Perspective on stroke in Mexico

According to the World Health Organization’s world health report 2004, cerebral-vascular disease --- stroke --- is the third leading cause of premature death in both genders. Its greatest impact is represented as the leading cause of disability in adults and the second leading cause of dementia

La vasorreactividad cerebral por Doppler transcraneal: una ventana al daño neurovascular en la enfermedad de Alzheimer.

La enfermedad de Alzheimer (EA) es la causa más común de demencia. Los mecanismos etiológicos neurodegenerativos se han enriquecido con nuevas evidencias sobre el papel del daño vascular en el origen y progresión de la enfermedad. Este artículo tiene como objetivo revisar el daño vascular en la enfermedad de Alzheimer, conocer a la unidad neurovascular como fundamento patológico, la participación de los factores de riesgo cardiovasculares, el papel del estrés oxidativo y la respuesta inflamatoria en la acumulación de la proteína b amiloide y otras proteínas de daño neurológico. Además nos permitirá proponer al ultrasonido Doppler transcraneal como un método no invasivo y accesible para analizar la velocidad de flujo intracraneal y la vasorreactividad cerebral a estímulos respiratorios como hipercapnia o hiperventilación para identificar pacientes con afectación neurovascular en la enfermedad de Alzheimer

Mild cognitive impairment

Abstract Mild Cognitive Impairment (MCI) is a disease between normal cognitive ageing and dementia. In recent years the term MCI has been recognized as a pre-dementia state, raising an important subject for investigation in the prevention of dementia. There are various terms related to pre-dementia MCI, such as isolated memory complaint and pre-Alzheimer’s disease; most of them do not comprise all the areas related to MCI. A central cholinergic deficit is present in amnestic MCI with neuronal loss in the Meynert basal nucleus. It is estimated that the rate of progression to dementia is about 10% every year. The prevalence of MCI is 10%-11% and the risk of progression to dementia is about 5%-16%. The continual development of pharmacologic approaches to modify and delay the natural history of progression of the disease motivates a great interest in an earlier diagnosis

Another one that extends the toe: the Austregésilo-Esposel sign Uno más que extiende el primer ortejo: el signo de Austregésilo-Esposel

With great interest we read the article by Novis and colleagues recently published in Arquivos de Neuro-Psiquiatria1. Where they present the life and work of Professor Faustino Esposel, considered the father of Brazilian neurology, who along with Antõnio Austregésilo, described a substitute sign for Babinski’s phenomenon eliciting of the extensor plantar response upon squeezing of the thigh: “Le phénomene de Babinski, provoqué par l’excitation de la cuisse”, now known as the Austregésilo-Esposel sign2. Upon a search of the literature, we were unable to find recent visual documentation of the sign. Therefore, to illustrate the excellent article by Novis and colleagues, we considered it appropriate to present the case of a patient with stroke in whom the Austregésilo-Esposel sign was present, along with the Babinski, Chaddock, and Oppenheim signs

Mean platelet volume in the differential diagnosis of tuberculous and bacterial meningitis

Abstract Introduction: Mean platelet volume (MPV) has been shown to reflect the inflammatory burden in different inflammatory and autoimmune diseases. Our objective was to analyze the MPV in patients with tuberculous (TBM) and bacterial meningitis (BM). Methodology: The demographic and clinical data of 73 consecutive patients that presented with either BM (n = 35) or TBM (n = 38) were retrospectively analyzed, as well as that of 28 age- and sex-matched controls. Results: MPV was 8.78 ± 1.58 fL in patients with BM and 6.42 ± 1.39 fL in the TBM group (p < 0.05). In the control group, MPV was 7.4 ± 0.66 fL, significantly higher and lower when compared with TBM and BM, respectively. MPV was significantly associated with diagnosis (adjusted OR: 5.15, 95% CI: 1.090–23.7; p = 0.03). With the optimal cut-off value of 7.62 fL, MPV had 82% sensibility and 78% specificity for the differential diagnosis of TBM versus BM. Lower platelet counts, higher serum creatinine, higher white blood cell counts, and higher blood-cerebrospinal fluid glucose ratio were also predictive of BM. Conclusions: Platelet counts were lower and MPV was higher in patients with BM compared to patients with TBM. Platelet indices, available in routine bloodwork, could be useful in the early differential diagnosis of these entities. Key words: meningitis; mean platelet volume; inflammation; platelets; thrombocytopenia

Evaluación Neuropsicológica de Conmoción Cerebral: estudio de caso de un jugador de fútbol americano

Cerebral Concussion (CC) is the main cause of brain injury in contact athletes, with American football (AF) being one of the most popular. The CC produces a wide range of physical, cognitive and emotional symptoms that most of the players (36,1%) do not know. Cognitive changes are observed in attention and memory processes, mental flexibility, verbal fluency, planning, working memory, inhibition and speed of processing. The Neuropsychological Assessment (NA) is fundamental for the detection and management of CC in the acute phase and its sequelae. The objective was to evaluate the cognitive performance of a defensive player of american football, major category, of 23 years of age and 15 years of schooling, before and after presenting a CC. Instruments were: General Data Questionnaire, MoCA test, Digits and Cubes in regression, Visual Detection, Semantic Verbal Fluency, Stroop test, Tower of Hanoi and Wisconsin Sorting Cards. Baseline cognitive profile was established and reevaluated during the season one week after a CC. In the pre-season evaluation the player presented a cognitive profile within the ranges expected. In the acute phase of CC, the player decreased his performance in processing speed tasks (pre: 26 sec, post: 120 sec), sustained attention (pre: 7 points, post: 6 points), inhibition (pre: 84) hits, post: 82 hits) and planning (pre: 15 movements, post: 20 movements). The NA has proven to be a sensitive and reliable tool for the detection of cognitive symptoms in the acute and post-CC phase. Key words: neuropsychology, football, cognition.La conmoción cerebral (CC) es la principal causa de lesión cerebral en deportistas de contacto siendo el fútbol americano (FA) uno de los más populares. La CC produce una amplia gama de síntomas físicos, cognitivos y emocionales que hasta el 36.1% de los jugadores desconocen. Los cambios cognitivos ocurren en la atención, memoria, flexibilidad mental, fluidez verbal, planeación, memoria de trabajo, inhibición y velocidad de procesamiento. El objetivo fue evaluar el rendimiento cognitivo de un jugador defensivo de FA categoría mayor, de 23 años de edad y 15 años de escolaridad, &nbsp;antes y después de presentar una CC. Se aplicaron los siguientes instrumentos: Cuestionario de Datos Generales, test de MoCA, Dígitos y Cubos en regresión, Detección Visual, Fluidez Verbal Semántica, test de Stroop, Torre de Hanoi y Wisconsin. Se estableció su perfil cognitivo basal en pretemporada y se reevaluó durante la temporada una semana posterior a una CC. &nbsp;En la evaluación pretemporada el jugador presentó un perfil cognitivo dentro de los rangos esperados para su edad y escolaridad. En la fase aguda de la CC, el jugador disminuyó su rendimiento en tareas de velocidad de procesamiento (pre: 26 seg; post:120 seg), atención sostenida (pre:7 puntos; post:6 puntos), inhibición (pre: 84 aciertos; post: 82 aciertos) y planeación (pre: 15 movimientos; post: 20 movimientos). La EN ha demostrado ser una herramienta sensible y confiable para la detección de los síntomas cognitivos en fase aguda y posterior a la CC. Palabras claves: neuropsicología, fútbol, cogniciónA concussão (CC) é a principal causa de lesão cerebral em atletas de contato, sendo o futebol americano (AF) um dos mais populares. O CC produz uma ampla gama de sintomas físicos, cognitivos e emocionais que até 36,1% dos jogadores não conhecem. Mudanças cognitivas ocorrem na atenção, memória, flexibilidade mental, fluência verbal, planejamento, memória de trabalho, inibição e velocidade de processamento. Objetivou-se avaliar o desempenho cognitivo de um jogador defensivo da categoria sênior de AF, 23 anos de idade e 15 anos de escolaridade, antes e depois de apresentar um CC. Foram aplicados os seguintes instrumentos: Questionário de dados gerais, teste MoCA, Dígitos e regressão cubos, detecção visual, Fluência Verbal Semântica, teste Stroop, Torre de Hanói e Wisconsin. Seu perfil cognitivo basal foi estabelecido na pré-temporada e reavaliado durante a estação uma semana após o CC. Na avaliação neuropsicológica pré-temporada o jogador apresentou um perfil cognitivo dentro das faixas esperadas para sua idade e escolaridade. Na fase aguda da CC, o jogador diminuição do desempenho em tarefas velocidade de processamento (pré: 26 seg; coloca-120 seg), atenção sustentada (pré: 7 pontos; pós 6 pontos), a inibição (pré: 84 hits, post: 82 hits) e planejamento (pré: 15 movimentos, post: 20 movimentos).&nbsp; Na avaliação neuropsicológica provou ser uma ferramenta sensível e confiável para a detecção de sintomas cognitivos em fase aguda e subsequente CC. Palavras-chave: neuropsicologia, futebol, cognição

Similarities between the lipid proile of Mexican patients with lupus and the general population

Premature cardiovascular events have been observed in systemic lupus erythematosus (SLE) patients, but the reason for this accelerated process is still debatable; although traditional risk factors are more prevalent in such patients than in the general population, the do not seem to fully explain that enhanced risk. One of the most important conditions is a proatherogenic lipid proile. There is not enough data about it in Mexican SLE patients. Objective: To establish the differences in the lipid proiles between Mexican patients with SLE and the general population. Material and methods: Observational, transversal, descriptive and comparative study, between SLE patients and age-sex-matched healthy volunteers. We performed a full lipid proile (by spectrophotometry) 14 hours of fast. The results obtained were analyzed by the statistical program SPSS® Statistics version 17. Results: We studied the full lipid proiles of 138 subjects, 69 with a diagnosis of SLE and 69 agesex- matched healthy volunteers; 95.7% were females and 4.3% males. Average age was 30 years; average body mass index (BMI) 25.96 ± 5.96 kg/m² in SLE patients and 26.72 ± 4.36 kg/m² in the control group (p = 0.396). Average of total cholesterol 156 mg/dl in the SLE patients and 169.4 mg/dl in the control group (p =0.028); average of low density lipoprotein (LDL) cholesterol 85.27 mg/dl in the SLE patients and 97.57 mg/dl in the control group (p = 0.023). Conclusions: We did not ind statistical differences in the lipid proiles among patients and healthy volunteers, which could explain increased cardiovascular morbidity and mortality observed in SLE patient

Saberes, Culturas y Derechos Sexuales en Colombia

Este libro reúne artículos de gran pertinencia académica en el tema, ponencias y discusiones que realizaron distintos grupos de trabajo en el marco del seminario Hacia una Agenda sobre Sexualidad y Derechos Humanos en Colombia, realizado en Bogotá durante los días 18, 19 y 20 de marzo de 2004. Este texto acerca a un público más amplio el debate que vienen desarrollando en Colombia investigadores, militantes, responsables y ejecutores de políticas públicas en materia de sexualidad y de derechos sexuales y reproductivos. La divulgación de los trabajos presentados en este libro permitirá a los lectores identificar las líneas de debate que orientan la investigación, las políticas públicas, los programas de intervención social y el derecho en este ámbito. El texto presenta hallazgos en torno a estos temas, con el objetivo de construir un referente común sobre la sexualidad como una construcción sociocultural e histórica objeto de una regulación pública. Igualmente, pretende inscribir la sexualidad en el ámbito de la construcción de ciudadanía y de la reivindicación de los derechos humanos

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning