Importance of differentiating Mycobaterium bovis in tuberculous meningitis

The aim of the article is to describe the principal findings among patients with M.tuberculosis and M. bovis CNS infection. Mycobacterium tuberculosis is one of the most common infectious agents that cause death and neurological sequelae around the world. Most of the complications of CNS TB can be attributed to a delay in the diagnosis. Unfortunately, there are no specific diagnostic tools to support an early diagnosis. Other prognostic factors different from delay in treatment have not been identified. Clinical, radiological and laboratory characteristics were analyzed retrospectively from the medical files of all the patients admitted with the diagnoses of tuberculosis. Of 215 patients admitted with systemic tuberculosis, 64 (30%) had a neurological infection. Positive cultures were found in 54 (84%) cases, 18 (33%) in the CSF and the rest in other fluids or tissues. Adenosin deaminase (ADA) enzyme determination was more sensitive than M. tuberculosis PCR in the CSF for supporting an early diagnosis. In addition to a later clinical stage and treatment lag, positive CSF cultures (P=0.001) and the presence of M. bovis (P=0.020) were prognostic factors for a worse outcome. Neither older age, the presence of tuberculomas versus meningeal enhancement, or HIV co-infection, was associated to a worse prognosis. The isolation of M. bovis subspecies was more common that previously reported, and it was associated to the development of parenchymal lesions (P=0.032) when compared to M. tuberculosis. In this study, positive CSF cultures for M. tuberculosis and further identifying M. bovis species were additional prognostic factors for worse outcome. Positive cultures in systemic fluids other than CSF, even when the patient had no obvious systemic manifestations, and ADA determination in the CSF were noteworthy diagnostic tools for the diagnosis

Hypothalamic abnormalities and Parkinsonism associated with H1N1 influenza infection

<p>Abstract</p> <p>Objective</p> <p>To describe a case of a young adult with severe H1N1 influenza illness associated with hypothalamic abnormalities and post-influenza parkinsonism.</p> <p>Design</p> <p>Case report.</p> <p>Patient</p> <p>A 22-year-old woman with H1N1 influenza infection developed encephalopathy followed by diverse hypothalamic dysfunction manifestations, sleeplessness, and persistent parkinsonian features.</p> <p>Results</p> <p>CSF analysis, brain imaging and EEG ruled out hypoxic brain injury or other illnesses.</p> <p>Conclusions</p> <p>A number of viruses have been associated with both acute and chronic parkinsonism. A link between parkinsonism and influenza viruses is somewhat controversial. This is the first reported case of parkinsonism following an H1N1 influenza infection.</p

Simultaneous central nervous system complications of C. neoformans infection

The most common neurological manifestation of Cryptococcus neoformans infection is meningitis. Other less common manifestations include parenchymal central nervous system (CNS) granulomatous disease, hydrocephalus and stroke. C. neoformans is often suspected in immunodepressed patients, but it can be easily overlooked in otherwise healthy patients. This paper provides a detailed clinical description of a patient without immunosupression who developed multiple simultaneous neurological manifestations after the infection with C. neoformans

Management of asymptomatic gene carriers of transthyretin familial amyloid polyneuropathy

© 2016 The Authors Muscle & Nerve Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a rare, severe, and irreversible, adult-onset, hereditary disorder caused by autosomal-dominant mutations in the TTR gene that increase the intrinsic propensity of transthyretin protein to misfold and deposit systemically as insoluble amyloid fibrils in nerve tissues, the heart, and other organs. TTR-FAP is characterized by relentless, progressively debilitating polyneuropathy, and leads to death, on average, within 10 years of symptom onset without treatment. With increased availability of disease-modifying treatment options for a wider spectrum of patients with TTR-FAP, timely detection of the disease may offer substantial clinical benefits. This review discusses mutation-specific predictive genetic testing in first-degree relatives of index patients diagnosed with TTR-FAP and the structured clinical follow-up of asymptomatic gene carriers for prompt diagnosis and early therapeutic intervention before accumulation of substantial damage.info:eu-repo/semantics/publishedVersio

Red-flag symptom clusters in transthyretin familial amyloid polyneuropathy

© 2015 The Authors. Journal of the Peripheral Nervous System published by Wiley Periodicals, Inc. on behalf of Peripheral Nerve Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a rare, progressive, life-threatening, hereditary disorder caused by mutations in the transthyretin gene and characterized by extracellular deposition of transthyretin-derived amyloid fibrils in peripheral and autonomic nerves, heart, and other organs. TTR-FAP is frequently diagnosed late because the disease is difficult to recognize due to phenotypic heterogeneity. Based on published literature and expert opinion, symptom clusters suggesting TTR-FAP are reviewed, and practical guidance to facilitate earlier diagnosis is provided. TTR-FAP should be suspected if progressive peripheral sensory-motor neuropathy is observed in combination with one or more of the following: family history of a neuropathy, autonomic dysfunction, cardiac hypertrophy, gastrointestinal problems, inexplicable weight loss, carpal tunnel syndrome, renal impairment, or ocular involvement. If TTR-FAP is suspected, transthyretin genotyping, confirmation of amyloid in tissue biopsy, large- and small-fiber assessment by nerve conduction studies and autonomic system evaluations, and cardiac testing should be performed.info:eu-repo/semantics/publishedVersio

Systemic lupus erythematosus : imaging findings in thoracic involvement

El lupus eritematoso sistémico (LES) es una enfermedad inflamatoria crónica de causa desconocida, que se caracteriza por la afección de múltiples órganos y por la presencia de varias anormalidades inmunológicas, en particular, la producción de anticuerpos antinucleares (ANA). El diagnóstico de LES se basa en los criterios más recientes propuestos en el año 2012 (Systemic Lupus International Collaborating Clinics, SLICC), que reevaluaron los criterios del Colegio Americano de Reumatología descritos desde el año 1982. Las imágenes diagnósticas son una herramienta útil para la evaluación de las manifestaciones de órganos específicos, la progresión de la enfermedad, y la identificación de complicaciones. El compromiso del sistema respiratorio y cardiovascular es frecuente. En esta revisión se describe el espectro de los hallazgos radiológicos de LES en la radiografía de tórax convencional y la escanografía de tórax de alta resolución, modalidades de imagen mediante las cuales se hace el abordaje inicial en el paciente con síntomas respiratorios. Es importante reconocer los hallazgos radiográficos más frecuentes, con el fin de orientar a los médicos en el diagnóstico y seguimiento de esta enfermedad.Artículo de revisión4486-4491Systemic erythematous lupus (SEL) is a chronic inflammatory disease of unknown cause, characterized for affecting multiple organs and for the presence of several immunological abnormalities, in particular the production of antinuclear antibodies (ANAs). SEL diagnosis is based on the most recent criteria proposed on 2012 (Systemic Lupus International Collaborating Clinics, SLICC), which reevaluated the criteria originally described by the American College of Rheumatology in 1982. Diagnostic images are a useful tool for evaluating organ specific manifestations, disease progression, and the identification of complications. Respiratory and cardiovascular system compromise is frequent. In this revision, SEL the spectrum of radiological findings in conventional thorax radiography and high-resolution tomography are described, as these two image modalities are commonly used in patients with respiratory symptoms. It is important to recognize the most frequent radiographic findings with the purpose of guiding physicians in the diagnosis and treatment of the disease

Hitler y el nazismo

14 p.Adolf Hitler fue un militar dictador nacido en Braunau am Inn, Austria el 20 de abril de 1889, fue el cuarto de seis hermanos, hijos de Alois Hitler y Klara Polzl. Adolf primeramente se interesó por las bellas artes a lo cual su padre Alois no estuvo de acuerdo, de igual manera también mostró desde una temprana edad interés frente al nacionalismo alemán y el rechazo de la autoridad Austria-Hungría lo que le dio un nuevo sentido y motivación para su vida.Biografía Carrera política Ideología nazi Terror nazi Obras Conclusión Bibliografí

Estudio de Factibilidad para la Creación de una Empresa de Asesorías en Marketing Digital Para la Pequeña y Mediana Empresa de la Ciudad de Bogotá

Determinar la factibilidad para la creación de una empresa en asesoría en marketing digital para pymes de la ciudad de BogotáEl presente estudio tiene como objetivo determinar la factibilidad de la creación de una empresa de asesoría en marketing digital que estará enfocada en las PYMES de la ciudad de Bogotá, proporcionando de esta forma apoyo comercial y publicitario a los emprendimientos que se generan en la actualidad, por medio de herramientas digitales como las redes sociales que son de fácil acceso y de menor costo, por este motivo el estudio se orientó en la realización de un análisis de mercado, técnico, administrativo, legal y financiero, los cuales permitieron determinar la viabilidad del proyecto, obteniendo como resultado que este es un proyecto rentable, que generará ganancias para la sociedad que constituirá la empresa, y en el caso de las PYMES de la ciudad de Bogotá podría facilitar que se den a conocer de una forma más ágil logrando cumplir con sus metas y objetivos de ventas.This study aims to determine the feasibility of creating a digital marketing consulting company that will be focused on SMEs in the city of Bogota, thus providing commercial and advertising support to enterprises that are generated today, through digital tools such as social networks that are easily accessible and lower cost, for this reason the study was oriented in conducting a market analysis, technical, administrative, legal and financial analysis, which allowed to determine the feasibility of the project, obtaining as a result that this is a profitable project, which will generate profits not only for the company that will constitute the company, but also for SMEs in the city of Bogota because it will make them to be known in a more agile way, achieving their goals and sales objectives

Estudio de Factibilidad para la Creación de una Empresa de Asesorías en Marketing Digital Para la Pequeña y Mediana Empresa de la Ciudad de Bogotá

Determinar la factibilidad para la creación de una empresa en asesoría en marketing digital para pymes de la ciudad de BogotáEl presente estudio tiene como objetivo determinar la factibilidad de la creación de una empresa de asesoría en marketing digital que estará enfocada en las PYMES de la ciudad de Bogotá, proporcionando de esta forma apoyo comercial y publicitario a los emprendimientos que se generan en la actualidad, por medio de herramientas digitales como las redes sociales que son de fácil acceso y de menor costo, por este motivo el estudio se orientó en la realización de un análisis de mercado, técnico, administrativo, legal y financiero, los cuales permitieron determinar la viabilidad del proyecto, obteniendo como resultado que este es un proyecto rentable, que generará ganancias para la sociedad que constituirá la empresa, y en el caso de las PYMES de la ciudad de Bogotá podría facilitar que se den a conocer de una forma más ágil logrando cumplir con sus metas y objetivos de ventas.This study aims to determine the feasibility of creating a digital marketing consulting company that will be focused on SMEs in the city of Bogota, thus providing commercial and advertising support to enterprises that are generated today, through digital tools such as social networks that are easily accessible and lower cost, for this reason the study was oriented in conducting a market analysis, technical, administrative, legal and financial analysis, which allowed to determine the feasibility of the project, obtaining as a result that this is a profitable project, which will generate profits not only for the company that will constitute the company, but also for SMEs in the city of Bogota because it will make them to be known in a more agile way, achieving their goals and sales objectives

Efficacy and safety of vutrisiran for patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy: a randomized clinical trial

BACKGROUND: The study objective was to assess the effect of vutrisiran, an RNA interference therapeutic that reduces transthyretin (TTR) production, in patients with hereditary transthyretin (ATTRv) amyloidosis with polyneuropathy. METHODS: HELIOS-A was a phase 3, global, open-label study comparing the efficacy and safety of vutrisiran with an external placebo group (APOLLO study). Patients were randomized 3:1 to subcutaneous vutrisiran 25 mg every 3 months (Q3M) or intravenous patisiran 0.3 mg/kg every 3 weeks (Q3W) for 18 months. RESULTS: HELIOS-A enrolled 164 patients (vutrisiran, n = 122; patisiran reference group, n = 42); external placebo, n = 77. Vutrisiran met the primary endpoint of change from baseline in modified Neuropathy Impairment Score +7 (mNIS+7) at 9 months (p = 3.54 × 10−12), and all secondary efficacy endpoints; significant improvements versus external placebo were observed in Norfolk Quality of Life-Diabetic Neuropathy, 10-meter walk test (both at 9 and 18 months), mNIS+7, modified body-mass index, and Rasch-built Overall Disability Scale (all at 18 months). TTR reduction with vutrisiran Q3M was non-inferior to within-study patisiran Q3W. Most adverse events were mild or moderate in severity, and consistent with ATTRv amyloidosis natural history. There were no drug-related discontinuations or deaths. CONCLUSIONS: Vutrisiran significantly improved multiple disease-relevant outcomes for ATTRv amyloidosis versus external placebo, with an acceptable safety profile