The Code Stroke: medical evaluation by a pre-hospital attention service

In 1996, the NINDS (National Institute of Neurological Disorders and Treatment of Acute Stroke) published targets for the management of patients with acute cerebrovascular events, setting a time of 3 h or less for administration of thrombolytics, creating the Code Stroke. Objective: Evaluate the time between onset of symptoms and arrival at the emergency department of a hospital as prognostic factors in patients with cerebrovascular events attended by the prehospital emergency medical service in the metropolitan area of Monterrey, Nuevo Leon. Materials and methods: Calls received in the ED (EMME) between January and December 2012 were included in a retrospective cross-sectional study, with symptoms showing within the first 8 h or with an unknown onset. The Mann---Whitney test and Fisher’s exact test were used. Results: Thirty-six patients were included in the study. In 21, the final diagnosis was cerebral infarction, 5 patients were treated with thrombolysis (23.8%). They were divided into two groups: group 1 died or were left with severe neurological sequelae (n = 9) and Group 2 survived without sequelae or mild neurological sequelae (n = 12). The door hospital arrival time was 67 (29---116) min (Group 1) versus 54 (24---86) min (Group 2) (p = 0.110). The neurological status at the start of the event affected prognosis and mortality (p = 0.018). Conclusions: There are few studies analyzing the time between the inception of the symptomatology and the arrival to the emergency room. In our study 23.8% of this series were thrombolyzed, which puts us in the range of international statistics, compared to the series published by Geffner-Sclarsky et al. The population of this study is small so it is not able to show statistical differences, but the few studies that evaluate the Code Stroke in Mexico open the doors to future work with a larger population in Latin American society

Expression of CCR5, CXCR4 and DC-SIGN in Cervix of HIV-1 Heterosexually Infected Mexican Women

Background: A number of studies have demonstrated that receptor and co-receptor expression levels which may affect viral entry, promoting cervical HIV infection. The aim was to evaluate the expression levels of CCR5, CXCR4 and DC-SIGN mRNA in a sample of heterosexually HIV infected Mexican women. Methods: We enrolled twenty-six HIV heterosexual infected women attending a local infectious diseases medical unit. RNA was isolated from the cervix and gene expression analysis was performed using real-time PCR. Results: Expression rates for mRNA of CCR5 (median 1.82; range 0.003–2934) were higher than those observed for CXCR4 (0.79; 0.0061–3312) and DC-SIGN (0.33; 0.006–532) receptors (p < 0.05). A high correlation was found between the mRNA expression levels of these three receptors (rs = 0.52 to 0.85, p < 0.01). Conclusion: Levels of expression of the tested chemokine receptors in the cervix are different from each other and also vary from woman to woman, and seem to support the suggestion that chemokine receptor expression in genital tissues may be playing a role in the HIV transmission

Bloqueo neurolítico del tercer ganglio simpático dorsal en pacientes con síndrome de Raynaud: Una serie de casos

Background: Raynaud's phenomenon, a vascular disorder that is common in the general population, consists of paroxysmal onset distal vasospasm in small cutaneous arteries and arterioles of extremities, usually with little systemic impact. There are anatomical and physiological bases to produce a selective sympathetic block ad using neurolytic agents in the thoracic ganglia T2 and T3 considered synaptic stations that are distributed in the upper limb. Objective: The objective of this work was to determine the efficacy of neurolytic block of the third dorsal ganglion due to Raynaud's syndrome in a series of cases. Material and methods: A review of records of eight cases with Raynaud's phenomenon that presented multifactorial origin were conducted on Clinic of the Pain located in the Unidad Médica de Alta Especialidad, Monterrey Nuevo León, México. Cases: Eight patients from 41 to 72 years old were medically treated for Raynaud's phenomenon using sympathicolysis dorsal third node. Conclusions: Raynaud's phenomenon with a prevalence ranging from 1 to 25% has an increased sympathetic activity. The ischemic pain that is determined by total or partial failure in the oxygen transport to tissues was reduced in these patients by performing a selective sympathicolysis in the thoracic ganglia T2 and T3 considered synaptic stations that are distributed in the upper limb. It was demonstrated in this study that this treatment is selective with less adverse effects to the patients.Introducción: El fenómeno de Raynaud es un trastorno vascular, frecuente en la población general, que consiste en la aparición paroxística de espasmo vascular distal, en pequeñas arterias y arteriolas cutáneas de las extremidades, con escasa repercusión sistémica. Existen bases anatómicas y fisiológicas para producir un bloqueo simpático selectivo utilizando agentes neurolíticos en los ganglios torácicos T2 y T3, considerados estaciones sinápticas que se distribuyen en el miembro superior. Objetivo: Determinar la eficacia del bloqueo neurolítico del tercer ganglio dorsal en el síndrome de Raynaud de una serie de casos. Material y métodos: Se realizó la revisión de expedientes de una serie de ocho casos con fenómeno de Raynaud de causa multifactorial, en la Clínica del Dolor de la Unidad Médica de Alta Especialidad Monterrey; Nuevo León, México. Casos: Ocho casos de 41 a 72 años de edad con fenómeno de Raynaud, tratados médicamente, a los cuales se les realizaron simpaticolisis del tercer ganglio dorsal. Conclusiones: El fenómeno de Raynaud tiene una prevalencia que va del 1 al 25%, en este hay una actividad simpática aumentada por lo que al realizar una simpaticolisis selectiva se logra mejorar el dolor isquémico, el cual está determinado por la insuficiencia total o parcial en el aporte de oxígeno a los tejidos, además de que tenemos bases anatómicas y fisiológicas para limitar el bloqueo a los ganglios T2 y T3, considerados como las estaciones sinápticas que interrumpen los impulsos que se distribuyen en el miembro superior, siendo por tanto más selectivos y con menores efectos adversos para el paciente