Juan M Marquez-Romero | IMSS (original) (raw)

Papers by Juan M Marquez-Romero

Lux médica, Jan 31, 2013

La hemorragia subaracnoidea (HSA) es una emergencia neurológica caracterizada por la extravasació... more La hemorragia subaracnoidea (HSA) es una emergencia neurológica caracterizada por la extravasación de sangre dentro de los espacios del sistema nervioso central en los cuales circula el líquido cefalorraquídeo extra ventricular. A pesar de que representa sólo el 5% de la enfermedad vascular cerebral (EVC) en general, es responsable del 25% de todas las muertes relacionadas con EVC. El uso médico más común del término HSA se refiere al tipo no traumático de esta patología y es el objeto de la presente revisión del tema.

Anales De Pediatría (english Edition), Mar 1, 2021

Introduction: The objective of the study was to analyse the correlation between extracorporeal li... more Introduction: The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD). Patients and methods: Study in a cohort of patients aged 0-15 years that underwent ECLS for cardiac surgery after obtention of signed informed consent. We calculated a sample size of 23 participants. First, we obtained 3 vertical and 3 horizontal measurements of the ONSD for each eye and calculated the mean of both eyes for each measurement to be used in the analysis. The measurements were made at admission and at 6 and 24 h post surgery. We retrieved the ECLS time and the aortic cross-clamp time were from the operative report. Results: We analysed data for 23 participants, 52.2% female, with a median age of 14 months. The median ECLS time was 60 min; the median aortic cross-clamp time was 32 min. The median baseline ONSD was 3.1 mm. ONSD values had increased a median of 0.015 mm at 6 h post surgery (P = .03). We found a positive correlation between ECLS time and ONSD values (r = 0.476, P < 0,05). The ONSD values returned to baseline by 24 h post surgery. None of the patients developed signs or symptoms of increased intracranial pressure. Conclusion: Our study found a correlation between ECLS time and ONSD at 24 h post surgery. We found variations in the ONSD even in patients without signs or symptoms of increased ICP. Further research is required to identify the factors related to these variations.

Clinical and experimental emergency medicine, Jul 22, 2022

The use of extracts from the hawthorn plant as cardiovascular agents dates back to the 1st centur... more The use of extracts from the hawthorn plant as cardiovascular agents dates back to the 1st century; recently, they have also been made available online as weight loss aids. Herein, we present a case of intentional intoxication with hawthorn root extract (HRE) in an adult patient that resulted in death. A 20-year-old female patient, who was clinically diagnosed with depression, developed hypotension, bradycardia, and depressed consciousness after ingestion of this extract. An electrocardiogram recorded a sinus arrest with a slow nodal rhythm, which rapidly deteriorated, leading to cardiac arrest. This case report illustrates the potentially fatal consequences of HRE for which the constituents have not yet been characterized. All physicians, especially those in the emergency department, should be aware of the dangerous, even potentially fatal interactions of HRE with prescription medications.

Revista de Neurología, 2015

Objetivo. Determinar la frecuencia de acidosis metabolica y sus factores relacionados en paciente... more Objetivo. Determinar la frecuencia de acidosis metabolica y sus factores relacionados en pacientes tratados con topiramato solo o como adyuvante para el tratamiento de epilepsia. Pacientes y metodos. Analisis transversal de la gasometria arterial de pacientes epilepticos que recibieron topiramato durante 2010 en la clinica de epilepsia del Centro Medico Nacional 20 de Noviembre en Mexico. Se registraron datos clinicos concernientes a la epilepsia y su tratamiento, asi como de los sintomas comunes de acidosis metabolica. Resultados. Se estudiaron 32 adultos con epilepsia, quienes recibieron topiramato en monoterapia o en combinacion por lo menos durante un mes. Se encontro acidosis metabolica en todos los pacientes (HCO3 < 22 Eq/L); nueve tomaron solo topiramato y 23 tomaron por lo menos dos farmacos antiepilepticos (FAE). Todos los pacientes fueron asintomaticos. No se encontro correlacion entre los niveles de bicarbonato y la dosis del medicamento o la duracion del tratamiento. La dosis fue significativamente mayor en el grupo de monoterapia y el nivel de bicarbonato fue mas bajo en los pacientes que tomaban mas de un FAE. Conclusiones. El uso concomitante de FAE incrementa los efectos conocidos del topiramato sobre los niveles sericos de bicarbonato y la presencia de acidosis metabolica; estos efectos parecen ser independientes del numero de FAE utilizados.

Revista Mexicana de Neurociencia, 2013

RESUMEN INTRODUCCIÓN: La evaluación de los efectos deletéreos del insomnio en el funcionamiento d... more RESUMEN INTRODUCCIÓN: La evaluación de los efectos deletéreos del insomnio en el funcionamiento diurno constituye una parte fundamental de la epidemiologia del insomnio. OBJETIVO: Describir las características demográficas, síntomas de insomnio y sus consecuencias diurnas de los pacientes mexicanos enrolados en el estudio internacional EQUINOX. MÉTODOS: El estudio descriptivo EQUINOX incluyó originalmente pacientes ambulatorios de diez países. En este reporte se analizó la información de pacientes que acudieron a atención primaria en México, con diferentes motivos de consulta médica. Se entrevistaron a todos los pacientes por dos días consecutivos de cada semana de trabajo. A aquellos identificados con insomnio les fue aplicado un cuestionario estandarizado que incluyó variables antropométricas y socio-demográficas, características del insomnio, consecuencias diurnas del insomnio y tipo de intervención para tratar el insomnio. RESULTADOS: Se evaluaron 3,021 mexicanos, con una frecuencia de insomnio de 62.3%. La dificultad para iniciar el sueño estuvo presente en 1,135 pacientes (82.4%), la dificultad para mantener el sueño en 1,108 (80.4%), los despertares matutinos tempranos en 983 (71.3%) y el sueño no reparador en 1,144 pacientes (83%). El funcionamiento social, laboral y emocional vio afectado en 75% de los pacientes y en 25% esta afectación fue severa. CONCLUSIONES: El insomnio constituye un trastorno del sueño muy frecuente en mexicanos que reciben atención primaria. Los médicos de primer contacto desempeñan un papel primordial para la identificación, tratamiento y seguimiento del insomnio y sus consecuencias diurnas.

Revista Mexicana de Neurociencia

European Neurology, 2022

Background: Given the high contribution of stroke to the global burden of disease, there is a nee... more Background: Given the high contribution of stroke to the global burden of disease, there is a need for good-quality information on Web platforms such as Wikipedia. Aims: This study aimed to describe the quality of the Wikipedia articles on stroke written in different languages. Methods: We studied the world’s 30 most spoken languages. With the DISCERN score, we evaluated the quality of the information within the Wikipedia articles. Three investigators assessed each of the texts translated to English. We also registered the word count, the number of references, and if the text referred to the emergency status of stroke, cues to suspect a stroke, and allusions to endovascular treatment. Results: There is a Wikipedia article for stroke in 23 out of the 30 languages. The mean DISCERN score was 35 29.9 ± 9.2. Overall quality ranged from 3/5 in 26.1% to 1/5 in 17.4%. Word count had a mean of 36 3,145.8 ± 3,048.9 words, and the texts included a mean of 43.1 ± 57.3 references; 69.6% of the articles referred to stroke as a medical emergency, 52.2% included awareness symptoms, and 34.8% included endovascular management among the stroke treatments. Three pages included steroids as part of the stroke treatment. The DISCERN score was not correlated with the number of speakers, but it was positively correlated with the number of references (r = 0.90, p < 0.001) and the number of words (r = 0.78, p < 0.001) in the articles. Conclusion: The analyzed Wikipedia articles do not contain relevant and up-to-date information to the general population. Further, the content varies widely across the different languages and is missing for some of them. The missing versions disproportionally affect millions of potential information seekers in undeveloped countries.

Frontiers in Neurology, Feb 9, 2021

Background: Providing endovascular treatment (EVT) access for acute ischemic stroke (AIS) is a ch... more Background: Providing endovascular treatment (EVT) access for acute ischemic stroke (AIS) is a challenge in Latin America. Even though the Mexican Endovascular Reperfusion Registry (MERR) and the RESILIENT trial have demonstrated the feasibility of EVT of AIS in Latin America, the MERR has uncovered potential challenges to delivering EVT to AIS patients. Aim: To identify the perceived barriers to access EVT for AIS in Mexico. Methods: We surveyed endovascular neurologists in Mexico. The survey addressed the situation of thrombectomy in the country and the infrastructure and resources available in the participants' institutions. The questionnaire inquired about costs, barriers, and challenges to accessing EVT for AIS, emphasizing the prices and availability of medical devices needed for EVT. Results: We analyzed data from 21 hospitals. The most extreme identified barriers to access EVT were the lack of health coverage for EVT in the National Health System, the cost of the medical supplies for EVT, and inadequate knowledge of stroke symptoms in the general population. The median cost for EVT was USD 20,000

Epilepsy & Behavior, Apr 1, 2020

Introduction: The incidence of mood disorders and psychopathology is more frequent in patients wi... more Introduction: The incidence of mood disorders and psychopathology is more frequent in patients with epilepsy (PWE) than in the general population. Also, it has been reported that PWE suffer more seizures during certain phases of their menstrual cycle (MC). Still, limited information exists regarding the relationship between the physical and emotional changes during the MC in PWE. Therefore, in this study, we aimed to evaluate the mood and personality traits of PWE during their MC and to compare them with controls. Methods: A cohort of 22 PWE and nine controls was gathered. All the participants underwent psychiatric, electroencephalographic, and gynecological evaluations. Results: Overall, PWE scored higher in depression compared with controls (p b 0.05), PWE also obtained higher scores for the personality traits of neuroticism and self-isolation (p b 0.05). During the evaluation of the symptoms of premenstrual syndrome (PMS), PWE were more symptomatic during the early follicular (EF) phase in comparison with the rest of the phases of their MC, whereas the control group showed the known premenstrual pattern of symptoms during the late luteal (LL) phase. The frequency of seizures (40.6%) and electroencephalographic abnormalities (34.8%) was also higher during the EF phase of the MC when compared with the other phases of the MC (p b 0.05). Conclusions: The results of this study suggest that unlike the PMS present in women without epilepsy, PWE appear to show a "menstrual syndrome" that consists of similar mood changes and physical symptoms. This arrangement of symptoms seems to have an impact on the increase in seizure activity.

Stroke, Jul 1, 2021

Background and Purpose: Sphenopalatine ganglion (SPG) electrical stimulation has been studied in ... more Background and Purpose: Sphenopalatine ganglion (SPG) electrical stimulation has been studied in the setting of acute ischemic stroke to enhance collateral flow. Capsaicin poses an alternative to chemically stimulate the sphenopalatine ganglion. Therefore, the objective of this study was to determine the safety and effect of increasing doses of capsaicin upon serial transcranial Doppler markers of cerebral blood flow. Methods: We performed serial transcranial Doppler testing in 30 healthy volunteers divided into 5 equal groups. Capsaicin doses ranged from 33 to 165 μMol. We recorded peak systolic and end-diastolic velocities in the middle cerebral artery, arterial pressure, and perceived pungency in 5-minute intervals up to 20 minutes. We then calculated the mean velocity, the pulsatility index, and the cerebral blood flow index. Results: The participants’ median age was 21 years (range, 5 years); all reported consumption of capsaicin in their diets. After and during the study, none reported side effects. Perceived pungency peaked at 5 minutes, and by the 20-minute mark, none perceived any pungency. All the tested doses produced the same pattern, consisting of augmentation of the middle cerebral artery mean velocity with the pulsatility index’s diminution. The effects peaked between the 5- and the 10-minute measurements and then returned to basal levels except for the 66-μMol doses, which produced a sustained effect. We found no correlation between perceived pungency and dose, but the middle cerebral artery mean velocity was strongly correlated with the dose administered. Conclusions: This study provides evidence supporting the safety and tolerability of oral capsaicin in a population of healthy volunteers. Capsaicin appears to produce effects similar to those of sphenopalatine ganglion electrical stimulation. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04545892.

Frontiers in Neurology, Feb 22, 2023

Neuroradiology, Nov 29, 2021

To describe the differences in the serum levels of MMP-2 and MMP-9 of patients with vertebrobasil... more To describe the differences in the serum levels of MMP-2 and MMP-9 of patients with vertebrobasilar dolichoectasia (VBD) with and without acute stroke. Case–control study. From an outpatient clinic, we recruited 14 controls and 19 patients with VBD. We also recruited 33 patients with stroke from two emergency departments, 14 without VBD (S/-VBD) and 19 with VBD (S/ + VBD). All the patients underwent serum MMP-2 and MMP-9 measurements and a non-contrast CT scan. Two investigators assessed the intracranial vertebral arteries (VA) and the basilar artery (BA) at the mid-pons. Diagnosis of VBD was made if the BA diameter was ≥ 4.5 mm. The mean age of the 66 patients studied was 57.6 + 16.0 years, 41% female. In the 33 patients with stroke, the median NIHSS was 8 (range 15); there were no differences in the NIHSS scores between both groups with stroke. Median MMP-2 levels were lower in the S/-VBD when compared to controls. Median MMP-9 serum levels were higher in both groups with VBD when compared to controls and the S/-VDB group. Both groups with stroke exhibited higher MMP-9 serum levels than controls but were not statistically different from those found in patients with VBD. Serum levels of MMP-9 were significantly correlated with the diameters of the BA (r = 0.344, p = 0.01) and the left VA (r = 0.305, p = 0.05). This study found that high serum levels of MMP-9 are associated with VBD independently of stroke and correlated with the degree of VBD.

Vascular and Endovascular Surgery, Feb 19, 2020

Background: There is inequality in access to recent advancements in endovascular treatment of acu... more Background: There is inequality in access to recent advancements in endovascular treatment of acute ischemic stroke (AIS), and Mexico is unusually sensitive to such inequality. Aims: To report the initial experience of the Mexican Endovascular Reperfusion Registry (MERR). Methods: The MERR is an academic, independent, prospective, multicenter, observational registry of patients treated with endovascular reperfusion techniques in Mexican hospitals. The registry includes information on demographic and clinical characteristics, diagnostic procedures, treatments, selected time metrics, and outcomes. Results: In all, 49 (57.1% female) patients from 8 centers were included and had the following characteristics: median National Institute of Health Stroke Scale score, 16; median Alberta Stroke Program Early CT Score score, 9; received intravenous tissue-type plasminogen activator, 49%; and treated with mechanical devices, 39 (79.6%), including 20 treated with stent retriever alone, 2 with retriever and intra-arterial thrombolysis (IAt), 10 with catheter aspiration (4 in combination with IAt), 6 with a combination of catheter aspiration and stent retriever, and 1 with IAt followed by balloon angioplasty. Recanalization (TICI 2b or better) was achieved in 69.4% of the patients. The median clot to recanalization time was 30 minutes. A modified Rankin scale 2 was achieved in 44.9% of the patients, and 68.2% of these were treated with stent retriever (P ¼ .011). Procedure-related morbidity was 12.2%, 7 patients presented intracerebral hemorrhage (71.4% asymptomatic), and all-cause mortality was 6.1%. Conclusions: Endovascular treatment of AIS in Mexico is feasible and has an efficacy comparable to that of other countries. Still, many challenges remain, especially pertaining to high costs and difficulties in equality in access to treatment.

Medical research archives, 2022

Neurology India, 2020

The actual investigation of the body of a patient by the clinician in search for the signs of the... more The actual investigation of the body of a patient by the clinician in search for the signs of the disease beginning with the primary vital signs and continues with the careful and attentive observation of the patient. This article reviews the key findings in the physical examination of patients with ischemic stroke that have the potential to indicate the etiology of the infarct and to help to choose the use of ancillary tests. Through a systematic search of articles published in English related to the physical examination of patients with stroke, we identified key findings in the vital signs and classic components of the physical exam (appearance of the patient, auscultation, and eye examination) that have shown clinical significance when determining ischemic stroke etiology. We further suggest that the prompt identification of such findings can translate into better use of diagnostic tools and selection of ancillary confirmatory tests, thus, reducing the time to etiology based treatment and secondary prevention of ischemic stroke. in this manuscript, we aim to show that even though nowadays the clinical skills tend to be overlooked due to the overreliance on technology, the physical exam continues to be a valuable tool in the clinician armamentarium when facing the challenge of a patient with ischemic stroke.