Cuando la Historia se encuentra con la Neurología

Las enfermedades neurológicas no perdonan a los famosos, y en el transcurso de la historia muchas celebridades se han visto afectadas. La lista es muy larga, así como las categorías de enfermedades. También múltiples enfermedades neurológicas son descritas en la literatura y en el cine. Este breve repaso de las celebridades, desde el músico hasta el emperador, ilustra que, al igual que el resto de nosotros, la vida de las celebridades se ha visto afectada y moldeada por una variedad de enfermedades del sistema nervioso

Variaciones normales de los potenciales evocados auditivos de corta, media y larga latencia: potenciales evocados auditivos de media y larga latencia en pacientes demenciados

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 18 de Octubre de 199

Anthropogenic and climatic factors enhancing hypolimnetic anoxia in a temperate mountain lake

19 Pags.- 7 Tabls.- 11 Figs.Oxygen depletion (temporal or permanent) in freshwater ecosystems is a widespread and globally important environmental problem. However, the factors behind increased hypolimnetic anoxia in lakes and reservoirs are often diverse and may involve processes at different spatial and temporal scales. Here, we evaluate the combined effects of different anthropogenic pressures on the oxygen dynamics and water chemistry of Lake Enol, an emblematic mountain lake in Picos de Europa National Park (NW Spain). A multidisciplinary study conducted over a period of four years (2013–2016) indicates that the extent and duration of hypolimnetic anoxia has increased dramatically in recent years. The extent and duration of hypolimnetic anoxia is typical of meso-eutrophic systems, in contrast with the internal productivity of the lake, which remains oligo-mesotrophic and phosphorus-limited. This apparent contradiction is ascribed to the combination of different external pressures in the catchment, which have increased the input of allochthonous organic matter in recent times through enhanced erosion and sediment transport. The most important among these pressures appears to be cattle grazing, which affects not only the import of carbon and nutrients, but also the lake microbiology. The contribution of clear-cutting, runoff channelling, and tourism is comparatively less significant. The cumulative effects of these local human impacts are not only affecting the lake metabolism, but also the import of sulfate, nitrate- and ammonium-nitrogen, and metals (Zn). However, these local factors alone cannot explain entirely the observed oxygen deficit. Climatic factors (e.g., warmer and drier spring and autumn seasons) are also reducing oxygen levels in deep waters through a longer and increasingly steep thermal stratification. Global warming may indirectly increase anoxia in many other mountain lakes in the near future.This Project was funded by Organismo Autónomo de Parques Nacionales (OAPN) through CLAM-1 Project (Ref. 533S/2012).Peer reviewe

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable