Erwin Chiquete, MD, PhD | Instituto Nacional de Ciencias Médicas y Nutrición S.Z. (original) (raw)
Papers by Erwin Chiquete, MD, PhD
Arquivos Brasileiros de Cardiologia, 2010
Background: Although the carotid stenosis is the main cause of cerebrovascular accident, the prev... more Background: Although the carotid stenosis is the main cause of cerebrovascular accident, the prevalence of clinically significant stenosis (≥50%) remains unknown in our country, mainly in individuals with a surgical indication for elective myocardial revascularization surgery. Objective: To identify the prevalence and degree of carotid stenosis in individuals with a surgical indication for MRS in a reference center in Cardiology in Brazil. Methods: Transversal study of 457 consecutive patients of both genders, evaluated between May 2007 and April 2008 through ultrasonography with color Doppler of the carotid arteries, during the preoperative period of elective MRS. The statistical analysis was performed with the SPSS program, version 10.1. A p value <0.05 was considered significant. Seven patients were lost throughout the study. Results: : The mean age (±standard deviation) was 62.2 ± 9.4 years and 65.6% of the patients were males. The prevalence of significant carotid stenosis was 18.7%. As for the stratification of the degree of carotid stenosis: absence of stenosis was observed in 3.6%; stenosis < 50% was observed in 77.8%; stenosis between 50% and 69% was observed in 11.6%; stenosis between 70% and 99% was observed in 6.9% and arterial occlusion was observed in 0.2% of the individuals. The sensitivity and specificity regarding the carotid bruit were 34.5% and 88.8%, respectively. Conclusion: The prevalence of significant carotid stenosis was high in the studied sample, which suggests this is a highrisk population for the occurrence of cerebrovascular accident. (Arq Bras Cardiol 2010;94(2): 169-174
Stroke
Introduction: Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular condition, which pr... more Introduction: Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular condition, which presents with a wide spectrum of symptoms' onset and clinical syndromes. Hypothesis: We assessed the hypothesis that there is a correlation among the main clinical syndromes in CVT and the sites of venous occlusion; also we analyzed functional outcome on each clinical syndrome in the acute setting (30-days). Methods: This is a retrospective analysis from a systematic database of hospitalized patients from January 1979 to December 2014. Univariate and adjusted multivariate models were used to evaluate in a first step, association between clinical syndromes and affected vessels, and in a second step functional outcome in the acute setting (30-day follow-up). Clinical syndromes were classified as: focal syndrome, encephalopathy, isolated intracranial hypertension, meningeal syndrome. Affected vessels were classified as isolated thrombosis or vessels combinations. Functional outcome was ba...
Revista medica del Instituto Mexicano del Seguro Social
to measure the frequency of type 2 diabetes mellitus (T2DM) in patients with confirmed HCV infect... more to measure the frequency of type 2 diabetes mellitus (T2DM) in patients with confirmed HCV infection. we studied 125 adults reactive to anti-HCV antibodies (62.4 % women, mean age 46.8 years) who received confirmatory RT-PCR testing for viremia (63.2 % HCV-RNA-positive). twenty-two patients had T2DM (17.6 %, 95 % confidence interval: 11.8-25.3 %; mean National prevalence: 14.4 %), more frequent among patients with detectable viremia than in negative cases (23.3 % vs. 9.6 %, respectively; p = 0.04), and among those with advanced liver disease, than in compensated patients (28.9 % vs. 11.3 %, respectively; p = 0.01). Fourteen (17.7 %) patients received interferon-based treatment and 6 (42.8 %) had sustained virology response. None of the 6 responders had T2DM, but 2 of the 8 (25 %) non-responders had diabetes. T2DM patients were older than those without diabetes (57.7 vs. 44.5 years, p < 0.001), and after multivariate analysis, only age was significantly associated with diagnosis o...
Latin american journal of clinical sciences and medical technology
Background. Distress is an unpleasant emotional experience of psychological, social or spiritual ... more Background. Distress is an unpleasant emotional experience of psychological, social or spiritual nature, which can interfere with the ability to cope. Objective. To describe the distress phenomenology in primary caregivers of adults with advanced cancer. Material and Methods. In this descriptive cross-sectional study we evaluated adults with advanced oncologic disease and their primary caregivers. A structured interview and clinimetric instruments (Palliative Performance Scale, Edmonton Symptom Assessment Scale, and The Distress Thermometer) were applied to estimate the frequency and severity of distress in both groups. We also examined possible variables associated with distress. Results. Information on 87 patient-caregiver dyads (n=174) was analyzed. Age was significantly lower in caregivers than in patients. Approximately half of the caregivers had a paid job; 38 % was a homemaker. The prevalence of distress was significantly higher among caregivers than their patients (86.2 % vs...
S R E UMEN ci n c ó Introdu i : La afección simultánea del sistema nervioso central (SNC) y perif... more S R E UMEN ci n c ó Introdu i : La afección simultánea del sistema nervioso central (SNC) y periférico (SNP) es una condición clínica infrecuente. Hasta donde sabemos, nunca se ha descrito en asociación con infección por el virus de la hepatitis C (VHC). : Caso clínico Un hombre de 51 años de edad se presentó a nuestro hospital con fiebre y depresión del nivel de conciencia, acompañado de cuadriparesia fláccida arrefléxica. Se documentó la presencia de anticuerpos anti-VHC. En la resonancia magnética (RM) de cráneo se identificó una lesión esplenial y la electromiografía (EMG) reportó una polirradiculoneuropatía axonal motora. La recuperación funcional fue casi completa a su egreso. o c e C n lusion s: La infección por VHC podría ser considerada dentro del diagnóstico diferencial de entidades que cursen con afección simultánea del SNC y SNP.
Introduction: Postsurgical pain is the main cause of acute pain in hospital settings. Selective α... more Introduction: Postsurgical pain is the main cause of acute pain in hospital settings. Selective α-2 adrenergic agonists such as clonidine and dexmedetomidine administered via peridural infusion have been evaluated in postsurgical pain control, since they act on brain stem, spinal and peripheral receptors, modulating the nociceptive input. In this context, clonidine is the most studied drug, but little information exists with dexmedetomidine. Objective: To evaluate the efficacy of the add-on use of dexmedetomidine in peridural anesthesia, as a strategy aimed to diminish postsurgical pain. Methods: An open-label trial was designed to com- pare bupivacaine via 24-h peridural infusion (n = 15) versus the combination of bupivacaine and dexmedetomidine (Bupi/Dexme, n = 21) in women who underwent abdominal hysterectomy. The main study outcome was the magnitude of postsurgical pain (as reflected in a visual analog scale) and the need for rescue analgesia during 24 h of peridural infusion af...
Introduction: Primary central nervous system lymphoma (PCNSL) is considered infrequent, even in c... more Introduction: Primary central nervous system lymphoma (PCNSL) is considered infrequent, even in cases of human immunodeff iciency vi rus (HIV) infect ion. However, little is known about the frequency of this association in Mexico. Objective: To determine the prevalence and neurological manifestat ions of patients with PCNSL and the HIV/AIDS complex, in a 10-year period in a reference hospital of the Mexico City. Methods: In this retrospective study, cl inical records of PCNSL cases in patients with HIV infection were reviewed from the clinical database of the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, from January 2001 to January 2011. Results: In this 10-year period, the pravalence of PCNSL in patients with HIV infection was 0.2% (5 cases, age range: 30-39 years): 3 (60%) man and 2 (40%) women. Histopathological analysis was achieved in 3 cases (all diffuse large B-cell non-Hodgkin lymphoma); in the rest, diagnosis was based on the clinical presentation, s...
Gaceta Medica De Mexico, 2015
espanolIntroduccion: Los estudios epidemiologicos sobre MG en Mexico derivan principalmente de ex... more espanolIntroduccion: Los estudios epidemiologicos sobre MG en Mexico derivan principalmente de experiencias en centros de referencia. Objetivo: describir las caracteristicas epidemiologicas de egresos hospitalarios efectuados durante el ano 2010 con el diagnostico de MG en adultos atendidos en el sistema sanitario publico mexicano. Metodos: se consulto la base de datos de egresos hospitalarios del ano 2010 del Sistema Nacional de Informacion en Salud (SINAIS) (Secretaria de Salud, Instituto Mexicano del Seguro Social [IMSS], IMSS Oportunidades, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado [ISSSTE], PEMEX, SEMAR y SEDENA). Se identificaron los registros de MG mediante el codigo G70.0 de la Clasificacion Internacional de Enfermedades, 10.a revision (CIE-10). Resultados: durante el ano 2010 se registraron 5,314,132 egresos hospitalarios (4,254,312 adultos), de los cuales 587 (0.01%) correspondieron a adultos con MG (mediana de la edad: 47 anos; 60% mujeres...
Introduction: Intracranial idiopathic hypertension, also known as pseudotumor cerebri is a syndro... more Introduction: Intracranial idiopathic hypertension, also known as pseudotumor cerebri is a syndrome of increased intracranial pressure usually associated with sixth cranial nerve palsy as a false localizing sign, in the absence of structural pathology. The involvement of other cranial nerves is infrequent. Case report: A 20-year-old obese woman presented to our Institution with a subacute intracranial hypertension syndrome with involvement of multiple cranial nerves (III, IV, VI, VII), as well as cervical radicular symptoms. Multimodal evoked potentials showed prolonged latencies. Intracranial structural pathology was ruled out with imaging studies and a CSF tap test confirmed the diagnosis, since this procedure completely resol- ved the clinical manifestations of involvement of multiple cranial nerves, with improvement in the evoked potentials. Conclusion: Idiopathic intracranial hypertension may occasionally be associated with various cranial nerve palsies that impose challenges i...
INTRODUCTION Moderate to severe stenosis is the less prevalent among the forms of carotid atheros... more INTRODUCTION Moderate to severe stenosis is the less prevalent among the forms of carotid atherosclerotic disease), but it carries a high risk of ischaemic stroke. AIM To characterise factors associated with moderate to severe carotid stenosis in a high-risk population. PATIENTS AND METHODS We performed an analysis on traditional risk factors associated with carotid stenosis ≥50% in 533 patients who received Doppler ultrasound due to a history of stroke (34%) or who had = 2 of the risk factors: age ≥55 years (86%), hypertension (65%), dyslipidemia (52%), obesity (42%), diabetes (40%) or smoking (40%). RESULTS The prevalence of carotid stenosis ≥50% was 7.1%, symptomatic (associated with stroke in congruent territory) in 5.6%, bilateral in 2.1% and bilateral symptomatic in 1.5%. A 36.8% of patients had moderate to severe load (≥4) of atherosclerotic plaques (25.9% moderate: 4-6 plaques, and 10.9% severe: ≥7 plaques). By multivariate analysis we identified the age ≥75 years, dyslipide...
BACKGROUND The recognition of stroke symptoms by patients or bystanders directly affects the outc... more BACKGROUND The recognition of stroke symptoms by patients or bystanders directly affects the outcomes of patients with acute cerebrovascular disease. OBJECTIVE The objective of the study was to assess the predictive value of the medical his- tory and clinical features recognized by the patients' bystanders to classify neurovascular syndromes in pre-hospital settings. METHODS We included 150 stroke patients of two Mexican referral centers: 50 with acute ischemic stroke (AIS), 50 with intracerebral hemorrhage (ICH), and 50 with subarachnoid hemorrhage (SAH). The performance of clinical prediction rules (CPR) to identify the stroke types was evaluated with features recognized by the patients' bystanders before hospital arrival. The impact of CPRs on early arrival and in-hospital mortality was also analyzed. RESULTS Overall, 72% of the patients had previous medical evaluations in other centers before final referral to our hospitals, and therefore, only 45% had a final onset- to-...
PLOS ONE
Background The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies n... more Background The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies neurologic features at presentation and complications during the disease course. We aimed to describe the characteristics and predictors for developing in-hospital neurologic manifestations in a large cohort of hospitalized patients with COVID-19 in Mexico City. Methods We analyzed records from consecutive adult patients hospitalized from March 15 to June 30, 2020, with moderate to severe COVID-19 confirmed by reverse transcription real-time polymerase chain reaction (rtRT-PCR) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurologic syndromes were actively searched by a standardized structured questionnaire and physical examination, confirmed by neuroimaging, neurophysiology of laboratory analyses, as applicable. Results We studied 1,072 cases (65% men, mean age 53.2±13 years), 71 patients had pre-existing neurologic diseases (diabetic neuropathy: 17, epilepsy: 15...
International Journal of Neuroscience
Introduction: Osmotic demyelination syndrome (ODS) is a non-inflammatory process of the central n... more Introduction: Osmotic demyelination syndrome (ODS) is a non-inflammatory process of the central nervous system caused by extracellular osmotic changes, which leads to oligodendrocyte apoptosis and disruption of myelin sheaths, usually affecting patients with underlying systemic conditions that impose susceptibility to osmotic stress. Description of ODS in patients with non-Hodgkin lymphoma (NHL) is limited to a few case reports.Methods: Here, we report a 44-year-old man with NHL that had an incidental diagnosis of ODS. We conducted a literature review of the published cases of ODS in NHL patients from 1959 to 2020, aiming to describe the characteristics of these patients.Results: A total of seven patients were summarized (four men and three women), including our case and six patients from published reports. Risk factors such as weight loss and alcoholism were reported in five (71.4%) patients. Hyponatremia was found in six (85.7%) of the cases, and none of them had overly rapid sodium correction. Four cases were asymptomatic, and diffuse large B-cell lymphoma was the most common subtype of NHL (85.7%). The outcome was favorable in most cases; only two deaths not directly related to ODS were reported.Conclusion: We wish to suggest that systemic and metabolic stress induced by NHL may be associated with the development of central osmotic demyelination, and therefore, NHL may be a novel risk factor for ODS. Clinicians should be aware of ODS in patients with hematological malignancies, even in the absence of traditional risk factors.
ABSTRACTIntroductionCoronavirus disease 2019 (COVID-19) is the systemic entity caused by the seve... more ABSTRACTIntroductionCoronavirus disease 2019 (COVID-19) is the systemic entity caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that may cause death through severe atypical pneumonia and acute lung injury. Valproic acid (VPA) has shown anti-inflammatory activity and mild intrinsic antiviral effect. These properties warrant the study of VPA as a possible active treatment in persons with severe COVID-19.MethodsConsecutive adult patients needing invasive mechanical ventilation (IMV) will be given intravenous (i.v.) VPA at a starting dose of 20 mg/kg/day and up to 60/kg/day (in 60 min i.v. infusions in 250 mL normal saline) as needed to reach plasma VPA concentrations of 50–100 μg/mL (measured every 72 h). These patients will be followed-up for 10 days for the primary outcome and for a further period of 30 days after treatment completion for the secondary outcome of recurrence. The primary study outcome is the reduction in the case fatality rate of at least 50%...
PLOS ONE
Background Adherence to disease-modifying therapies is determinant to attain maximal clinical ben... more Background Adherence to disease-modifying therapies is determinant to attain maximal clinical benefit in multiple sclerosis (MS). RebiSmart® is an electronic auto-injector for subcutaneous delivery of interferon β-1a (INF-β1a) that monitors adherence by featuring a log of each drug administration for objective evaluation. The aim of this study was to assess long-term adherence to INF-β1a by using the RebiSmart® device in Mexican patients with relapsing MS. Methods This is an observational multicenter study on patients with relapsing MS treated with INF-β1a subcutaneously delivered by the RebiSmart® device. Adherence was computed as the number of injections received during the study period divided by the number of injections scheduled and expressed as percent. Results A total of 66 patients from 6 specialized MS centers were evaluated (45 females and 21 males, mean age 43.91±13.32 years). Mean adherence was 79.51±18% (median: 85.54%, range: 34.4-100%). During a median follow-up of 27.5 months (mean 33.36±29.39 months) the annualized relapse rate had a mean of 0.50±1.63. Mean initial EDSS was 1.90±1.52, and mean EDSS at the end of follow-up was 1.80±1.74. Compared with their counterparts, the mean number of relapses was significantly lower among patients with high (>80%) adherence (0.25±0.44 vs 0.67±92 relapses, respectively; P = 0.03). The proportion of relapse-free patients was 75.0% among patients with high adherence and 53.3% in low-PLOS ONE
Journal of Stroke and Cerebrovascular Diseases
BACKGROUND Transcranial color-coded sonography (TCCS) allows direct observation of arteries and t... more BACKGROUND Transcranial color-coded sonography (TCCS) allows direct observation of arteries and the possibility of correcting the insonation angle for reliable evaluation of hemodynamics. We obtained TCCS reference values of the cerebral hemodynamics after correction of insonation angles. METHODS We studied 195 healthy adults equally allocated into 3 age groups: 18-40, 41-60, and greater than or equal to 61 years. The middle (MCA), anterior (ACA), and posterior cerebral arteries (PCA) were evaluated through the temporal acoustic window using conventional pulsed transcranial Doppler and TCCS. Peak systolic, end diastolic, and mean blood flow velocities were registered, as well as pulsatility and resistance indices at 0° and with correction by alignment of insonation angle parallel to the blood flow vector. We derived normative values assuming both the parametric and nonparametric distributions. RESULTS We excluded 33 participants due to inadequate acoustic window (10.3%), carotid disease (2.1%), and embryonic variants (4.6%), leaving out 162 for final analysis (50% female, median age 48 years). The 2.5th-97.5th percentiles of the corrected angle for MCA was 0°-60°, ACA 0°-44°, and PCA 30°-60°. After angle correction, 2.5th-97.5th percentiles for flow velocity of MCA, ACA, and PCA were 37.7-112.5 cm/s, 25.6-71.2 cm/s, and 29.2-80.8 cm/s, respectively. There were wide discrepancies between hemodynamics values obtained with insonation angles at 0° and after angle correction. No differences were found between ultrasound methods at exactly 0° or between hemispheres, however, there were differences according to age and sex. CONCLUSIONS Specific normative tables should be used in TCCS when the corrected angle is greater than 0° since the hemodynamics values greatly differ after correction of the insonation angle. Further studies are necessary to determine critical cutoffs indicating disease.
Gaceta de M�xico
be documented in approximately 80 % of cases, according to the group under study. 6-12 Clinically... more be documented in approximately 80 % of cases, according to the group under study. 6-12 Clinically significant CAD can be defined according to the degree of stenosis, arterial wall thickening, atheroma plaque load or dimensions, which depends on the method used to document the CAD (carotid ultrasound, tomography, magnetic resonance, autopsy, among others). 2,4,12 In the general population, clinically significant CAD is more common due to plaque
Arquivos Brasileiros de Cardiologia, 2010
Background: Although the carotid stenosis is the main cause of cerebrovascular accident, the prev... more Background: Although the carotid stenosis is the main cause of cerebrovascular accident, the prevalence of clinically significant stenosis (≥50%) remains unknown in our country, mainly in individuals with a surgical indication for elective myocardial revascularization surgery. Objective: To identify the prevalence and degree of carotid stenosis in individuals with a surgical indication for MRS in a reference center in Cardiology in Brazil. Methods: Transversal study of 457 consecutive patients of both genders, evaluated between May 2007 and April 2008 through ultrasonography with color Doppler of the carotid arteries, during the preoperative period of elective MRS. The statistical analysis was performed with the SPSS program, version 10.1. A p value <0.05 was considered significant. Seven patients were lost throughout the study. Results: : The mean age (±standard deviation) was 62.2 ± 9.4 years and 65.6% of the patients were males. The prevalence of significant carotid stenosis was 18.7%. As for the stratification of the degree of carotid stenosis: absence of stenosis was observed in 3.6%; stenosis < 50% was observed in 77.8%; stenosis between 50% and 69% was observed in 11.6%; stenosis between 70% and 99% was observed in 6.9% and arterial occlusion was observed in 0.2% of the individuals. The sensitivity and specificity regarding the carotid bruit were 34.5% and 88.8%, respectively. Conclusion: The prevalence of significant carotid stenosis was high in the studied sample, which suggests this is a highrisk population for the occurrence of cerebrovascular accident. (Arq Bras Cardiol 2010;94(2): 169-174
Stroke
Introduction: Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular condition, which pr... more Introduction: Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular condition, which presents with a wide spectrum of symptoms' onset and clinical syndromes. Hypothesis: We assessed the hypothesis that there is a correlation among the main clinical syndromes in CVT and the sites of venous occlusion; also we analyzed functional outcome on each clinical syndrome in the acute setting (30-days). Methods: This is a retrospective analysis from a systematic database of hospitalized patients from January 1979 to December 2014. Univariate and adjusted multivariate models were used to evaluate in a first step, association between clinical syndromes and affected vessels, and in a second step functional outcome in the acute setting (30-day follow-up). Clinical syndromes were classified as: focal syndrome, encephalopathy, isolated intracranial hypertension, meningeal syndrome. Affected vessels were classified as isolated thrombosis or vessels combinations. Functional outcome was ba...
Revista medica del Instituto Mexicano del Seguro Social
to measure the frequency of type 2 diabetes mellitus (T2DM) in patients with confirmed HCV infect... more to measure the frequency of type 2 diabetes mellitus (T2DM) in patients with confirmed HCV infection. we studied 125 adults reactive to anti-HCV antibodies (62.4 % women, mean age 46.8 years) who received confirmatory RT-PCR testing for viremia (63.2 % HCV-RNA-positive). twenty-two patients had T2DM (17.6 %, 95 % confidence interval: 11.8-25.3 %; mean National prevalence: 14.4 %), more frequent among patients with detectable viremia than in negative cases (23.3 % vs. 9.6 %, respectively; p = 0.04), and among those with advanced liver disease, than in compensated patients (28.9 % vs. 11.3 %, respectively; p = 0.01). Fourteen (17.7 %) patients received interferon-based treatment and 6 (42.8 %) had sustained virology response. None of the 6 responders had T2DM, but 2 of the 8 (25 %) non-responders had diabetes. T2DM patients were older than those without diabetes (57.7 vs. 44.5 years, p < 0.001), and after multivariate analysis, only age was significantly associated with diagnosis o...
Latin american journal of clinical sciences and medical technology
Background. Distress is an unpleasant emotional experience of psychological, social or spiritual ... more Background. Distress is an unpleasant emotional experience of psychological, social or spiritual nature, which can interfere with the ability to cope. Objective. To describe the distress phenomenology in primary caregivers of adults with advanced cancer. Material and Methods. In this descriptive cross-sectional study we evaluated adults with advanced oncologic disease and their primary caregivers. A structured interview and clinimetric instruments (Palliative Performance Scale, Edmonton Symptom Assessment Scale, and The Distress Thermometer) were applied to estimate the frequency and severity of distress in both groups. We also examined possible variables associated with distress. Results. Information on 87 patient-caregiver dyads (n=174) was analyzed. Age was significantly lower in caregivers than in patients. Approximately half of the caregivers had a paid job; 38 % was a homemaker. The prevalence of distress was significantly higher among caregivers than their patients (86.2 % vs...
S R E UMEN ci n c ó Introdu i : La afección simultánea del sistema nervioso central (SNC) y perif... more S R E UMEN ci n c ó Introdu i : La afección simultánea del sistema nervioso central (SNC) y periférico (SNP) es una condición clínica infrecuente. Hasta donde sabemos, nunca se ha descrito en asociación con infección por el virus de la hepatitis C (VHC). : Caso clínico Un hombre de 51 años de edad se presentó a nuestro hospital con fiebre y depresión del nivel de conciencia, acompañado de cuadriparesia fláccida arrefléxica. Se documentó la presencia de anticuerpos anti-VHC. En la resonancia magnética (RM) de cráneo se identificó una lesión esplenial y la electromiografía (EMG) reportó una polirradiculoneuropatía axonal motora. La recuperación funcional fue casi completa a su egreso. o c e C n lusion s: La infección por VHC podría ser considerada dentro del diagnóstico diferencial de entidades que cursen con afección simultánea del SNC y SNP.
Introduction: Postsurgical pain is the main cause of acute pain in hospital settings. Selective α... more Introduction: Postsurgical pain is the main cause of acute pain in hospital settings. Selective α-2 adrenergic agonists such as clonidine and dexmedetomidine administered via peridural infusion have been evaluated in postsurgical pain control, since they act on brain stem, spinal and peripheral receptors, modulating the nociceptive input. In this context, clonidine is the most studied drug, but little information exists with dexmedetomidine. Objective: To evaluate the efficacy of the add-on use of dexmedetomidine in peridural anesthesia, as a strategy aimed to diminish postsurgical pain. Methods: An open-label trial was designed to com- pare bupivacaine via 24-h peridural infusion (n = 15) versus the combination of bupivacaine and dexmedetomidine (Bupi/Dexme, n = 21) in women who underwent abdominal hysterectomy. The main study outcome was the magnitude of postsurgical pain (as reflected in a visual analog scale) and the need for rescue analgesia during 24 h of peridural infusion af...
Introduction: Primary central nervous system lymphoma (PCNSL) is considered infrequent, even in c... more Introduction: Primary central nervous system lymphoma (PCNSL) is considered infrequent, even in cases of human immunodeff iciency vi rus (HIV) infect ion. However, little is known about the frequency of this association in Mexico. Objective: To determine the prevalence and neurological manifestat ions of patients with PCNSL and the HIV/AIDS complex, in a 10-year period in a reference hospital of the Mexico City. Methods: In this retrospective study, cl inical records of PCNSL cases in patients with HIV infection were reviewed from the clinical database of the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, from January 2001 to January 2011. Results: In this 10-year period, the pravalence of PCNSL in patients with HIV infection was 0.2% (5 cases, age range: 30-39 years): 3 (60%) man and 2 (40%) women. Histopathological analysis was achieved in 3 cases (all diffuse large B-cell non-Hodgkin lymphoma); in the rest, diagnosis was based on the clinical presentation, s...
Gaceta Medica De Mexico, 2015
espanolIntroduccion: Los estudios epidemiologicos sobre MG en Mexico derivan principalmente de ex... more espanolIntroduccion: Los estudios epidemiologicos sobre MG en Mexico derivan principalmente de experiencias en centros de referencia. Objetivo: describir las caracteristicas epidemiologicas de egresos hospitalarios efectuados durante el ano 2010 con el diagnostico de MG en adultos atendidos en el sistema sanitario publico mexicano. Metodos: se consulto la base de datos de egresos hospitalarios del ano 2010 del Sistema Nacional de Informacion en Salud (SINAIS) (Secretaria de Salud, Instituto Mexicano del Seguro Social [IMSS], IMSS Oportunidades, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado [ISSSTE], PEMEX, SEMAR y SEDENA). Se identificaron los registros de MG mediante el codigo G70.0 de la Clasificacion Internacional de Enfermedades, 10.a revision (CIE-10). Resultados: durante el ano 2010 se registraron 5,314,132 egresos hospitalarios (4,254,312 adultos), de los cuales 587 (0.01%) correspondieron a adultos con MG (mediana de la edad: 47 anos; 60% mujeres...
Introduction: Intracranial idiopathic hypertension, also known as pseudotumor cerebri is a syndro... more Introduction: Intracranial idiopathic hypertension, also known as pseudotumor cerebri is a syndrome of increased intracranial pressure usually associated with sixth cranial nerve palsy as a false localizing sign, in the absence of structural pathology. The involvement of other cranial nerves is infrequent. Case report: A 20-year-old obese woman presented to our Institution with a subacute intracranial hypertension syndrome with involvement of multiple cranial nerves (III, IV, VI, VII), as well as cervical radicular symptoms. Multimodal evoked potentials showed prolonged latencies. Intracranial structural pathology was ruled out with imaging studies and a CSF tap test confirmed the diagnosis, since this procedure completely resol- ved the clinical manifestations of involvement of multiple cranial nerves, with improvement in the evoked potentials. Conclusion: Idiopathic intracranial hypertension may occasionally be associated with various cranial nerve palsies that impose challenges i...
INTRODUCTION Moderate to severe stenosis is the less prevalent among the forms of carotid atheros... more INTRODUCTION Moderate to severe stenosis is the less prevalent among the forms of carotid atherosclerotic disease), but it carries a high risk of ischaemic stroke. AIM To characterise factors associated with moderate to severe carotid stenosis in a high-risk population. PATIENTS AND METHODS We performed an analysis on traditional risk factors associated with carotid stenosis ≥50% in 533 patients who received Doppler ultrasound due to a history of stroke (34%) or who had = 2 of the risk factors: age ≥55 years (86%), hypertension (65%), dyslipidemia (52%), obesity (42%), diabetes (40%) or smoking (40%). RESULTS The prevalence of carotid stenosis ≥50% was 7.1%, symptomatic (associated with stroke in congruent territory) in 5.6%, bilateral in 2.1% and bilateral symptomatic in 1.5%. A 36.8% of patients had moderate to severe load (≥4) of atherosclerotic plaques (25.9% moderate: 4-6 plaques, and 10.9% severe: ≥7 plaques). By multivariate analysis we identified the age ≥75 years, dyslipide...
BACKGROUND The recognition of stroke symptoms by patients or bystanders directly affects the outc... more BACKGROUND The recognition of stroke symptoms by patients or bystanders directly affects the outcomes of patients with acute cerebrovascular disease. OBJECTIVE The objective of the study was to assess the predictive value of the medical his- tory and clinical features recognized by the patients' bystanders to classify neurovascular syndromes in pre-hospital settings. METHODS We included 150 stroke patients of two Mexican referral centers: 50 with acute ischemic stroke (AIS), 50 with intracerebral hemorrhage (ICH), and 50 with subarachnoid hemorrhage (SAH). The performance of clinical prediction rules (CPR) to identify the stroke types was evaluated with features recognized by the patients' bystanders before hospital arrival. The impact of CPRs on early arrival and in-hospital mortality was also analyzed. RESULTS Overall, 72% of the patients had previous medical evaluations in other centers before final referral to our hospitals, and therefore, only 45% had a final onset- to-...
PLOS ONE
Background The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies n... more Background The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies neurologic features at presentation and complications during the disease course. We aimed to describe the characteristics and predictors for developing in-hospital neurologic manifestations in a large cohort of hospitalized patients with COVID-19 in Mexico City. Methods We analyzed records from consecutive adult patients hospitalized from March 15 to June 30, 2020, with moderate to severe COVID-19 confirmed by reverse transcription real-time polymerase chain reaction (rtRT-PCR) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurologic syndromes were actively searched by a standardized structured questionnaire and physical examination, confirmed by neuroimaging, neurophysiology of laboratory analyses, as applicable. Results We studied 1,072 cases (65% men, mean age 53.2±13 years), 71 patients had pre-existing neurologic diseases (diabetic neuropathy: 17, epilepsy: 15...
International Journal of Neuroscience
Introduction: Osmotic demyelination syndrome (ODS) is a non-inflammatory process of the central n... more Introduction: Osmotic demyelination syndrome (ODS) is a non-inflammatory process of the central nervous system caused by extracellular osmotic changes, which leads to oligodendrocyte apoptosis and disruption of myelin sheaths, usually affecting patients with underlying systemic conditions that impose susceptibility to osmotic stress. Description of ODS in patients with non-Hodgkin lymphoma (NHL) is limited to a few case reports.Methods: Here, we report a 44-year-old man with NHL that had an incidental diagnosis of ODS. We conducted a literature review of the published cases of ODS in NHL patients from 1959 to 2020, aiming to describe the characteristics of these patients.Results: A total of seven patients were summarized (four men and three women), including our case and six patients from published reports. Risk factors such as weight loss and alcoholism were reported in five (71.4%) patients. Hyponatremia was found in six (85.7%) of the cases, and none of them had overly rapid sodium correction. Four cases were asymptomatic, and diffuse large B-cell lymphoma was the most common subtype of NHL (85.7%). The outcome was favorable in most cases; only two deaths not directly related to ODS were reported.Conclusion: We wish to suggest that systemic and metabolic stress induced by NHL may be associated with the development of central osmotic demyelination, and therefore, NHL may be a novel risk factor for ODS. Clinicians should be aware of ODS in patients with hematological malignancies, even in the absence of traditional risk factors.
ABSTRACTIntroductionCoronavirus disease 2019 (COVID-19) is the systemic entity caused by the seve... more ABSTRACTIntroductionCoronavirus disease 2019 (COVID-19) is the systemic entity caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that may cause death through severe atypical pneumonia and acute lung injury. Valproic acid (VPA) has shown anti-inflammatory activity and mild intrinsic antiviral effect. These properties warrant the study of VPA as a possible active treatment in persons with severe COVID-19.MethodsConsecutive adult patients needing invasive mechanical ventilation (IMV) will be given intravenous (i.v.) VPA at a starting dose of 20 mg/kg/day and up to 60/kg/day (in 60 min i.v. infusions in 250 mL normal saline) as needed to reach plasma VPA concentrations of 50–100 μg/mL (measured every 72 h). These patients will be followed-up for 10 days for the primary outcome and for a further period of 30 days after treatment completion for the secondary outcome of recurrence. The primary study outcome is the reduction in the case fatality rate of at least 50%...
PLOS ONE
Background Adherence to disease-modifying therapies is determinant to attain maximal clinical ben... more Background Adherence to disease-modifying therapies is determinant to attain maximal clinical benefit in multiple sclerosis (MS). RebiSmart® is an electronic auto-injector for subcutaneous delivery of interferon β-1a (INF-β1a) that monitors adherence by featuring a log of each drug administration for objective evaluation. The aim of this study was to assess long-term adherence to INF-β1a by using the RebiSmart® device in Mexican patients with relapsing MS. Methods This is an observational multicenter study on patients with relapsing MS treated with INF-β1a subcutaneously delivered by the RebiSmart® device. Adherence was computed as the number of injections received during the study period divided by the number of injections scheduled and expressed as percent. Results A total of 66 patients from 6 specialized MS centers were evaluated (45 females and 21 males, mean age 43.91±13.32 years). Mean adherence was 79.51±18% (median: 85.54%, range: 34.4-100%). During a median follow-up of 27.5 months (mean 33.36±29.39 months) the annualized relapse rate had a mean of 0.50±1.63. Mean initial EDSS was 1.90±1.52, and mean EDSS at the end of follow-up was 1.80±1.74. Compared with their counterparts, the mean number of relapses was significantly lower among patients with high (>80%) adherence (0.25±0.44 vs 0.67±92 relapses, respectively; P = 0.03). The proportion of relapse-free patients was 75.0% among patients with high adherence and 53.3% in low-PLOS ONE
Journal of Stroke and Cerebrovascular Diseases
BACKGROUND Transcranial color-coded sonography (TCCS) allows direct observation of arteries and t... more BACKGROUND Transcranial color-coded sonography (TCCS) allows direct observation of arteries and the possibility of correcting the insonation angle for reliable evaluation of hemodynamics. We obtained TCCS reference values of the cerebral hemodynamics after correction of insonation angles. METHODS We studied 195 healthy adults equally allocated into 3 age groups: 18-40, 41-60, and greater than or equal to 61 years. The middle (MCA), anterior (ACA), and posterior cerebral arteries (PCA) were evaluated through the temporal acoustic window using conventional pulsed transcranial Doppler and TCCS. Peak systolic, end diastolic, and mean blood flow velocities were registered, as well as pulsatility and resistance indices at 0° and with correction by alignment of insonation angle parallel to the blood flow vector. We derived normative values assuming both the parametric and nonparametric distributions. RESULTS We excluded 33 participants due to inadequate acoustic window (10.3%), carotid disease (2.1%), and embryonic variants (4.6%), leaving out 162 for final analysis (50% female, median age 48 years). The 2.5th-97.5th percentiles of the corrected angle for MCA was 0°-60°, ACA 0°-44°, and PCA 30°-60°. After angle correction, 2.5th-97.5th percentiles for flow velocity of MCA, ACA, and PCA were 37.7-112.5 cm/s, 25.6-71.2 cm/s, and 29.2-80.8 cm/s, respectively. There were wide discrepancies between hemodynamics values obtained with insonation angles at 0° and after angle correction. No differences were found between ultrasound methods at exactly 0° or between hemispheres, however, there were differences according to age and sex. CONCLUSIONS Specific normative tables should be used in TCCS when the corrected angle is greater than 0° since the hemodynamics values greatly differ after correction of the insonation angle. Further studies are necessary to determine critical cutoffs indicating disease.
Gaceta de M�xico
be documented in approximately 80 % of cases, according to the group under study. 6-12 Clinically... more be documented in approximately 80 % of cases, according to the group under study. 6-12 Clinically significant CAD can be defined according to the degree of stenosis, arterial wall thickening, atheroma plaque load or dimensions, which depends on the method used to document the CAD (carotid ultrasound, tomography, magnetic resonance, autopsy, among others). 2,4,12 In the general population, clinically significant CAD is more common due to plaque