendations were coherent across CPGs on steroid treatment, except for minor differences in dosing regimens. However, the recommendations were different for new drugs. Discussion: There is a need for current and reliable CPGs that develop broad topics on the management of DMD and consider the challenges of developing recommendations for RDs.

Clinical Pathway for the Diagnosis and Management of Patients With Relapsing-Remitting Multiple Sclerosis: A First Proposal for the Peruvian Population.

Background: Relapsing-remitting multiple sclerosis (RRMS) is a subtype of degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system and leads to multifocal neurological impairment. Objectives: To develop a clinical pathway (CP) for the management of Peruvian patients with RRMS. Methods: First, we performed a literature review using Medline, Embase, Cochrane, ProQuest, and Science direct. Then, we structured the information as an ordered and logical series of five topics in a defined timeline: (1) How should MS be diagnosed? (2) How should a relapse be treated? (3) How should a DMT be initiated? (4) How should each DMT be used? and (5) How should the patients be followed? Results: The personnel involved in the care of patients with RRMS can use a series of flowcharts and diagrams that summarize the topics in paper or electronic format. Conclusions: We propose the first CP for RRMS in Peru that shows the essential steps for diagnosing, treating, and monitoring RRMS patients based on an evidence-based medicine method and local expert opinions. This CP will allow directing relevant clinical actions to strengthen the multidisciplinary management of RRMS in Peru.

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis.

AIMS: The objective of this systematic review and meta-analysis is to estimate the prevalence and incidence of diabetic peripheral neuropathy (DPN) in Latin America and the Caribbean (LAC). MATERIALS AND METHODS: We searched MEDLINE, SCOPUS, Web of Science, EMBASE and LILACS databases of published observational studies in LAC up to December 2020. Meta-analyses of proportions were performed using random-effects models using Stata Program 15.1. Heterogeneity was evaluated through sensitivity, subgroup, and meta-regression analyses. Evidence certainty was performed with the GRADE approach. RESULTS: Twenty-nine studies from eight countries were included. The estimated prevalence of DPN was 46.5% (95%CI: 38.0-55.0) with a significant heterogeneity (I2 = 98.2%; p<0.01). Only two studies reported incidence, and the pooled effect size was 13.7% (95%CI: 10.6-17.2). We found an increasing trend of cumulative DPN prevalence over time. The main sources of heterogeneity associated with higher prevalence were diagnosis criteria, higher A1c (%), and inadequate sample size. We judge the included evidence as very low certainty. CONCLUSION: The overall prevalence of DPN is high in LAC with significant heterogeneity between and within countries that could be explained by population type and methodological aspects. Significant gaps (e.g., under-representation of most countries, lack of incidence studies, and heterogenous case definition) were identified. Standardized and population-based studies of DPN in LAC are needed.

Neurological diseases in Peru: a systematic analysis of the global burden disease study.

BACKGROUND: Disease burden indicators assess the impact of disease on a population. They integrate mortality and disability in a single indicator. This allows setting priorities for health services and focusing resources. OBJECTIVE: To analyze the burden of neurological diseases in Peru from 1990-2015. METHODS: A descriptive study that used the epidemiological data published by the Institute for Health Metrics and Evaluation of Global Burden of Diseases from 1990 to 2015. Disease burden was measured using disability-adjusted life years (DALY) and their corresponding 95% uncertainty intervals (UIs), which results from the addition of the years of life lost (YLL) and years lived with disability (YLD). RESULTS: The burden of neurological diseases in Peru were 9.06 and 10.65%, in 1990 and 2015, respectively. In 2015, the main causes were migraine, cerebrovascular disease (CVD), neonatal encephalopathy (NE), and Alzheimer's disease and other dementias (ADD). This last group and nervous system cancer (NSC) increased 157 and 183% of DALY compared to 1990, respectively. Young population (25 to 44 years old) and older (>85 years old) were the age groups with the highest DALY. The neurological diseases produced 11.06 and 10.02% of the national YLL (CVD as the leading cause) and YLD (migraine as the main cause), respectively. CONCLUSION: The burden of disease (BD) increased by 1.6% from 1990 to 2015. The main causes were migraine, CVD, and NE. ADD and NSC doubled the DALY in this period. These diseases represent a significant cause of disability attributable to the increase in the life expectancy of our population among other factors. Priority actions should be taken to prevent and treat these causes.

Neuro-Behçet's disease in Peru: a case report and literature review. / Enfermedad de neuro-Behçet en Perú: reporte de caso y revisión de la literatura.

Behçet's disease is a vasculitis that can cause inflammatory lesions in multiple organs or systems including the nervous system. Most cases worldwide have been reported along what is called the "Silk Route" from the Mediterranean region to Japan, so it is considered a rare disease in Latin American countries. The frequency of neurological involvement ranges from 5 to 13%. We present the case of a young adult woman with diagnostic criteria for Behçet's disease and manifestations of neurological disease, as well as a review of the literature.

La enfermedad de Behçet es una vasculitis que puede ocasionar lesiones inflamatorias en múltiples órganos o sistemas como el neurológico. El mayor número de casos a nivel mundial se han reportado a lo largo de la llamada Ruta de la Seda, que va desde la región mediterránea hasta Japón, siendo considerado una enfermedad rara en países latinoamericanos. La frecuencia de afectación neurológica oscila en un rango entre 5 y 13%. Se presenta el caso de una mujer adulta joven con criterios diagnósticos de enfermedad de Behçet y manifestaciones de afectación neurológica, así como una revisión de la literatura en Perú.

Chronic meningitis as an initial presentation of Sjögren syndrome / La meningitis crónica como presentación inicial del síndrome de Sjögren

ABSTRACT Sjögren syndrome (SS) is an autoimmune disease, rarely affecting the central nervous system. The case is reported on a 68-year-old male patient who presented with keratocon-junctivitis sicca and xerostomia, during neuropsychological evaluation showed moderate to severe multidomain cognitive impairment. The magnetic resonance showed evidence of hypertrophic pachymeningitis. The CSF study showed pleocytosis, mild proteinuria, and negative cultures. The immune positive profile, Anti SS-A, SS-B and salivary gland biopsy was compatible with SS. The treatment was started with methylprednisolone pulses at a dose of 1g every 24 h for three days, and controlled with maintenance therapy, showing a favorable response. Chronic meningitis is a diagnostic challenge; among the less common causes is hypertrophic pachymeningitis in SS, and less frequently in male patients (1/9). Non-specific neurological manifestations should be considered, such as headaches or neuropsychiatric symptoms, as on some occasions rare cases may be encountered, such as the one described.

RESUMEN El síndrome de Sjögren (SS) es una enfermedad autoinmune que rara vez afecta al sistema nervioso central. En este informe de caso describimos a un paciente varón, de 68 años, que presentó queratoconjuntivitis seca y xerostomía, y a la evaluación neuropsicológica mostró deterioro cognitivo multidominio en grado de moderado a grave. La resonancia magnética mostró evidencia de paquimeningitis hipertrófica. El estudio del LCR mostró pleocitosis, proteinuria leve y cultivos negativos; el perfil inmunológico positivo anti SS-A, SS-B y la biopsia de la glándula salival compatible con SS. El tratamiento se inició con pulsos de metilprednisolona a una dosis de 1 g/cada 24 h/durante 3 días, control con terapia de mantenimiento, mostrando una respuesta favorable. La meningitis crónica es un desafío para el diagnóstico, entre las causas menos frecuentes está la paquimeningitis hipertrófica en el SS, y con menor frecuencia en los pacientes varones (1/9). Se deben considerar manifestaciones neurológicas inespecíficas, como dolores de cabeza o síntomas neuropsiquiátricos, ya que en algunas ocasiones podemos enfrentarnos a casos raros como el descrito.

Neurological diseases in Peru: a systematic analysis of the global burden disease study / Enfermedades neurológicas en el Perú: un análisis sistemático del Global Burden Disease Study

ABSTRACT Background: Disease burden indicators assess the impact of disease on a population. They integrate mortality and disability in a single indicator. This allows setting priorities for health services and focusing resources. Objective: To analyze the burden of neurological diseases in Peru from 1990-2015. Methods: A descriptive study that used the epidemiological data published by the Institute for Health Metrics and Evaluation of Global Burden of Diseases from 1990 to 2015. Disease burden was measured using disability-adjusted life years (DALY) and their corresponding 95% uncertainty intervals (UIs), which results from the addition of the years of life lost (YLL) and years lived with disability (YLD). Results: The burden of neurological diseases in Peru were 9.06 and 10.65%, in 1990 and 2015, respectively. In 2015, the main causes were migraine, cerebrovascular disease (CVD), neonatal encephalopathy (NE), and Alzheimer's disease and other dementias (ADD). This last group and nervous system cancer (NSC) increased 157 and 183% of DALY compared to 1990, respectively. Young population (25 to 44 years old) and older (>85 years old) were the age groups with the highest DALY. The neurological diseases produced 11.06 and 10.02% of the national YLL (CVD as the leading cause) and YLD (migraine as the main cause), respectively. Conclusion: The burden of disease (BD) increased by 1.6% from 1990 to 2015. The main causes were migraine, CVD, and NE. ADD and NSC doubled the DALY in this period. These diseases represent a significant cause of disability attributable to the increase in the life expectancy of our population among other factors. Priority actions should be taken to prevent and treat these causes.

RESUMEN Introducción: Los indicadores de carga de la enfermedad evalúan el impacto que producen las enfermedades en una población. Integran la mortalidad y discapacidad en un solo indicador. Esto permite fijar prioridades para los servicio de salud y enfocar los recursos. Objetivo: Analizar los datos de carga de enfermedades neurológicas en Perú para el periodo 1990-2015. Métodos: Estudio descriptivo de datos del The Institute for Health Metrics and Evaluation de carga de enfermedad global desde el año 1990 al 2015. La medida de carga de la enfermedad utilizada fue los años de vida ajustados por discapacidad y sus correspondientes intervalos de incertidumbre (95%), que resultan de la suma de los años de vida perdidos debido a muerte prematura y los vividos con discapacidad. Resultados: La carga de enfermedades neurológicas en Perú fue de 9,06 y 10,65% en 1990 y 2015, respectivamente. En 2015, las principales causas fueron: migraña, enfermedad cerebrovascular, encefalopatía neonatal, enfermedad de Alzheimer y otras demencias. Este último grupo y el cáncer del sistema nervioso presentaron un incremento del 157 y 183% de los años de vida ajustados por discapacidad con respecto a 1990, respectivamente. Los adultos jóvenes (25 a 44 años) y adultos mayores (>85 años) fueron los grupos de edad con más años de vida ajustado por discapacidad. Las enfermedades neurológicas produjeron el 11.06 y el 10.02% de los años de vida perdidos debido a muerte prematura (enfermedad cerebrovascular como la causa principal) y años vividos con discapacidad (migraña como la causa principal), respectivamente. Conclusiones: La carga de la enfermedad aumentó un 1,6% entre 1990 y 2015. Las principales causas fueron migraña, la enfermedad cerebrovascular y la encefalopatía neonatal. La enfermedad de Alzheimer y otras demencias y cáncer del sistema nervioso duplicaron los años de vida ajustados por discapacidad en este período. Estas enfermedades representan una causa importante de discapacidad atribuible al aumento de la esperanza de vida de nuestra población, entre otros factores. Se deben tomar medidas prioritarias para prevenir y tratar estas causas.

¿La medicina científica y el programa Medicina Basada en Evidencia han fracasado? / Has scientific medicine and the EBM program failed?

La medicina científica y el programa de medicina basada en evidencia han fracasado, afirman críticos y detractores. La medicina basad en la evidencia es un programa que busca dar respuesta a la necesidad de sistematizar el conocimiento médico, mejorar el proceso de toma de decisiones en salud y, por ende, mejorar los sistemas de salud. A pesar de su gran difusión no está exenta de críticas, desde cuestionamientos a su enfoque filosófico positivista, a su visión estrictamente biológica y de eficacia y al innegable conflicto de intereses de las investigaciones biomédicas financiadas en su mayoría por la industria farmacéutica. Sin embargo, a pesar de sus limitaciones aún queda un largo camino por desarrollar y sus alcances y beneficios ya se verifican en el ejercicio mismo de las decisiones médicas

According to its critics and detractor, scientific medicine and the Evidence-Based Medicine (EBM) program have failed. EBM is a program that seeks to respond to the need to systematise medical knowledge, improve the decision-making process in health and thus improve health systems. Despite its wide dissemination, it is not without criticism, from the questioning of its positivist philosophical approach, to its strictly biological and of effectiveness vision, and to the undeniable conflict of interests of biomedical research, which is mostly financed by the pharmaceutical industry. However, despite its limitations, there is still a long way to go, and its scope and benefits are already demonstrated in the current making of medical decisions

Salud mental y calidad de sueño en estudiantes de ocho facultades de medicina humana del Perú / Mental health and quality of sleep from eight faculties of medical students in Peru

Introduction: The quality of sleep refers to the fact that we sleep well at night and daytime functioning. Thus, influences health and quality of life. Sleep loss is one of the most striking problem of modern society especially in medical students. This is related to the constant academic demands causing mental health problems and high levels of stress. Methods: A cross-sectional study. We evaluated 1,040 medical students in 8 universities of Peru from the first to the sixth year of study. Of these, 892 surveys were used. Mental health were evaluated according to the scale of Depression, Anxiety and Stress (DASS-21) and "poor sleepers" students were established with a score > 5 according to the Pittsburgh Sleep Quality Index (PSQI). Results: It was found that 693 (77.69%) students were poor sleepers. About mental health was found that 290 (32.51%) suffered from depression, 472 (52.91%) of anxiety and 309 (34.64%) stress. A significant association (p < 0.05) was found between poor sleep quality and female sex (OR = 1.13, CI = 1.05 to 1.21); depression (OR = 1.23, CI = 1,15-1,31); anxiety (OR = 1.32, CI = 1.23 to 1.43); and stress (OR = 1.26, CI = 1.19 to 1.35). Conclusion: We observed a high frequency of poor sleepers in medical students from eight universities of Peru. The poor quality of sleep was associated with anxiety, depression and stress in students of second and third year, respectively.

Introducción: La calidad de sueño nos hace referencia al hecho de dormir bien durante la noche y el rendimiento diurno. De esa forma, influye en salud y la buena calidad de vida. La pérdida de sueño es uno de los problemas de la sociedad moderna más llamativos especialmente en estudiantes de medicina humana. Esto se relaciona a la constante y creciente exigencia académica ocasionando problemas de salud mental y altos niveles de estrés. Métodos: Estudio transversal analítico. Se evaluaron 1.040 estudiantes de medicina humana obtenidos en forma equitativa de 8 universidades del Perú desde el primer al sexto año de estudios. De ellos, se usaron 892 encuestas. Se evaluó la salud mental según la escala de Depresión, Ansiedad y Estrés (DASS-21) y se estableció a los estudiantes "malos dormidores" como aquellos con una puntuación > 5 según el índice de calidad de sueño de Pittsburgh (ICSP). Resultados: Se encontró que 693 (77,69%) alumnos fueron malos dormidores. Con respecto a la salud mental se halló que 290 (32,51%) sufrían de depresión, 472 (52,91%) de ansiedad y 309 (34,64%) de estrés. Se halló asociación significativa (p < 0,05) entre la mala calidad de sueño y el sexo femenino (RP = 1,13; IC = 1,051,21); depresión (RP = 1,23; IC = 1,15-1,31); ansiedad (RP = 1,32; IC = 1,23-1,43); y estrés (RP = 1,26; IC = 1,19-1,35). Conclusión: Se observa una frecuencia elevada de malos dormidores en estudiantes de medicina de ocho universidades del Perú. La mala calidad de sueño se asoció con la ansiedad, depresión y estrés en los estudiantes de segundo y tercer año, respectivamente.