Disability
Discapacidad e inclusión educativa en la enseñanza superior de Honduras: Lecciones aprendidas. Disability and educational inclusion in higher education in Honduras: Lessons learned.
Palabras clave: Discapacidad,
educación superior,
Honduras,
inclusión educativa,
lecciones aprendidas,
Factores asociados al tiempo libre de discapacidad en pacientes con Esclerosis Múltiple de un instituto de neurología en Medellín, Colombia. Factors associated with disability-free time in patients with Multiple Sclerosis of a neurology institution in Medellin, Colombia
Introduction: Multiple Sclerosis is the leading neurological cause of disability in young adults. The objective of this study was to describe the time free from disability since diagnosis and to analyze associated factors.
Method: Retrospective follow-up study of a cohort based on records of patients who consulted the Neurological Institute of Colombia between 2013 and 2021. Progression to disability was defined as the time to obtain a value greater than 3.5 on the EDSS scale. Parametric survival model for interval censored data with Weibull distribution was used to estimate survival function and Hazard Ratios.
Results: 216 patients were analyzed. The median disability-free time was 12 years (95% CI 7.56-17.66). Cerebellar complications (aHR = 8.18; 95% CI 4.09-16.35), vision (aHR = 2.25; 95% CI 1.25-4.05) and age at diagnosis over 40 (aHR = 1 .28; 95% CI 0.68-2.4) were associated with shorter time to progression, other initial symptoms (aHR = 0.35; 95% CI 0.18-0.68), stem lesions (aHR = 0.6; 95% CI 0.33-1.1), MSRR (aHR = 0.17; 95% CI 0.08-0.33) and women were associated with a longer time to progression.
Conclusion: Clinical and imaging factors allow identifying patients at high risk of rapid progression to disability.
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Palabras clave: Análisis de Supervivencia,
Discapacidad,
esclerosis múltiple,
Supervivencia sin Progresión,
Discapacidad asociada a manifestaciones neurológicas de COVID-19. Disability associated with COVID-19’s neurological manifestations
Introduction: COVID-19 is mainly a respiratory illness, however, with an incidence in nearly a third of patients of neurological manifestations secondary to affection to the central or peripheral nervous system, used to be more frequent in severe illness, having a wide range of disability and mortality.
Clinical case: We present the clinical case of a 39 years old female ,previously healthy, with diagnosis of COVID-19, initiating her illness with encephalitis and status epilepticus, posteriorly longitudinally extensive myelitis and anoxic-ischemic encephalopathy, which, despite of opportune diagnosis and treatment, she had a poor outcome developing persistent vegetative state.
Conclusions: COVID-19’s neurological manifestations could lead to a high risk of disability and mortality, needing an opportune detection and treatment, with a high suspicion of encephalitis and status epilepticus in patients with decrease of alertness and focal motor symptoms.
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Palabras clave: COVID-19,
Discapacidad,
encefalitis,
estado epiléptico,
Manifestaciones neurológicas,
Mielitis,
Keywords: COVID-19,
Disability,
encephalitis,
myelitis,
neurological manifestations,
Status Epilepticus,
Magnetic Resonance Poor Prognostic Factors In Mexican Multiple Sclerosis Patients. Factores de Mal Pronóstico Por Resonancia Magnética en Pacientes Mexicanos Con Esclerosis Múltiple.
Introduction: Multiple sclerosis is one of the main causes of disability in young people. It has characteristic lesions in magnetic resonance images which are part of diagnosis criteria, and some of them could predict a long-term disability. In mexican population there is no description about multiple sclerosis imaging characteristics.
Materials and methods: We performed an observational, descriptive, cross-sectional, and retrolective study at the Neurology Service of Specialties Hospital of Siglo XXI National Medical Center of Mexican Social Security Institute, in Mexico, evaluating magnetic resonance images characteristics of patients with multiple sclerosis diagnosis between January 2017 and January 2020.
Results: 75 patients were included, 8% had 1-3 T2-weighted lesions, 18.6% had 4-9 T2-weighted lesions, and 73.3% had 10 or more T2-weighted lesions. 50.6% had infratentorial lesions and 61.3% had spinal cord lesions. Gadolinium enhancing lesions were found in 48%, with a median of lesions 2 (IQR 1,3).
Conclusions: Mexican patients with multiple sclerosis have a great incidence of magnetic resonance image poor prognosis factors, which should lead to a closer follow-up and influence treatment options.
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Keywords: Disability,
epidemiology,
magnetic resonance,
mexican patients,
multiple sclerosis,
Prognosis,
Parálisis Cerebral en Pediatría: Problemas Asociados. Cerebral Palsy In Pediatrics: Associated Problems
Introduction: Cerebral palsy is the most frequent cause of childhood disability. Children with CP will associate, in addition to neurological problems, other non-neurological disorders that will be more frequent with a greater degree of CP involvement.
Objective: To address the clinical manifestations of children with cerebral palsy and their diagnostic and therapeutic management in order to provide a comprehensive approach to these patients in a single document.
Development: A review is made of the clinical manifestations of the child with cerebral palsy including neurological disorders, orthopedic problems, digestive disorders, respiratory problems, bone health, visual and hearing problems, urological and sexual disorders, oral health, hypersalivation, sleep disorder and pain.
Conclusions: The approach to the patient with CP has changed in recent years. Care provided by an specialized multidisciplinary team is essential. However, from our experience, the role of a pediatrician who knows all the associated problems seems essential to coordinate all the follow-up.
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Palabras clave: diagnóstico,
Discapacidad,
parálisis cerebral,
trastornos neurológicos,
Tratamiento,
Estatus Epiléptico. Factores Asociados a Una Evolución Desfavorable en un Centro Terciario. Status Epilepticus. Prognostic Variables For An Unfavorable Outcome In A Tertiary Center Of Care.
Introduction. Status Epilepticus (SE) is a frequent neurologic emergency. Little research has been done in South America to evaluate the prognostic variables of mortality and disability in patients with SE. Objective. To determine the variables associated to an unfavorable outcome at hospital discharge in the patients who were treated for SE. Methods. A retrospective study was performed during the period of January 2016–June 2017. A total of 26 patients were diagnosed of SE and its different variants. The effects of clinical, radiological, and electroencephalographic features on hospital outcome according Rankin scale were evaluated Results. Twelve (46.2%) patients had an unfavorable outcome at hospital discharge, while the mortality rate reached 23.1%. There was a predominance of males with a 76.9% of all the patients. The independent variables associated with an unfavorable outcome were the number of comorbidities (p=0.01, OR: 4.27-95%CI1.33-13.6), structural lesions on the Magnetic Resonance Image (MRI) (p=0.04, OR: 3.92-95%CI1.05-14.61) and refractory SE (p=0.01, OR: 12.52-95%CI1.85-84.44). There was also a trend for age (p=0.07 OR: 1.03-95%CI0.99-1.07). While an initial good clinical condition, according to the Glasgow Scale represent a protective factor (p=0.00 OR: 0.49-IC95% 0.29-0.84) of an unfavorable outcome. Conclusions. The unfavorable outcome was marginally associated with patient age, clinical status at the onset of SE according to the Glasgow Coma Scale, as well as brain lesions on brain MRI. Refractory SE and more than 4 comorbidities are predictors of an unfavorable outcome at hospital discharge.
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Palabras clave: Discapacidad,
Epilepsia,
Estatus epiléptico,
Estatus Epiléptico refractario,
Mortalidad,
Keywords: Disability,
Epilepsy,
Mortality,
outcome,
Refractory status Epilepticus,
Status Epilepticus,
Código Ictus: Protocolo de Tratamiento del Ictus Cerebral Isquémico
Cardiovascular diseases are the leading causes of mortality worldwide and Ecuador is not an exception. One of the great issues about these phenomena is the impact on vital organs such as the brain. Several features of cerebrovascular diseases, such as the high rate of associated disability and radiological advances, have encouraged the different government health institutions to establish standardized procedures, which are executed in order to generate an early diagnosis and individually analyze following procedures in affected patients. This article reviews the literature about CODE STROKE, which is a standardized approach performed in spaniards hospitals.
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La Creatinfosfokinasa tiene utilidad en la Evaluación Pronóstica Temprana de Discapacidad en el Infarto Cerebral.
Introduction: Cerebral infarction is the third cause of morbidity and mortality in the occidental world. The diagnosis is usually based on clinical and imaging studies, like computerized axial tomography. However, the prognostic value is limited especially in the first 48 h after the event. Currently, creatinphosphokinase tests are not known as a prognostic tool.
Objective: To study the creatinphosphokinase serum levels in patients with cerebral infarction in the first hours after the event, to determinate prognosis and establish a relation with disability.
Patients and methods: Forty hospitalized patients with cerebral infarction were studied. Levels of creatinphosphokinase in serum were measured at 12, 24 and 48 hours after infarction and were associated with disability using the Rankin modified scale.
Results: The creatinphosphokinase concentration increased during the first 12 hours after infarction, was higher at 24 hours and, at 48 hours, it began to decrease. The levels of creatinphosphokinase are correlated with disability results in the Rankin scale.
Conclusions: The creatinphosphokinase can be a useful tool in the prognostic evaluation of disability in patients suffering brain infarction, in the first hours after the event takes place, and preceding tomographic alterations.
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Palabras clave: Creatinfosfokinasa,
Discapacidad,
infarto cerebral,
Marcador biológico,
Pronóstico,
Rankin,
Keywords: Biological marker,
Cerebral infarction,
Creatinphosphokinase,
Disability,
Prognosis,
Rankin,
