17 research outputs found
Tiempo es cerebro ¿solo en la fase aguda del ictus?
Introduction and objective: In Spain, stroke is the leading cause of death in women as well as
the leading cause of disability in adults. This translates into a huge human and economic cost.
In recent years there have been significant advances both in the treatment of acute stroke and
in the neuro-rehabilitation process; however, it is still unclear when the best time is to initiate
neurorehabilitation and what the consequences of delaying treatment are. To test the effect
of a single day delay in the onset of neurorehabilitation on functional improvement achieved,
and the influence of that delay in the rate of institutionalisation at discharge.
Methods: A retrospective study of patients admitted to Parkwood Hospital’s Stroke Neurorehabilitation
Unit (UNRHI) (University of Western Ontario, Canada) between April 2005 and
September 2008 was performed. We recorded age, Functional Independence Measurement (FIM)
score at admission and discharge, the number of days between the onset of stroke and admission
to the Neurorehabilitation Unit and discharge destination.
Results: After adjustment for age and admission FIM, we found a significant association between
patient functional improvement (FIM gain) and delay in starting rehabilitation. We also
observed a significant correlation between delay in initiating therapy and the level of institutionalisation
at discharge.
Conclusions: A single day delay in starting neurorehabilitation affects the functional prognosis
of patients at discharge. This delay is also associated with increased rates of institutionalisation
at discharge
Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios. A propósito de un caso
We present the case of a 36 year-old woman, with history of transient
consciousness disorders with vegetative state, interpreted as epileptic crises
and treated with valproate for two years. After nine asymptomatic years, they
reappeared associated with migraine, vomiting and some generalized convulsions.
Electroencephalogram and cerebral magnetic resonance turned out normal, and
treatment with zonisamide was started, without beneficial results. Later
cardiological studies objectified a blockage of the left branch that coincided
with dizziness. The study was completed with Video-EGG monitoring, where there
was an episode that showed temporary right epileptiform activity, with a
diagnosis established of focal epilepsy of unknown cause. At present, she remains
asymptomatic with oxycarbazepine
Neuroimagen estructural y funcional en las enfermedades priónicas humanas
INTRODUCTION:
Prion diseases are neurodegenerative disorders resulting from the accumulation of a misfolded isoform of the cellular prion protein (PrPc). They can occur as acquired, sporadic or hereditary forms. Although prion diseases show a wide range of phenotypic variations, pathological features and clinical evolution, they are all characterised by a common unfavourable course and a fatal outcome.
REVIEW SUMMARY:
Some variants, such as kuru, have practically disappeared, while others, for example the variant Creutzfeldt-Jakob (vCJD) or those attributable to iatrogenic causes, are still in force and pose a challenge to current medicine. There are no definitive pre-mortem diagnostic tests, except for vCJD, where a tonsil biopsy detects 100% of the cases. For this reason, diagnostic criteria dependent on statistical probability have had to be created. These require complementary examinations, such as an electroencephalogram (EEG) or the detection of 14-3-3 protein in cerebrospinal fluid (CSF). Only the "pulvinar sign" in magnetic resonance imaging (MRI) has been included as a vCJD diagnostic criterion. The present review discusses neuroimaging findings for each type of prion disease in patients with a definitive histopathological diagnosis.
CONCLUSIONS:
The aim is to define the usefulness of these complementary examinations as a tool for the diagnosis of this family of neurodegenerative diseases
Brain aging and Parkinson's disease: new therapeutic approaches using drugs delivery systems
ABSTRACT
The etiology and pathogenesis of Parkinson’s disease (PD) is unknown, aging being the
strongest risk factor for brain degeneration. Understanding PD pathogenesis and how
aging increases the risk of disease would aid the development of therapies able to slow
or prevent the progression of this neurodegenerative disorder. In this review we provide
an overview of the most promising therapeutic targets and strategies to delay the loss of
dopaminergic neurons observed both in PD and aging. Among them, handling alphasynuclein
toxicity, enhancing proteasome and lysosome clearance, ameliorating
mitochondrial disruptions and modifying the glial environment are so far the most
promising candidates. These new and conventional drugs may present problems related
to their labile nature and to the difficulties in reaching the brain. Thus, we highlight the
latest types of drug delivery system (DDS)-based strategies for PD treatment, including
DDS for local and systemic drug delivery. Finally, the ongoing challenges for the
discovery of new targets and the opportunities for DDS-based therapies to improve and
efficacious PD therapy will be discussed
Perfil neuropsicológico de la degeneración lobar frontotemporal
La degeneración lobar frontotemporal engloba tres síndromes diferentes, que comparten características clínicas y patológicas comunes, dificultando así su diagnóstico en estadios iniciales. Se incluyen en este grupo las tres variantes de la demencia frontotemporal, el síndrome corticobasal y el síndrome de parálisis supranuclear progresiva. Se ha llevado a cabo una revisión del perfil neuropsicológico de cada uno de los síndromes, que permita clarificar las características fundamentales que los definen y ayudar a diferenciarlos de otras demencias. Se ha hecho una revisión de los diferentes trabajos publicados en la literatura al respecto, describiendo las características clínicas, patológicas y los hallazgos de imagen fundamentales de cada entidad para describir de manera exhaustiva los hallazgos en los diferentes dominios neuropsicológicos y su progresión. Aunque existe un solapamiento entre los síndromes que conforman la degeneración lobar frontotemporal, la comparación del perfil neuropsicológico de las mismas entre sí y frente a otras demencias permite establecer características propias de su perfil neuropsicológico para llevar a cabo un diagnóstico diferencial.Frontotemporal lobar degeneration encompasses
three different syndromes, with clinical and pathologic commonalities, making diagnosis difficult in early
stages. Three subtypes are recognized: frontotemporal
dementia and its three variants, corticobasal syndrome
and supranuclear palsy syndrome. The objective of this
study is to review the neuropsychological features of
each syndrome in order to differentiate amongst subtypes as well as from other forms of dementia.
We review multiple studies from the literature,
highlighting the main clinical features, neuropathology
and changes in brain imaging of each syndrome. Subsequently, we describe the neuropsychological profile
compared to other dementias, and how it progresses
over time.
Although there is an overlap amongst the different
subtypes of frontotemporal lobar degeneration, neuropsychological profiles can help identify subtypes and
discriminate frontotemporal lobar degeneration from
other forms of dementia
A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)
Meeting abstrac
Evaluation of appendicitis risk prediction models in adults with suspected appendicitis
Background
Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.
Methods
A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).
Results
Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent).
Conclusion
Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified
Tiempo es cerebro ¿solo en la fase aguda del ictus?
Introduction and objective: In Spain, stroke is the leading cause of death in women as well as
the leading cause of disability in adults. This translates into a huge human and economic cost.
In recent years there have been significant advances both in the treatment of acute stroke and
in the neuro-rehabilitation process; however, it is still unclear when the best time is to initiate
neurorehabilitation and what the consequences of delaying treatment are. To test the effect
of a single day delay in the onset of neurorehabilitation on functional improvement achieved,
and the influence of that delay in the rate of institutionalisation at discharge.
Methods: A retrospective study of patients admitted to Parkwood Hospital’s Stroke Neurorehabilitation
Unit (UNRHI) (University of Western Ontario, Canada) between April 2005 and
September 2008 was performed. We recorded age, Functional Independence Measurement (FIM)
score at admission and discharge, the number of days between the onset of stroke and admission
to the Neurorehabilitation Unit and discharge destination.
Results: After adjustment for age and admission FIM, we found a significant association between
patient functional improvement (FIM gain) and delay in starting rehabilitation. We also
observed a significant correlation between delay in initiating therapy and the level of institutionalisation
at discharge.
Conclusions: A single day delay in starting neurorehabilitation affects the functional prognosis
of patients at discharge. This delay is also associated with increased rates of institutionalisation
at discharge
Brain aging and Parkinson's disease: new therapeutic approaches using drugs delivery systems
ABSTRACT
The etiology and pathogenesis of Parkinson’s disease (PD) is unknown, aging being the
strongest risk factor for brain degeneration. Understanding PD pathogenesis and how
aging increases the risk of disease would aid the development of therapies able to slow
or prevent the progression of this neurodegenerative disorder. In this review we provide
an overview of the most promising therapeutic targets and strategies to delay the loss of
dopaminergic neurons observed both in PD and aging. Among them, handling alphasynuclein
toxicity, enhancing proteasome and lysosome clearance, ameliorating
mitochondrial disruptions and modifying the glial environment are so far the most
promising candidates. These new and conventional drugs may present problems related
to their labile nature and to the difficulties in reaching the brain. Thus, we highlight the
latest types of drug delivery system (DDS)-based strategies for PD treatment, including
DDS for local and systemic drug delivery. Finally, the ongoing challenges for the
discovery of new targets and the opportunities for DDS-based therapies to improve and
efficacious PD therapy will be discussed
Perfil neuropsicológico de la degeneración lobar frontotemporal
La degeneración lobar frontotemporal engloba tres síndromes diferentes, que comparten características clínicas y patológicas comunes, dificultando así su diagnóstico en estadios iniciales. Se incluyen en este grupo las tres variantes de la demencia frontotemporal, el síndrome corticobasal y el síndrome de parálisis supranuclear progresiva. Se ha llevado a cabo una revisión del perfil neuropsicológico de cada uno de los síndromes, que permita clarificar las características fundamentales que los definen y ayudar a diferenciarlos de otras demencias. Se ha hecho una revisión de los diferentes trabajos publicados en la literatura al respecto, describiendo las características clínicas, patológicas y los hallazgos de imagen fundamentales de cada entidad para describir de manera exhaustiva los hallazgos en los diferentes dominios neuropsicológicos y su progresión. Aunque existe un solapamiento entre los síndromes que conforman la degeneración lobar frontotemporal, la comparación del perfil neuropsicológico de las mismas entre sí y frente a otras demencias permite establecer características propias de su perfil neuropsicológico para llevar a cabo un diagnóstico diferencial.Frontotemporal lobar degeneration encompasses
three different syndromes, with clinical and pathologic commonalities, making diagnosis difficult in early
stages. Three subtypes are recognized: frontotemporal
dementia and its three variants, corticobasal syndrome
and supranuclear palsy syndrome. The objective of this
study is to review the neuropsychological features of
each syndrome in order to differentiate amongst subtypes as well as from other forms of dementia.
We review multiple studies from the literature,
highlighting the main clinical features, neuropathology
and changes in brain imaging of each syndrome. Subsequently, we describe the neuropsychological profile
compared to other dementias, and how it progresses
over time.
Although there is an overlap amongst the different
subtypes of frontotemporal lobar degeneration, neuropsychological profiles can help identify subtypes and
discriminate frontotemporal lobar degeneration from
other forms of dementia