Status Epilepticus (SE) is a neurological emergency that is by itself a syndrome defined according its clinical presentation and electroencephalographical manifestations, both highly variable. There aren’t any case series about this relatively common neurological emergency in Colombian indexed journals, for which a search for cases was performed in two neurological critical care institutions in the Colombian capital city in the period between 2011-2015. We describe demographical, diagnostic and therapeutic characteristics emphasizing in its clinical and paraclinical presentation, as the treatment applied according international guidelines. We found convulsive SE was three times more common that the non-convulsing time, 1.4 times more common in females that in males, more common in the pediatric group and less common in the geriatric group, the majority of this cases presented SE secondary to a congenital structural injury while adult and elder patients presented SE as a consequence of non-voluntary discontinuation of the therapy, and in 66% of the cases the SE described was not the first of its kind. The therapeutic regime applied corresponded to the stipulated in international guidelines in only 41.67%.
Artículos Originales
Estudio Poblacional de Prevalencia de Cisticercosis Porcina en Atahualpa, Ecuador. Metodología y Definiciones Operacionales. Population-Based Study Of Porcine Cysticercosis Prevalence In Atahualpa, Ecuador. Methodology And Operational Definitions.
Objective: To assess sero-prevalence of porcine cysticercosis in Atahualpa, a rural Ecuadorian village endemic for human neurocysticercosis.
Design: We aim to collect at least 600 blood samples of local pigs, to quantify the number of positive bands in the EITB, and to estimate crude prevalence rates of porcine cysticercosis in the village. Sampling will only include pigs older than 2 months of age. Only healthy pigs will be sampled, to avoid risks inherent to manipulation of sick animals. There will be no risk for pigs as the result of the procedure. According to the estimated endemicity of human cysticercosis, we expect to find about 25% of infected pigs in this study. In the event of prevalence rates above or below the expected percentage, we will attempt to assess the causes of such discrepancies. All pig positive to 3 bands of more in the EITB will receive treatment with oxfendazole at a single dose of 30 mg/kg.
Comment: The importance of defining the prevalence of porcine cysticercosis in a village endemic for human neurocysticercosis is to confirm the existence of active transmission. If this is true, treatment of infected pigs will help to interrupt the life cycle of Taenia solium, thus reducing the prevalence of this disease in humans.
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Prevalencia de la Enfermedad de Parkinson: Estudio Puerta-Puerta en la Provincia de Manabí-Ecuador. Prevalence of Parkinson’s Disease: Door-to-door Study in Manabi-Ecuador.
Parkinson’s disease (PD) is one of the most frequent neurodegenerative disorders after dementias, with a worldwide prevalence of more than 1% in patients older than 65 years. In Ecuador, there are not direct statistical data on this disease. The aim of our research lies in establishing for the first time, the prevalence of Parkinson’s disease in the province of Manabi. For that, a door-to-door study was designed in two phases. They were selected 116,983 people, over forty years old. During the first phase, they were evaluated by survey, according to the London Brain Bank criteria for diagnosis. In the second phase, patients who met the criteria were referred to a neurologist for a definitive diagnosis. A total of 285 people (0.24%) were positive for Parkinson’s disease, predominating those aged over 61 years (33.33%), and with a slightly higher prevalence among males (56.14%) than in women (43.86%).
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Evaluación Neuropsicológica del Control Inhibitorio y el Control de la Interferencia: Validación de Tareas Experimentales en el Contexto Ecuatoriano. Neuropsychological Evaluation Of Inhibitory Control And Interference Control: Validation Of Experimental Tasks In The Ecuadorian Context.
In this article we report a study in which three experimental tasks (SIMON, Go / No-Go and Stroop Victoria) were adapted and validated to evaluate the inhibitory control and interference control in a sample of Ecuadorian students. The sample consisted of 100 students between 6 and 15 years old (M = 10.13 years, SD = 2.48) belonging to the public education system of Ecuador. The process followed in the adaptation and validation was through the linguistic translation of the experiments, followed by an expert judgment and a pilot study. In the results it was found that there are no statistically significant differences in the measures that assess the inhibitory control and the interference considering the sociodemographic variables of the participants as comparison factors. In the correlation analysis we found a statistically significant association between the measurements of the experiments. We conclude by analyzing the associations found and underlining the need to continue providing evidence in the research line of adaptation and validation of test for using in neuropsychological evaluation.
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Funcionamiento de los Comités de Ética de Investigación en Seres Humanos en Ecuador, 2015
Research Ethics Committees play an important role in securing the quality of interventional studies in humans; in Ecuador, they are in process of becoming stronger. The aim of this observational study was to describe the evolution of Ecuadorian legislation, training processes implemented by the health authority in the period of 2006-2015 and the performance of six committees (Quito and Guayaquil) during 2015. A self-assessment survey and a questionnaire to determine training needs were applied. Each committee was visited to evaluate its performance. The average member number was 10 and, although there was no gender equity, all members had the profile required for membership. The average response time was 26 days and the average quorum at meetings was of six members. Among the weaknesses are, little training in biostatistics and clinical research methodology and a poor follow-up of the studies; concerning strengths, we highlight the willingness of the members to improve the performance of the committees, and the willingness of Ministry of Public Health to support them. This study reports for the first time, the evolution of Ecuadorian legislation regarding ethics committee, its basic characteristics, weakness and strengths.
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Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 Años de Mortalidad, Realidad Actual y Recomendaciones
Background. Cerebrovascular disease is the second cause of death and occupies the third place as a factor causing disability worldwide. At present, despite the recognition of its importance, the available data about Ecuador is scarce and there are not published analysis of its behavior. Methods. Retrospective longitudinal analysis of available public data on cerebrovascular disease in Ecuador, from 1991 to 2015. Results Cerebrovascular disease was the leading cause of mortality by 77 897 (6.70%) deaths and it is the only one with a constant trend pattern in the last 25 years. Conclusions. Cerebrovascular disease is the number one cause of death in Ecuador and its mortality is steadily increasing. Government policies must be implemented to reduce their mortality.
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Prevalencia de Enfermedades Neurológicas no Transmisibles en una Población Rural del Estado de Chiapas, México: Protocolo y Resultados Basales. Estudio Pro-Mas (Proyecto Comunitario La Soledad)
Objective: We aimed to assess cardiovascular health and neurological status of community-dwelling adults living in “La Soledad,” Chiapas, México, to calculate prevalence and incidence of cerebrovascular diseases, epilepsy and cognitive decline. Among others, these conditions are currently considered as the new epidemics in rural.
Design: Following a protocol similar to that used for the Atahualpa Project, we conducted a two-phase epidemiological study. During phase I, La Soledad residents were interviewed with validated field instruments to assess cardiovascular health status and well as to detect suspected stroke, epilepsy and cognitive impairment patients. During phase II, trained physicians examined suspected individuals as well as a random sample of non-suspected individuals to assess prevalence of diseases of interest.
Comment: Public health strategies must be based on the study of region-specific risk factors. Studies such the Atahualpa Project were proven to be effective for the assessment of public health problems in a rural Ecuadorian village. PROMAS will likely be cost effective to increase current knowledge on these conditions in Mexican rural villages and to promote a better cardiovascular health status among their inhabitants.
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Características Pre y Perinatales de Niños que Viven en Sectores de Alto Riesgo Ambiental por Exposición a Solventes Orgánicos en el Municipio de Sampués-Sucre
The purpose of this study is to characterize -through the Maternal and Perinatal Risk Questionnaire CMRP – the pre and perinatal aspects of children whose mothers had frequent exposure to organic solvents during pregnancy.
The results demonstrates that exposed mothers had a higher number of urinary infections both before and during pregnancy, pre term deliveries, motor decline and cesarean deliveries, which are potential causes of developmental disorders, cerebral palsy, decreased growth of the baby and impaired psychomotor development. A significant data was the number of children who suffered hypoxia and anoxia during delivery, with subsequent risk of brain damage, learning disabilities, reduced IQ and potential behavior problems.
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Sistemas de Atención Focalizada, Sostenida y Selectiva en Universitarios de Quito-Ecuador
Introduction. Attention is a neuropsychological function that has threads of targeting, selectivity, sustainability, division and alternation, which enable human beings identify a particular stimulus for cognitive and brain processing. Objective. To analyze the performance of college students in a focused, sustained and selective attention test, considering age group, gender and academic level comparing factors. Method. A quantitative, non experimental, transectional and based on the comparison group research design was used. The sample size was 246 college students (50.8% men and 49.2% women), within17 and 29 years (M = 21.01, SD = 2.35) Results. It was found that targeting attentional processes, sustainability and selectivity are similar between the different age groups, educational level and gender. Conclusions. The basic attentional processes are fully developed in college students. Data are discussed around previous research and theoretical postulates of cognitive neuroscience.
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Uso del Electroencefalograma en un Hospital de Tercer Nivel
Objective: To describe the EEG indications in Baca Ortiz Children Hospital and how they are related to the EEG results. Materials and Methods: This is a descriptive study with a sample of 659 pediatric EEG records from March to June 2016. Data of variables related to EEG indications and EEG results were obtained, and it was done a descriptive statistics analysis. Results: Fifty-six percent of the patients were male. The mean age was 6.46 years. Seventy percent of EEG requests came from the Outpatient Area and 88.16% from Neurology as specialty. Fifty-six percent of indications were related to Epilepsy. Fifty-one percent of requests were inadequate, where Epilepsy had again the highest percentage, 24.13% of all indications or 47,04% or all inadequate indications. Eighty-one percent of the EEG results were abnormal. Conclusions: These results reflect that EEG was misused as a routine diagnostic method, even in Epilepsy.
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Trombectomía Mecánica: Técnica de Primera Elección en el Tratamiento del Ictus Isquémico Agudo. Análisis de Beneficios y Resultados
The main objective of this article is to portrait mechanical thrombectomy as the modality of choice for interventional stroke treatment.
Methods and materials: Nine patients with acute ischemic stroke were diagnosed. Mechanical thrombectomy was perfomed in all of them with a solitaire type device associated with intraarterial rTPA. Eight patients (89%) had anterior vascular occlusion and only one (11%) had posterior vascular compromise. Treatment efficacy was assesed using a modified Rankin scale (mRs).
Results: Five patients (55%) had complete recovery while three of them (33%) had partial recovery. Only one patient (11%) showed no recovery at all.
Discussion: Although more data is needed, mechanical thrombectomy prooved to be effective and shows promising outcomes in patients with acute ischemic stroke.
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Experiencia Quirúrgica de Dos Años en el Manejo de la Epilepsia Refractaria Multifocal
Objective: To describe the series of patients with multifocal refractory epilepsy who have undergone surgery in our center.
Methods: A prospective analysis of patients with multifocal refractory epilepsy treated in our hospital during the last two years was performed.
Results: In this period we studied 25 patients with multifocal refractory epilepsy who have completed > or =1 year postoperative follow-up after callosotomy. The ages of the patients were between 3.8 and 18.8 years (mean 11, SD 4.46). The most common cause of refractory epilepsy in our series was Lennox Gastaut syndrome (ten patients). We perform 14 callosotomy in 13 patients. Of these, 10 were of the above callosotomías 2/3 and four complete. Overall there was a 66.5% reduction in seizures; in the case of total callosotomías this reduction was 90%. We report two minor complications and death from a pneumonic process.
Conclusion: The surgical management of multifocal refractory epilepsy is a safe procedure that provides good results in controlling the crisis. The complete callosotomy is the most efficient procedure in this population.
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Impacto del Aprendizaje del Inglés Sobre los Procesos Cognitivos en Adultos Mayores. Un Estudio Preliminar en Cuenca
A descriptive exploratory study, before and after a six-month english learning course for seniors is conducted to evaluate the cognitive effect of learning another language in this age group in the city of Cuenca.
Materials and Methods: 80 adults of average age 70.48 ± 4.9 years (31 men, 19 women) were included; who underwent neurological and neuropsychological evaluation at baseline, six and twelve months after the course; including tests for executive function (working memory and attention processes).
Results: Data show significant statistical association between impaired olfactory perception related to age. Neuropsychological tests show interesting data relating cognitive maintenance and even improvement in the Performance Testing Direct and inverse series (Wais III) and Symbol Digital Modality Test (SMDT) six and twelve months after initiating a learning course of English.
Conclusion: The study suggests that learning English, even without functional objective of a new language, may have protective effect on the executive functions and neuronal brain networks are claimed the first findings in patients with cognitive impairment. We suggest perform this follow up long term in time to find strongest evidence, related to international bibliography.
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Validación de la Escala de Impulsividad Bis 11-C para su Aplicación en Adolescentes Ecuatorianos
Barratt scale (BIS) is an assessment tool often used to evaluate impulsivity. In this study, an analysis of the psychometric properties of the BIS 11 c scale Ecuadorian adolescent students (N = 245) is performed. Internal consistency through Cronbach’s alpha coefficient and homogeneity of the items were evaluated. For assessing the construct validity we perform a confirmatory factor analysis. The results obtained were acceptable parameters of valid and reliability to use the BIS 11 c scale in Ecuadorian adolescents. Finally, a discriminant analysis in a clinical sample of 18 students with ADHD was conducted.
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Neuronavegación en Tumores de Fosa Posterior en Pediatría
Introduction. Primary tumors of the central nervous system represent about 2% of the total of the neoplasms in adults and 20% of total neoplasms in children. Posterior fossa tumors represent 48% of pediatric population and are the first cause of malignancy of solid organs in the pediatric age. In our environment, the use of neuronavigation in the excision of posterior fossa tumors in pediatric population has not yet been adequately standardized.
Materials and methods. A retrospective observational study from january 2014 to may 2016 of patients diagnosed with posterior fossa tumors is reviewed. We included 20 patients with diagnosis of space-occupying lesion in posterior fossa.
Results. The relationship man: woman was 1:1. The average age was 4 years and 4 months. The degree of precision of the intraoperative neuronavigation prior to craniotomy had an average error margin less than 1.5 millimeters, varying from 1 to 3 millimeters.
Conclusions. Neuronavigation is useful in performing a precise surgery, reducing risks associated with the intervention and shortening the surgical times. Because of greater tumor resecting, neuronavigation is usefel in increasing survival of oncologic pediatric patients.
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Deterioro Cognitivo y Riesgo de Demencia, una Realidad para el Ecuador. Estudio de Factores de Riesgo en un Grupo de Pacientes Jubilados del IESS en Cuenca en el año 2013
According to WHO in 2050, 110 million people will be affected by dementia. Ecuador will see among the diseases related to underdevelopment, those related to increased life expectancy. We conducted a cross-sectional study in a health facility IESS in Cuenca. 391 peopled signed an informed consent and answered a form to define the demographics and identify potential risk factors associated to dementia. The mental state was studied using the Minimental-test (MMSE) tool and comorbidity of depression by Yesabage screening test. Data was analyzed using SPSS 15 for Windows. The average age was 70 years, 84% were women and 97% of them live as urban residents in Cuenca. By applying the MMSE, 17.1% showed cognitive impairment with RR of 3.81 for ages 65 and older and female condition. Chronic diseases such as diabetes and arthrosis were the most frequent comorbidities with statistical association for risk; hypertension, COPD, etc., showed no statistical association. 40.9% of the sample group where possitive for depression showing serious nature in 37.5%.
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Capacidad Diagnóstica y Validación Preliminar del Test del Reloj, Versión de Cacho a la Orden, para Enfermedad de Alzheimer de Grado Leve en Población Chilena
Background: To perform a study with discriminant power and validity using the Clock drawing Test by instruction (CDTI) in patients with mild Alzheimer’s disease (MAD).
Materials and Methods: Phase I diagnostic test study. We included a healthy control arm of 58 elderly people and 40 cases with mild Alzheimer’s disease. All participants were examined and diagnosed by clinical consensus. The MMSE, CDTI and clinical record were obtained.
Results: There were significant differences between the study groups regarding cognitive tests’ performance when comparing age and education, but no differences were found when comparing gender. ANCOVA test showed no significant effect exerted by the demographic variables on cognitive performance in any group. The sensitivity (CTO=84% vs MMSE=79,3%), specificity (92,5% vs
82,5%) and diagnostic utility of the CDTO were higher than one’s resulting form the MMSE (=0,90, p=0,000). The combined use of both
instruments increased diagnostic capacity. The best cutoff point for the diagnosis of mild dementia was ≤6 points in CDTO and ≤23 in
MMSE. Both instruments correlated statistically.
Conclusions: The CTO is a useful test and can discriminate between cognitively healthy subjects and patients with EAL when appliying the “to order” criteria from Cacho’s version.
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Validación de Diferentes Escalas en la Evaluación del Pronóstico de Pacientes con Hemorragia Subaracnoidea Espontánea en el Hospital Regional “Dr. Teodoro Maldonado Carbo” entre Mayo-2011 y Mayo-2014
Background: Subarachnoid Hemorrhage (SAH) is associated with a high mortality rate and functional consequences. Several scales have been created in order to assess prognosis after SAH, and even though they have been widely studied, neither has achieved universal acceptance.
Objective: Validate different scales assessing the prognosis of patients with spontaneous SAH in a local hospital population.
Methods: A retrospective, cross-sectional study was conducted on patients admitted to the “Dr. Teodoro Maldonado Carbo” Hospital, diagnosed with spontaneous SAH, between 18 and 75 years. Descriptive statistics and Spearman correlation coefficient were calculated in order to evaluate the association of the Hunt and Hess, WFNS and Fisher Scales with functional outcome.
Results: Hunt and Hess Scale had a higher correlation (60,3%; p=0,000) with the functional outcome at discharge or death, compared to 55,3% (p=0,000) obtained by the World Federation of Neurological Surgeons Scale and 50% (p=0,000) by Fisher Scale. In addition, the Glasgow Coma Scale score (-58,4%; p=0,000), altered pupillary response (54,7%; p=0,000) and the need for invasive mechanical ventilation (73,8%; p=0,000) were factors associated with functional score.
Conclusion: Hunt and Hess Scale revealed a good correlation with the Rankin functional scale at discharge or death, and is superior to the other scales in evaluating the prognosis of patients with spontaneous subarachnoid hemorrhage.
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Concepto de la Demencia como Enfermedad en un Grupo Poblacional de la Ciudad de Guayaquil
Background: Dementia is a clinical condition that causes progressive cognitive impairment, and early diagnosis may have a significant impact on the quality of life. So far, no studies have been conducted to evaluate the conception of the general population about this disease.
Methods: Cross-sectional, descriptive and analytical study, which surveyed individuals between 55 and 65 years old without neurocognitive pathology about the concept of the term “dementia”. The educational level of each respondent was also collected. The responses were assigned to one of 6 possible response groups for analysis, depending on which group better matched each individual response. The percentage of each type of response was calculated, and chi-square was used to observe the relationship between level of education and the type of answers given.
Results: a total of 274 individuals were surveyed, 35.8% were male and 64.2% female. Most patients (36.5%) had only elementary education. 11.7% did not know what dementia means. 45.5% defined it as memory loss and 23% incorrectly identified it as a psychiatric illness. A very small percentage of individuals correctly defined it as a type of cognitive impairment. We found a statistically significant relationship between the level of education and the type of answers obtained (p <0.001).
Discussion: more than half of respondents gave an acceptably correct answer about the concept of dementia, but there is still a significant percentage of people who do not know its meaning, or confuse it with psychiatric illness. It is imperative to carry out health campaigns to alert people about this disease and how to delay it’s onset by lowering risk factors, and to train as well primary care physicians to provide better information to their patients in order to improve the prevention of dementia and lessen its impact on quality of life.
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Electroestimulación En Músculos Rectos Abdominales Para el Aumento de la Capacidad Respiratoria Proporcional Para el Habla en Personas con Lesiones Medulares Cervicales.
Cervical spine injuries present with dysfunctions of the respiratory system characterized by: a reduction in forced vital capacity, ineffective cough, decreased peak expiratory and speech problems. Speech therapy intervention using an exercise program improves the intensity of the voice and fluency, the objective of this study was to determine the effect of electrotherapy in abdominal muscles on respiratory capacity proportional to speak in cervical injuries. We studied 60 people with chronic traumatic cervical spinal cord injury and restrictive breathing; they were divided in two groups: experimental (n=30) and control (n=30). Control group received speech therapy exercises and the experimental group received speech therapy and electrotherapy in abdominal muscles prior to the workout. Patients were assessed before and after application of the treatment with the following variables: forced vital capacity, peak expiratory flow, maximum phonation time, reading the words of two syllabes, vocal intensity and rate of speech disabilities. Two groups showed significant improvement in speech therapy variables evaluated after treatment (p ≤0.05). However, the use of electrical stimulation significantly increased the recovery of variables: vocal intensity (p =0.0485) and peak expiratory flow (p =0.0000) and both variables showed positive correlation [F (1, 28)=7.5478, p <0.01]. Conclusions: electrotherapy in abdominal muscles is beneficial for the improvement of peak expiratory flow and vocal intensity. Peak expiratory flow demonstrated to be a predictor of vocal in tensity.
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Estudio de ochenta pacientes con Epilepsia Benigna de la Niñez con Espigas Centrotemporales.
The Benign Epilepsy of Childhood with centrotemporal Spikes (BECCTS) constitutes the most common form of idiopathic epilepsy in the paediatric population.
We present 80 cases with this diagnosis analyzing its clinical and electrophysiological characteristics, and particularly its atypical evolution. Results: 71% were male (relation 2.5:1), the partial motor seizures were the most frequent (40%) followed by the partial generalized secondarily (35%). 75% of the seizures appeared during sleep. The 66% of our patients were not medicated and a patient showed an electro-clinical picture of BECCTS and of Occipital Benign Epilepsy, Panayiotopoulos type, in concomitant form. 5% evolved in atypical form: a patient as atypical BECCTS with compromised language and hyperactivity, another developed a continuous point-wave syndrome of slow sleep and a patient debuted as focal epileptic state in hemi face with anarthria. Conclusions: The present study remarks its differential diagnosis and alerts about the phenomena of secondary bisynchronism that can appear in this type of epilepsy, the role that antiepileptic drugs play in its probable appearance and the proper and adequate changes to avoid future cognitive compromise. However, in 95% of our cases, the evolution of the BECCTS was favourable.
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Valor de la pulsioximetría nocturna en pacientes tetrapléjicos.
Sleep breathing disorders are common in quadriplegic patients and can be accompanied by significative oxygen desaturations. The purpose of this investigation was to evaluate the behavior of the oxygen saturation during sleep in 20 patients diagnosed as traumatic cervical tetraplegia admitted at the Julio Diaz National Rehabilitation Center, considering the intensity of the injury according to ASIA scale as well as the behavior of demographic, anthropometric, spiro metrical, oxymetrical variables and the muscle strength in both complete and incomplete injuries.
Ventilatory function and nocturnal oxygen saturation were studied, with findings of higher percent of incomplete injuries (70%) toward the complete ones (30%). There were not significant differences between both groups age, body mass index, neck circumference, neck length, time of injury, espiratory volume in the first second, forced vital capacity, espiratory volume in the first second/forced vital capacity index, vital capacity, maximal inspiratory pressure, and maximal espiratory pressure.
All patients showed a restrictive ventilatory disorder. Though significant oxyhemoglobin desaturations were not found in any case; complete injuries displayed a higher rate of desaturations after an hour sleep than the incomplete ones and they showed a significant negative correlation between the desaturation episode per hour of sleep index, and mean oxygen saturation.
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Programa de Riesgo Vasculocerebral Multifactorial orientado a la Comunidad. Policlínica Buenaventura 2005.
Community-oriented multifactorial cerebrovascular risk program is a community health project for cerebrovascular risk factors control. Primary objective was to reduce morbimortality of this group of patients as risk was stratified.
Material and method: This intra-group controlled study included 101 patients, any gender, older than 45 years with a a past history of hypertension. A multidisciplinary group applied a Cerebrovascular Risk Evaluation Scale, which divided patients in low, moderate and high risk. Results were compared before and after intervention over modifiable risk factors. Statistical significance was considered at 95%.
Results: Modifiable risk factors control was beneficial in case of arterial hypertension. Lack of knowledge in the population stroke management was high. There was not good adherence to different treatments including diet, drug therapy and routine exercises. All these indicators were considered positive and were validated for the scale.
Conclusions: Clinical and administrative indicators in the evaluation of program effectiveness permitted to validate the applied instrument as an alternative in primary care assistance.
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Prevalencia y Tendencia de Trastornos Mentales en el Instituto Nacional de Neurología y Neurocirugía.
A mental disorder is the result of an imbalance between biological and social aspects that reflect an alteration of cerebral functions which intervene in the life and productiveness of each individual. In this study the prevalence and trend of mental disorders were estimated in the National Institute of Neurology and Neurosurgery in Mexico City. This was a transversal study. The information was obtained during 1995 to 2004 of clinical records of patients admitted by first time in the Institute with diagnosis of mental disorder according to ICD-10, and different epidemiological variables were identified.
One thousand four hundred eighty three cases were identified. 56% were woman. The more frequent group of age was 20-29 years. In first place was Schizophrenia (22%), followed by Depressive Episode (16.5%) and in third place Bipolar Affective Disorder (8.6%). The prevalence was higher in 1995. In general, a tendency to decrease of mental disorders was observed, although it was not statistically significant.
Previous reports affirm that the number or patients with neuropsychiatric disorders will increase around the world in next years. Because most patients are assisted in the beginning by general or alternative medicine, it is essential for cases to be promptly identified and be addressed to specialized institutions for their attention.
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Predictores del nivel de somnolencia en pacientes con Apnea Obstructiva del Sueño.
Excessive daytime sleepiness (EDS) is the obstructive sleep apnea syndrome (OSAS) most frequent symptom. The relationship between the level of daytime sleepiness and standard polysomnographic variables (i.e., apnea/hypopnea index [AHI] and oxygen saturation SaO2) has been the subject of a number of studies. To date, the results have been inconsistent. The goal of this study is to assess the variables significantly related with daytime sleepiness severity. The variables chosen were: AHI, percentage of total time that the subject remains with arterial oxygen saturation level below 90% (SaO2<90%), minimum oxygen saturation (SaO2 m), body mass index (BMI), and age. The study sample was composed of 51 obstructive sleep apnea patients selected from a medical centre.
Subjects completed using the Epworth Sleepiness Scale (ESS) to determine daytime sleepiness. The OSAS was diagnosed by conventional polysomnography.
The results indicated significant correlations between level of daytime sleepiness and age (r=.302; p<.05), BMI (r=.339, p<.05), SaO2 m (r=-.393, p<.01) and SaO2 < 90% (r=.492, p<.01). Significant correlations were also found between AHI and SaO2<90% (r=.314, p<.05), BMI and SaO2<90% (r=.387; p<.05), and SaO2 m and SaO2<90% (r=- .746; p<. 01). No significant correlation was detected between AHI and level of daytime sleepiness. According to the results, the percentage of total time that the subject remains with arterial oxygen saturation level below 90% (SaO2< 90%) is the best predictor of daytime sleepiness severity.
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Descripción y Valoración Pronóstica de la Hemorragia Cerebelosa no Traumática.
Spontaneous cerebellar hematomas (CH) represent 5%–10% of intracranial hemorrhages The purpose of this study was to describe CH characteristics in patients admitted to the critical care unit, to determine the prevalence of risk factors, to describe the clinical presentation, the treatment and the clinical situation at discharge. Thirty four consecutive patients were included. The mean age was 67±15 years. In the univariant analysis, only Glasgow Coma Score was associated with high mortality. An hematoma diameter > 3 cm., intraventricular hemorrhage and hydrocephalus were associated with mortality, but without statistical significance.
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The incongruities of the NPI−Q score obtained by the caregiver versus that obtained directly from the non−demented patient with Parkinson’s disease.
Background: Neuropsychiatric symptomatology frequently accompanies Parkinson’s disease. Purpose: In this work (a one point time analytical study), we wished to explorer the Neuropsychiatric Inventory in its shorter format (NPI–Q) in seventy consecutive patients. To find out in what way information obtained from the caregiver (CG) is correlated with that which the patients provide. If this tool, designed to evaluate patients with dementia, can be applied to non-demented subjects with Parkinson’s disease (NDP).
Method: The study, the NPI–Q Spanish version was employed, first with the CG alone and subsequently, with the individual patient alone by a researcher with no knowledge of the previous result from the CG. The weighted kappa correlation coefficient was measured to evaluate the CG–NDP consistency rate (Test–retest reliability; obtained by judging the reproductibility or stability of a instrument over time; two or more observers; or two or more times); a value of 0.7 or higher was accepted as significant. Because the correlation results were found to be insignificant, a post–hoc analysis was performed. We study the convergent validity (Validity–Construct–related, include examining the logical relations that should exist with other measures, know too as convergent validity) analyzed using the Spearman rank correlation statistic values greater than (r <0.29 are weak correlations; r <0.3– .58 are moderate correlations and; r < 0.59 are high correlations the convergent validity).
Results: The consistency inter-rater (CG–NDP), were without any significant agreement; in the inter- tems correlations the best values were for the patients; and in the Spearman’s correlations (a measure of converging validity), the values obtained on the NDP were more significant.
Conclusions: We can assume that the patient’s NDP is the best source of information, and hence for these patients, we consider that the NPI–Q (reported by the CG) is not the best tool to evaluate the Neuropsychiatric symptomatology of NDP sufferers.
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Valor del Potencial Evocado Auditivo de Latencia Media en el estudio de personas con Esclerosis Múltiple Forma Brote–Remisión.
A prospective study was carried out to establish the utility of Auditory Middle Latency Response (AMLR) in the evaluation of patients with relapsing- remitting multiple sclerosis. Twenty subjects were evaluated with the multimodal battery of auditory, visual and somatosensory evoked potentials, AMLR, and motor evoked potential by transcraneal magnetic stimulation. The results showed the following abnormalities: 60 % in the AMLR, (only 50 % of them with clinical symptoms), 25% in the auditory brainstem response, 85 % in the visual response and 90 % in somatosensorial and motor potentials. We found significant differences between the auditory tests and the rest of the electrophysiological techniques (rate comparison, p<.05). Those differences disappeared when auditory tests were considered together. There was a significant association between anatomical and functional tests in the evaluation of the auditory pathway, and a positive correlation between the absolute latency of Na, Pa, and Pb components and the temporal course of the disease. The results suggest the convenience of including AMLR in the battery of evoked potentials for the study of relapsing- remitting multiple sclerosis patients.
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Subtipos de Enfermedad Cerebrovascular: Análisis del registro de la Unidad de Ictus del Hospital Clínica Kennedy.
The main goal of this study was to determine the relative incidence of the different subtypes of stroke in a group of people from Guayaquil, considered of a relatively high socioeconomic stratus, to establish a relationship that was previously proposed as a probable cause of the etiologic stroke subtype variation found in our city. We conducted a retrospective study, in which were identified 100 consecutive patients with acute first-ever stroke admitted to the stroke unit of Hospital-Clínica Kennedy. The results were: male prevalence (57% vs 43%), mean age of onset 70 years for infarcts and 54 years for hemorrhages. Sixtythree patients had a cerebral infarction and 37 had an intracranial hemorrhage. As conclusion, we found that this relatively high prevalence of hemorrhages were related to rupture of intracranial aneurysms, and that most infarcts were related to hypertensive vasculopathy. We also found that the main risk factors were arterial hypertension and cardiopathies (p<0.05). Is important to resolve the controversies that were provoke in the last years about onset variability in types and subtypes of stroke, for which more studies and further are required.
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Cadena de supervivencia del Ictus: Un desafío de la medicina actual.
A quasi experimental study was carried out in patients with cerebrovascular disease, through the stroke survival chain at the Municipality Holguín, in order to characterize the access getting of these patients to the secondary care unit at the Hospital Provincial Docente V. I. Lenin, from May to October 2006. Neurological evaluation and cerebrovascular risk scales were applied, obtaining the following results: ages from 60 to 74 years were the more affected, predominantly in male. Atherotrombotic cerebral infarcts were the more frequent. Only 8 patients (23,5%) arrived to the hospital during the first three hours of the event. High blood pressure, history of cerebrovascular disease and cardiopathies were the more frequent risk factors. Glasgow coma scale above 11 points was observed in all the cases. We conclude that, in order to reestablish cerebral blood flow after stroke, it is necessary to participate in a whole performance survival chain.
