Parasitosis del snc

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Erwin Chiquete, MD, PhD

Parasitosis del sistema nervioso central. Erwin Chiquete

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Plus de Erwin Chiquete, MD, PhD

Mortality associated with a diagnosis of Guillain-Barré syndrome in adults of Mexican health institutions Introduction. Guillain-Barré syndrome (GBS) is a neurological emergency representing the main cause of flaccid paralysis around the world, affecting all age groups. Little is known about the essential epidemiology of GBS in most Latin American countries. Aim. To determine the mortality associated with the diagnosis of GBS in hospital discharges during 2010 in hospitals of the Ministry of Health, Mexico. Patients and methods. We analyzed the database of hospital discharges of institutions pertaining to the Ministry of Health. Study cases were identified by the code G61.0 of the International Classification of Diseases, 10th revision (ICD-10). We excluded records of patients younger than 18 years and patients without complete demographic information. Results. During the year 2010 there were 2,634,339 discharges from hospitals of the Ministry of Health. We identified a total of 467 hospitalizations due to GBS in adults (median age: 41 years; 62.1% male) from 121 health institutions of the 32 Republic States. The highest frequency of GBS hospitalizations occurred during summer and fall. The median hospital stay was 8 days. The hospital mortality rate was 10.5%. The probability of death was directly associated with age, without a particular trend regarding gender, hospital care or state. Conclusions. In 2010 GBS hospital mortality in this part of the Mexican health system was higher than that reported in contemporary studies. A seasonal association was observed regarding the frequency of hospitalizations for GBS. Key words. Climate. Epidemiology. Guillain-Barré syndrome. Mortality. Mexico. Rogelio Domínguez-Moreno, Paulina Tolosa-Tort, Anais Patiño-Tamez, Alejandra Quintero-Bauman, Deisy K. Collado-Frías, María G. Miranda-Rodríguez, Obet J. Canela-Calderón, Pablo Hurtado-Valadez, Raúl de Gante-Castro, Karoll M. Ortiz-Guillén, Bruno Estañol-Vidal, Horacio Sentíes-Madrid, Guillermo García-Ramos, Carlos Cantú-Brito, José Luis Ruiz-Sandoval, Erwin Chiquete

Mortalidad asociada al diagnóstico de síndrome de Guillain-Barré en adultos i...

Erwin Chiquete, MD, PhD

Background: The prevalence of toxoplasmosis in the general population of Guadalajara, Mexico, is around 32%. Toxoplasmosis can cause ocular lesions and slowing of reaction reflexes. Latent toxoplasmosis has been related with traffic accidents. We aimed to assess the prevalence of anti-Toxoplasma gondii antibodies and visual impairments related with traffic accidents in drivers from the metropolitan Guadalajara. Methods: We prospectively evaluated the prevalence of IgG and IgM anti-T. gondii antibodies in 159 individuals involved in traffic accidents, and in 164 control drivers never involved in accidents. Cases of toxoplasmosis reactivation or acute infection were detected by PCR in a subset of 71 drivers studied for the presence of T. gondii DNA in blood samples. Ophthalmologic examinations were performed in drivers with IgG anti-T. gondii antibodies in search of ocular toxoplasmosis. Results: Fifty-four (34%) traffic accident drivers and 59 (36%) controls were positive to IgG anti-T. gondii antibodies (p = 0.70). Among the 113 seropositive participants, mean anti-T. gondii IgG antibodies titers were higher in traffic accident drivers than in controls (237.9 ± 308.5 IU/ml vs. 122.9 ± 112.7 IU/ml, respectively; p = 0.01 by Student’s t test, p = 0.037 by Mann–Whitney U test). In multivariate analyses, anti-T. gondii IgG antibody titers were consistently associated with an increased risk of traffic accidents, whereas age showed an inverse association. The presence of IgM-anti-T. gondii antibodies was found in three (1.9%) subjects among traffic accident drives, and in two (1.2%) controls. Three (4.2%) samples were positive for the presence of T. gondii DNA, all among seropositive individuals. No signs of ocular toxoplasmosis were found in the entire cohort. Moreover, no other ocular conditions were found to be associated with the risk of traffic accidents in a multivariate analysis. Conclusions: Anti-T. gondii antibody titers are associated with the risk of traffic accidents. We could not determine any association of ocular toxoplasmosis with traffic accidents. Our results warrant further analyses in order to clarify the link between toxoplasmosis and traffic accidents.

Seroepidemiology of Toxoplasma gondii infection in drivers involved in road t...

Erwin Chiquete, MD, PhD

Introducción: La información sobre el tiempo de llegada hospitalaria después de un infartocerebral (IC) se ha originado en países con unidades especializadas en ictus. Existe poca infor-mación en naciones emergentes. Nos propusimos identificar los factores que influyen en eltiempo de llegada hospitalaria a 1, 3 y 6 h y su relación con el pronóstico funcional después delictus.Métodos: Se analizó la información de pacientes con IC incluidos en el estudio Primer RegistroMexicano de Isquemia Cerebral (PREMIER) que tuvieran tiempo definido desde el inicio de lossíntomas hasta la llegada hospitalaria. El desenlace funcional se evaluó mediante la escalamodificada de Rankin a los 30 días, 3, 6 y 12 meses.Resultados: De 1.096 pacientes con IC, 61 (6%) llegaron en < 1 h, 250 (23%) en < 3 h y 464 (42%)en < 6 h. Favorecieron la llegada temprana en < 1 h: el antecedente familiar de cardiopatíaisquémica y ser migrañoso; en < 3 h: edad 40-69 años, antecedente familiar de hipertensión,antecedente personal de dislipidemia y cardiopatía isquémica, así como la atención en hospitalprivado; en < 6 h: antecedente familiar de hipertensión, ser migrañoso, ictus previo, cardiopatíaisquémica y atención en hospital privado. La llegada hospitalaria tardía se asoció a ictus lacunary alcoholismo. Solo el 2,4% recibió trombólisis. Independientemente de la trombólisis, la llegadaen < 3 h se asoció a menor mortalidad a los 3 y 6 meses, además de menos complicacionesintrahospitalarias.

Tiempo de llegada hospitalaria y pronóstico funcional después deun infarto ce...

Erwin Chiquete, MD, PhD

Caroline Malamud-Kessler, Bruno Estañol-Vidal, Óscar Infante-Vázquez, Miguel Campos-Sánchez, Erwin Chiquete Introducción. El síncope mediado neuralmente, también conocido como síncope vasovagal, se define como la pérdida súbita y transitoria del estado de alerta como consecuencia de un descenso brusco y profundo de la presión arterial. Objetivo. Conocer las diferencias de los parámetros hemodinámicos que median el barorreflejo durante el ortostatismo activo en pacientes con diagnóstico clínico de síncope vasovagal y sujetos sanos. Sujetos y métodos. Estudio transversal, observacional y comparativo. Se incluyeron 20 pacientes con diagnóstico de síncope neuralmente mediado y 30 controles, a los que se les practicó la prueba de ortostatismo activo y se les registró por finometría la presión arterial sistólica (PAS) y la frecuencia cardíaca (intervalo entre latidos) de manera continua (latido a latido) y no invasiva. Resultados. Los pacientes con síncope presentaron una PAS basal con una media significativamente mayor que la de los sanos. Las magnitudes medidas desde la PAS basal demostraron una diferencia significativa, que era de menor valor en el grupo de los controles. No se demostraron diferencias entre grupos en la caída de la PAS desde el primer pico, recuperación de la PAS desde la sima o en las latencias medidas en la frecuencia cardíaca. Conclusiones. La PAS basal y la caída de la PAS medida desde la basal en posición supina fue mayor en los pacientes con síncope mediado neuralmente que en los sujetos sanos. La magnitud de la elevación de la frecuencia cardíaca tuvo una tendencia a ser mayor en el grupo de pacientes en comparación con el grupo control. Esto sugiere una hiperactividad simpática en los pacientes con síncope

Comportamiento del barorreflejo en pacientes con síncope vasovagal durante el...

Erwin Chiquete, MD, PhD

Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura con un enfoque sistemáticoSofía Sánchez-Romána, Cristina Beltrán Zavalab, Argelia Lara Solaresby ErwinChiquetea,∗ El delírium en pacientes que reciben cuidados paliativos es frecuente y constituyeun importante reto de diagnóstico y tratamiento. Nuestro objetivo fue realizar en 2 fases unanálisis bibliométrico de la evidencia científica reciente (2007 a 2012) sobre diagnóstico y tra-tamiento del delírium en adultos en cuidados paliativos. En la fase 1 (estudios descriptivos yrevisiones narrativas) se identificaron 133 artículos relevantes: 73 trataron el tema del delíriumde forma secundaria y en 60 artículos como tema principal. Sin embargo, solo se identificaron4 estudios observacionales prospectivos en los que el delírium fue central. De 135 artículos iden-tificados en la fase 2 (ensayos clínicos o estudios descriptivos sobre tratamiento del delírium enpacientes paliativos), solo 3 fueron sobre prevención o tratamiento: 2 estudios retrospectivosy un ensayo clínico sobre prevención multicomponente en pacientes con cáncer. Gran parte dela literatura reciente corresponde a revisiones que hablan de estudios realizados hace másde una década en pacientes diferentes a los que reciben cuidados paliativos. En conclusión, laevidencia científica reciente sobre el delírium en cuidados paliativos es escasa y subóptima.Urgen estudios prospectivos que se enfoquen específicamente en esta población altamentevulnerable.

Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura...

Erwin Chiquete, MD, PhD

Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito Background: The waist-to-height ratio (WHtR) may be a better adiposity measure than the body mass index (BMI). We evaluated the prognostic performance of WHtR in patients with acute ischemic stroke (AIS). Methods: First, we compared WHtR and BMI as adiposity measures in 712 healthy adults by tetrapolar bioimpedance analysis. Thereafter, baseline WHtR was analyzed as predictor of 12-month allcause mortality in 821 Mexican mestizo adults with first-ever AIS by a Cox proportional hazards model adjusted for baseline predictors. Results: In healthy individuals, WHtR correlated higher than BMI with total fat mass and showed a higher accuracy in identifying a high percentage of body fat (p < 0.01). In AIS patients a U-shaped relationship was observed between baseline WHtR and mortality (fatality rate 29.1%). On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently predicted 12-month all-cause mortality (h

Central Adiposity and Mortality after First-Ever Acute Ischemic Stroke

Erwin Chiquete, MD, PhD

José L. Ruiz-Sandoval, Guadalupe Ramírez-Guzmán, Erwin Chiquete and Ángel Vargas-Sánchez A 45-year-old garbage collector was referred to our department with a history of tonic-clonic seizures and risky sexual behavior (anilingus). A neurological examination was normal. Contrast-enhanced cranial CT showed calcified lesions and viable parasites compatible with a diagnosis of massive non-encephalitic neurocysticercosis. Oral metallic implants impeded performing brain MRI. Hepatitis and HIV serologies were negative. The patient was discharged with steroids and an anticonvulsant. Delayed cysticidal therapy was planned; however, albendazole therapy was immediately initiated in another hospital, which led to brain edema, uncontrolled seizures, rostrocaudal deterioration and death. Cestoda infections are rare in developed countries (1). In contrast, neurocysticercosis is a leading cause of adult-onset epilepsy in Latin America. Massive infections are classified as encephalitic or non-encephalitic (2). In patients with the encephalitic presentation, cysticidal drugs can cause extensive parasite lysis and aggravate brain inflammation (2). In patients with non-encephalitic massive neurocysticercosis, cysticidal therapy is usually considered; (2) however, rapid initiation of antiparasitic medications can launch an encephalitic process.

Massive Non-Encephalitic Neurocysticercosis

Erwin Chiquete, MD, PhD

Miguel A. Macı´as-Islas • Isaac F. Soria-Cedillo • Merced Velazquez-Quintana • Victor M. Rivera • Vero´nica I. Baca-Muro • Edith A. Lemus-Carmona • Erwin Chiquete Limited data exist on the costs of care of patients with multiple sclerosis (MS) in low- to middleincome nations. The purpose of this study was to describe the economic burden associated with care of Mexican patients with relapsing-remitting MS in a representative sample of the largest institution of the Mexican public healthcare system. We analysed individual data of 492 patients (67 % women) with relapsing-remitting MS registered from January 2009 to February 2011 at the Mexican Social Security Institute. Direct costs were measured about the use of diagnostic tests, disease-modifying therapies (DMTs), symptoms control, medical consultations, relapses, intensive care and rehabilitation. Four groups were defined according to DMT alternatives: (1) interferon beta (IFNb)-1a, 6 million units (MU); (2) IFNb-1a, 12MU; (3) IFNb-1b, 8MU; and (4) glatiramer acetate. All patients received DMTs for at least 1 year. The most frequently used DMT was glatiramer acetate (45.5 %), followed by IFNb-1a 12MU (22.6 %), IFNb-1b 8MU (20.7 %), and IFNb-1a 6MU (11.2 %). The mean cost of a specialised medical consultation was €74.90 (US $107.00). A single relapse had a mean total cost of €2,505.97 (US $3,579.96). No differences were found in annualised relapse rates and costs of relapses according to DMT. However, a significant difference was observed in total annual costs according to treatment groups (glatiramer acetate being the most expensive), mainly due to differences in unitary costs of alternatives. From the public institutional perspective, when equipotent DMTs are used in patients with comparable characteristics, the costs of DMTs largely determine the total expenses associated with care of patients with relapsing-remitting MS in a middle-income country.

Cost of care according to disease-modifying therapy in Mexicans with relapsin...

Erwin Chiquete, MD, PhD

Introduction: The importance of the admission blood pressure (BP) for intracerebral hemorrhage (ICH) outcome is not completely clear. Our objective was to analyze the clinical impact of BP at hospital arrival in patients with primary ICH. Material and methods: We studied 316 patients (50% women, mean age: 64 years, 75% with hypertension history) with acute primary ICH. The first BP reading at admission was evaluated for its association with neuroimaging findings and outcome. A Cox proportional hazards model and Kaplan-Meier analyses were constructed to evaluate factors associated with in-hospital mortality. Results: Intraventricular irruption occurred in 52% of cases. A high frequency of third ventricle extension was observed in patients with BP readings in the upper quartiles of the distribution (systolic, diastolic, or mean arterial pressure). Blood pressure readings did not correlate with hematoma volumes. In-hospital case fatality rate was 46% (63% among those with ventricular irruption). Systolic BP (SBP) > 190 mm Hg was independently associated with in-hospital mortality in supratentorial (n = 285) ICH (hazard ratio: 1.19, 95% confidence interval: 1.02-1.38, for the highest vs. the lowest quartile) even after adjustment for known strong predictors (age, ICH volume, Glasgow coma scale and ventricular extension). Blood pressure was not significantly associated with ventricular extension or outcome in patients with infratentorial ICH. Conclusions: A high BP on admission is associated with an increased risk of intraventricular extension and early mortality in patients with supratentorial ICH. However, a significant proportion of patients with high BP readings without ventricular irruption still have an increased risk of death.

Blood pressure at hospital admission and outcome after primary intracerebral ...

Erwin Chiquete, MD, PhD

Background: Current evidence shows that uric acid is a potent antioxidant whose serum concentration increases rapidly after acute ischemic stroke (AIS). Nevertheless, the relationship between serum uric acid (SUA) levels and AIS outcome remains debatable. We aimed to describe the prognostic significance of SUA in AIS. Methods: We studied 463 patients (52% men, mean age 68 years, 13% with glomerular filtration rate <60 />2) at 30 days, or with any outcome measure at 3, 6 or 12 months poststroke. After adjustment for age, gender, stroke type and severity (NIHSS <9),><24 h. Conclusions: A low SUA concentration is modestly associated with a very good short-term outcome. Our findings support the hypothesis that SUA is more a marker of the magnitude of the cerebral infarction than an independent predictor of stroke outcome.

Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER Study

Erwin Chiquete, MD, PhD

Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients.

Erwin Chiquete, MD, PhD

Erwin Chiquete, MD, PhD Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk. Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and cardiovascular mortality in this Latin American cohort. Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry. Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality were congestive heart failure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were associated with a reduced risk. Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin

Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...

Erwin Chiquete, MD, PhD

José L. Ruiz-Sandoval, Erwin Chiquete, Lucía E. Álvarez-Palazuelos, Miguel A. Andrade-Ramos & Luis R. Rodríguez- Rubio Osmotic demyelination syndrome (ODS) is the damage over the central nervous system caused by several electrolytes, metabolic and toxic disorders. We aimed to describe cases of unusual forms of ODS. In a 9-year period, 25 consecutive patients with ODS (15 men; mean age 42 years) were registered in our referral institution, among them, four (16 %) with atypical neuroimaging findings were abstracted for this communication. None of them presented cardiorespiratory arrest, head trauma, seizures, neuromyelitis optica spectrum or contact with toxic chemicals. Case 1 was a 33-year-old alcoholic man without hypertension or electrolyte imbalance, who presented a classic central pontine myelinolysis (CPM) and a hemorrhage within the pons. Case 2 was a 34-year-old alcoholic man with hypoglycemia and hyponatremia who presented CPM and diffuse bihemispheric extrapontine myelinolysis (EPM) after correction of serum sodium. Case 3 was a 52-year-old woman with mild hypokalemia and hyponatremia (inadequately corrected), who presented a peduncular and cerebellar EPM. Case 4 was a 67-year-old woman who had a suicidal attempt with antidepressants and carbamazepine without impaired consciousness, who complicated with mild hyponatremia associated with a classical CPM and a spinal cord EPM. Case 2 died and the rest remained with variable neurological impairments at last follow-up visit. With modern neuroimaging, the so-called atypical forms of ODS may not be as rare as previously thought; however, they could have a more adverse outcome than the classical ODS.

Atypical forms of the osmotic demyelination syndrome

Erwin Chiquete, MD, PhD

Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology, management and outcome of ICH in Mexico. Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up. Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH (53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%) and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in 43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7 points, whereas it decreased to 27% in patients with ICH-GS 11-13 points. Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH.

Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...

Erwin Chiquete, MD, PhD

Juan J. Ramı´rez, Erwin Chiquete, Juan J. Ramı´rez, Jr., Ernesto Go´mez-Limo´n, and Juan M. Ramı´rez An expandable vertebral body prosthesis with dual cage-and-plate function in a single device (JR prosthesis) was designed to test the hypothesis that this modular system can provide the biomechanical requirements for immediate and durable spine stabilization after corpectomy. Cadaver assays were performed with a stainless steal device to test fixation and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors (eight metastatic) underwent corpectomy and vertebral body replacement with a titaniummade JR prosthesis. All patients had neurological deficit, severe pain and spine instability prior to surgery. Mean pain score before surgery on a visual analog scale decreased from 7.6e3.0 points after operation ( p 5 0.002). All patients achieved at least one grade of improvement in the Frankel score ( p 5 0.003), excepting the three patients with Frankel grade A before surgery. Two patients with renal cell carcinoma died during the following 4 days after surgery. The remaining patients attained a painless and stable spine immediately, which was maintained for long periods (mean follow-up: 25.4 months). No significant infections or implant failures were registered. A nonfatal case of inferior vena cava surgical injury was observed (repaired during surgery without further complications). In conclusion, the JR prosthesis stabilizes the spine immediately after surgery and for the rest of the patients’ life. To our knowledge, this is the first report on the clinical experience of any expandable vertebral body prosthesis with dual cage-and-plate function in a single device.

An Expandable Prosthesis with Dual Cage-and-Plate Function in a Single Device...

Erwin Chiquete, MD, PhD

Gloria Loredo-Pozos, Erwin Chiquete, Antonio Oceguera-Villanueva, Arturo Panduro, Fernando Siller-Lo´pez, Martha E. Ramos-Márquez Low BRCA1 gene expression is associated with increased invasiveness and influences the response of breast carcinoma (BC) to chemotherapeutics. However, expression of BRCA1 and BRCA2 genes has not been completely characterized in premenopausal BC. We analyzed the clinical and immunohistochemical correlates of BRCA1 and BRCA2 expression in young BC women. We studied 62 women (mean age 38.8 years) who developed BC before the age of 45 years. BRCA1 and BRCA2 mRNA expression was assessed by reverse transcriptase-polymerase chain reaction (RT-PCR) and that of HER-2 and p53 proteins by immunohistochemistry. Body mass index (BMI) C27 (52%) and a declared family history of BC (26%) were the main risk factors. Ductal infiltrative adenocarcinoma was found in 86% of the cases (tumor size [5 cm in 48%). Disease stages I–IV occurred in 2, 40, 55, and 3%, respectively (73% implicating lymph nodes). Women aged B35 years (24%) had more family history of cervical cancer, stage III/IV disease, HER-2 positivity, and lower BRCA1 expression than older women (P-.05). BRCA1 and BRCA2 expression correlated in healthy, but not in tumor tissues (TT). Neither BRCA1 nor BRCA2 expression was associated with tumor histology, differentiation, nodal metastasis or p53 and HER-2 expression. After multivariate analysis, only disease stage explained BRCA1 mRNA levels in the lowest quartile. Premenopausal BC has aggressive clinical and molecular characteristics. Low BRCA1 mRNA expression is associated mainly with younger ages and advanced clinical stage of premenopausal BC. BRCA2 expression is not associated with disease severity in young BC women.

Expression profile of BRCA1 and BRCA2 genes in premenopausal Mexican women wi...

Erwin Chiquete, MD, PhD

31. cost of bc care

Erwin Chiquete, MD, PhD

En conclusión, la neurotoxicidad por exposición crónica a PDCB es rara y ha sido poco descrita en la bibliografía. Las propiedades lipofílicas de este compuesto producen desmielinización central, y dan lugar a leucoencefalopatía difusa, supra e infratentorial. Las manifestaciones más frecuentemente descritas son agudas, y son de interés particular, en nuestro paciente, las manifestaciones cognitivas de tipo demenciales en un seguimiento a largo plazo. Las recomendaciones domésticas deben dirigirse a evitar el contacto por parte de los menores de edad con este compuesto, así como a su eventual sustitución por productos menos tóxicos.

Demencia asociada a intoxicación por paradiclorobenceno

Erwin Chiquete, MD, PhD

José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz, Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga, Fernando Barinagarrementería, Carlos Cantú-Brito, and the RENAMEVASC investigators Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology, management and outcome of ICH in Mexico. Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up. Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH (53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%) and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in 43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7 points, whereas it decreased to 27% in patients with ICH-GS 11-13 points. Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH.

Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...

Erwin Chiquete, MD, PhD

José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz, Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga, Fernando Barinagarrementería, Carlos Cantú-Brito, investigadores RENAMEVASC Introducción. Existe poca información respecto a la hemorragia intracerebral (HIC) en América Latina, y la existente ha sido derivada de registros hospitalarios de un solo centro con conclusiones no generalizables. El objetivo de este estudio es describir la frecuencia, etiología, manejo y desenlace clínico de la HIC en México. Pacientes y métodos. Se estudiaron pacientes consecutivos con HIC incluidos en el Registro Nacional Mexicano de Enfermedad Vascular Cerebral (RENAMEVASC), conducido en 25 centros de 14 estados de la República Mexicana. Se usó la Intracerebral Hemorrhage Grading Scale (ICH-GS) para estimar el pronóstico a 30 días. Resultados. De 2.000 pacientes con ictus agudo en el RENAMEVASC, 564 (28%) presentaron HIC espontánea (53% mujeres; edad media: 63 años; rango intercuartílico: 50-75 años). La hipertensión arterial (70%), las malformaciones vasculares (7%) y la angiopatía amiloidea (4%) fueron las causas más frecuentes. No se determinó la etiología en el 10% de los casos. Las localizaciones más frecuentes fueron ganglionar (50%), lobar (35%) y cerebelosa (5%). La irrupción hacia el sistema ventricular ocurrió en el 43%. La mediana en la escala ICH-GS al ingreso hospitalario fue de 8 puntos: el 49% presentó 5-7 puntos; el 37%, 8-10 puntos, y el 15%, 11-13 puntos. La tasa de mortalidad a 30 días fue del 30%, y el 31% mostró discapacidad grave. La sobrevida a 30 días fue del 92% en pacientes con 5-7 puntos en la escala ICH-GS, mientras que se redujo al 27% en aquellos con 11-13 puntos. Conclusiones. En México, la HIC representa casi un tercio de las formas de enfermedad vascular cerebral aguda, y la mayoría de los pacientes que la padecen presentan discapacidad funcional grave o muerte a 30 días. La hipertensión es la principal causa, por lo que el control de este importante factor de riesgo debería reducir la carga sanitaria de la HIC.

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