A proposal for a semantic change in the current diagnostic criteria of Parkinson’s disease Psychosis

Psychosis may emerge as part of Parkinson’s disease (PD) process but is also associated with PD treatment. When the NINDS-NIMH criteria were applied to a cross-sectional PD cohort, the prevalence of PD psychosis in PD patients reached 60% [1].The most frequent symptoms in PD-associated psychosis (PDAP) are related to sensory perception areas, especially hallucinations. Graham et al. [2], reported that 70% of their patients with hallucinations had retained insight. This seems a contradiction because psychosis is a mental disorder characterized by symptoms, such as delusions or hallucinations that indicate an impaired contact with reality [3]. If we adhere to this definition, which is in fact the common and accepted one, those patients who retained insight about abnormal sensory perceptive phenomena should not be diagnosed as “psychotic”. Moreover, Fénelon and Alves reviewed the epidemiology of psychosis across different centers worldwide, showing that although psychosis could be diagnosed at that point of time, visual hallucinations were not always present for diagnosis: other features were taken into account to make this diagnosis for example the presence of delusions or illusions [4].</p

Efficacy and safety of opioid therapy guided by pharmacogenetics: A systematic review

Aim: To perform a systematic review to determine the efficacy/safety of PGx-guided opioid therapy for chronic/postoperative pain. Materials & methods: We searched PubMed and other specialized databases. Articles were considered if they compared the efficacy/safety of PGx-guided opioid therapy versus usual care. The risk of bias assessment was performed using Cochrane tools. Results: A total of 3794 records were retrieved. Only five were included for data extraction. A lower requirement of analgesics during postoperative in the PGx-guided intervention arm was reported in two studies. Also, two studies reported significant pain improvement in favor of the PGx-guided therapy when analyzing the subgroup of patients with a high-risk CYP2D6 phenotype. Conclusion: Despite the findings described, information on the efficacy/safety of this intervention is scarce.Fil: Rodriguez Cairoli, Federico. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Appiani, Francisco. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Sambade, Juan Manuel. Provincia de Buenos Aires. Municipalidad de Vicente López. Hospital Municipal Doctor Bernardo Houssay; ArgentinaFil: Comandé, Daniel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Camacho Arteaga, Lina. Universidad Autónoma de Barcelona. Hospital Vall D' Hebron; EspañaFil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin

Memorias del segundo coloquio de lenguas extranjeras

1 archivo PDF (156 páginas)"La Coordinación de Lenguas Extranjeras y el Grupo de investigación en Lingüística Aplicada de la Universidad Autónoma Metropolitana de Azcapotzalco presenta en este ejemplar, algunos de los trabajos que formaron parte del "2° Coloquio de Lenguas Extranjeras" que se llevó a cabo en septiembre de 1999 en el campus Azcapotzalco. Las líneas de investigación presentadas fueron las siguientes: El autoaprendizaje en Lenguas Extranjeras; Evaluación del Aprendizaje en Lenguas Extranjeras; Aspectos interculturales en el Aprendizaje de Lenguas Extranjeras"

Registry of neurological manifestations due to coronavirus-19 (COVID-19)

La enfermedad por COVID-19 se ha extendido por el mundo desde diciembre de 2019. Los síntomas neurológicos forman parte de su espectro clínico. Objetivo: Conocer las manifestaciones neurológicas en pacientes infectados por COVID-19 en Argentina. Métodos: Estudio multicéntrico realizado en adultos, desde mayo de 2020 a enero de 2021, con COVID-19 confirmado y síntomas neurológicos. Se consignaron variables demográficas, existencia de comorbilidades sistémicas o neurológicas, la forma de comienzo de la infección, alteración en estudios complementarios y el grado de severidad de los síntomas neurológicos. Resultados: Se incluyeron 817 pacientes de todo el país, 52% varones, edad promedio 38 anos. ˜ La mayoría sin comorbilidades ni patología neurológica previa. El primer síntoma de la infección fue neurológico en 56,2% de los casos, predominando la cefalea (69%), luego anosmia/ageusia (66%). También se reportaron mialgias (52%), alodinia/hiperalgesia (18%), astenia (6%). Un 3,2% mostró compromiso difuso del SNC como encefalopatía o convulsiones. Un 1,7% tuvo complicaciones cerebrovasculares. Los trastornos del sueno˜ se observaron en 3,2%. Se reportaron seis pacientes con síndrome de Guillain-Barré (GBS), neuropatía periférica (3,4%), parestesias en lengua (0,6%), hipoacusia (0,4%), plexopatía (0,3%). La severidad de síntomas neurológicos se correlacionó con la edad y la existencia de comorbilidades. Conclusiones: Nuestros resultados, similares a los de otros países, muestran dos tipos de síntomas neurológicos asociados a COVID-19: algunos potencialmente incapacitantes o mortales como el GBS o la encefalitis, y otros menos devastadores, pero más frecuentes, como cefalea o anosmia que demandan en forma creciente atención a largo plazo.COVID-19 disease has spread around the world since December 2019. Neurological symptoms are part of its clinical spectrum. Objective: To know the neurological manifestations in patients infected by COVID-19 in Argentina. Methods: Multicenter study conducted in adults, from May 2020 to January 2021, with confirmed COVID-19 and neurological symptoms. Demographic variables, existence of systemic or neurological comorbidities, the form of onset of the infection, alteration in complementary studies and the degree of severity of neurological symptoms were recorded. Results: 817 patients from all over the country were included, 52% male, mean age 38 years, most of them without comorbidities or previous neurological pathology. The first symptom of the infection was neurological in 56.2% of the cases, predominantly headache (69%), then anosmia/ageusia (66%). Myalgias (52%), allodynia/hyperalgesia (18%), and asthenia (6%) were also reported. 3.2% showed diffuse CNS involvement such as encephalopathy or seizures. 1.7% had cerebrovascular complications. Sleep disorders were observed in 3.2%. 6 patients were reported with Guillain Barré (GBS), peripheral neuropathy (3.4%), tongue paresthesia (0.6%), hearing loss (0.4%), plexopathy (0.3%). The severity of neurological symptoms was correlated with age and the existence of comorbidities. Conclusions: Our results, similar to those of other countries, show two types of neurological symptoms associated with COVID-19: some potentially disabling or fatal such as GBS or encephalitis, and others less devastating, but more frequent such as headache or anosmia that demand increasingly long-term care.Fil: Alessandro, Lucas. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Appiani, Franco. Fundación Favaloro; ArgentinaFil: Bendersky, Mariana. Universidad de Buenos Aires; ArgentinaFil: Borrego Guerrero, Brenda. Sanatorio Tandil; ArgentinaFil: Bruera, Guadalupe. Hospital Privado de Rosario; ArgentinaFil: Cairola, Patricia. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Calandri, Ismael. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Cardozo Oliver, Juan Martín. Sanatorio Finochietto; ArgentinaFil: Clément, María Emilia. Hospital Privado de la Comunidad; ArgentinaFil: Di Egidio, Marianna. Tornu Hospital; ArgentinaFil: Di Pace, José Luis. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Diaconchuk, Melina Alejandra. Hospital San Luis; ArgentinaFil: Esliman, Celeste. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Esnaola y Rojas, María Martha. Universidad de Buenos Aires; ArgentinaFil: Fernández Boccazzi, Julián. Sanatorio de la Trinidad; ArgentinaFil: Franco, Andrea Fabiana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Gargiulo Monachelli, Gisella Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Giardino, Daniela Laura. Centro de Educación Medica E Invest.clinicas; ArgentinaFil: Gómez, César. No especifíca;Fil: Guevara, Ana Karina. No especifíca;Fil: Gutiérrez, Natalia. Sanatorio Julio Méndez; ArgentinaFil: Hryb, Javier. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Ibarra, Viviana. Sanatorio Julio Méndez; ArgentinaFil: Janota, Franco. Universidad de Buenos Aires; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Larcher, Luis Alfredo. Sanatorio del Norte; ArgentinaFil: Leone, Fernando. Centro Médico Roca; ArgentinaFil: Luetic, Geraldine. No especifíca;Fil: Medina, Claudia Andrea. Sanatorio Las Lomas; ArgentinaFil: Menichini, María Laura. No especifíca;Fil: Nieto, Gonzalo. Hospital General de Agudos Bernardino Rivadavia ; Gobierno de la Ciudad Autonoma de Buenos Aires;Fil: Páez, María Fernanda. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Peñalver, Francisco. No especifíca;Fil: Perassolo, Mónica. Universidad de Buenos Aires; Argentina. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Persi, Gabriel. Universidad de Buenos Aires; ArgentinaFil: Pestchanker, Claudia. Hospital San Luis; ArgentinaFil: Porta, Oscar. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Rey, Roberto Daniel. Universidad de Buenos Aires; ArgentinaFil: Rodríguez, Gabriel Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Romano, Marina. Centro de Educación Medica E Invest.clinicas; ArgentinaFil: Rugiero, Marcelo. Hospital Italiano; ArgentinaFil: Saidón, Patricia. Universidad de Buenos Aires; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Sica, María Florencia. Hospital Privado de la Comunidad; ArgentinaFil: Stankievich, Erica. No especifíca;Fil: Tarulla, Adriana. No especifíca;Fil: Zalazar, Guillermo. Hospital San Luis; Argentin

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)