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PURPOSE: Accurate height and weight measurement can be challenging in older adults and complicates nutritional status assessment. Other parameters like the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte count (LC) could be an option to these measurements. We aimed to test these variables as subrogates of body mass index (BMI) or calf-circumference (CC) for malnutrition screening in community-dwelling older adults. METHODS: This is a secondary analysis from the Salud, Bienestar y Envejecimiento (SABE) survey from Ecuador (2009). Includes data on demographics, health-related factors, physical assessments, and complete blood count, allowing to calculate NLR and LC to be used as part of the Mini Nutritional Assessment (MNA), instead of the BMI. Consequently, 4 models were included: standard MNA, MNA-CC, MNA-NLR and MNA-LC. Finally, age, sex, and comorbidities were considered as confounding variables. RESULTS: In our analysis of 1,663 subjects, 50.81% were women. Positive correlations with standard MNA were found for MNA-NLR (Estimate = 0.654, p < 0.001) MNA-CC (Estimate = 0.875, p value < 0.001) and MNA-LC (Estimate = 0.679, p < 0.001). Bland-Altman plots showed the smallest bias in MNA-CC. Linear association models revealed varying associations between MNA variants and different parameters, being MNA-NLR strongly associated with all of them (e.g. Estimate = 0.014, p = 0.001 for albumin), except BMI. CONCLUSION: The newly proposed model classified a greater number of subjects at risk of malnutrition and fewer with normal nutrition compared to the standard MNA. Additionally, it demonstrated a strong correlation and concordance with the standard MNA. This suggests that hematological parameters may offer an accurate alternative and important insights into malnutrition.
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Índice de Massa Corporal , Avaliação Geriátrica , Desnutrição , Neutrófilos , Avaliação Nutricional , Humanos , Feminino , Masculino , Idoso , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/sangue , Equador/epidemiologia , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Idoso de 80 Anos ou mais , Contagem de Linfócitos/métodos , Linfócitos , Estado Nutricional , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Vida Independente/estatística & dados numéricosRESUMO
OBJECTIVE: Ongoing research has evidenced the importance of muscle measurement in predicting adverse outcomes. Measurement of other muscles is promising in current research. This study aimed to determine the correlation between temporal muscle thickness (TMT) and appendicular lean soft tissue (ALSTI) in older adults. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: Single cohort gathered in Gothenburg, Sweden, consisting of individuals born in 1944 (n = 1203). METHODS: We studied 657 magnetic resonance images to measure TMT. Comparisons of TMT with dual-energy X-ray absorptiometry ALSTI (kg/m2) as a reference standard were performed. Finally, TMT associations with cognition evaluated using the Mini-Mental State Examination (MMSE), gait speed, and handgrip strength were explored with linear regressions. RESULTS: The correlation between TMT and ALSTI was weak yet significant (r = 0.277, P < .001). TMT exhibited significant associations with MMSE (estimate = 0.168, P = .002), gait speed (estimate = 1.795, P < .001), and ALSTI (estimate = 0.508, P < .001). These associations varied when analyzed by sex. In women, TMT was significantly associated with gait speed (estimate = 1.857, P = .005) and MMSE (estimate = 0.223, P = .003). In men, TMT scores were significantly correlated with ALSTI scores (estimate = 0.571, P < .001). CONCLUSION AND IMPLICATIONS: Repurposing head images can be an accessible alternative to detect muscle mass and ultimately detect sarcopenia. These studies have the potential to trigger interventions or further evaluation to improve the muscle and overall health of individuals. However, additional research is warranted before translating these findings into clinical practice.
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Força da Mão , Sarcopenia , Masculino , Humanos , Feminino , Idoso de 80 Anos ou mais , Idoso , Força da Mão/fisiologia , Músculo Temporal , Estudos Transversais , Sarcopenia/diagnóstico por imagem , Cognição/fisiologia , Força Muscular/fisiologiaRESUMO
El síndrome de Guillain Barré es una enfermedad derivada del compromiso en las neuronas del sistema nervioso periférico por una respuesta descontrolada del sistema inmune que conduce daño axonal y/o desmielinización. El objetivo de este reporte fue describir los 10 primeros casos sospechosos de Síndrome de Guillain Barré en Piura. Se logró identificar la presencia de Campylobacter jejuni en las muestras de heces del 80% de los pacientes reportados. Es muy importante reconocer rápida y oportunamente al paciente con diagnóstico sospechoso de Guillain Barré, y realizar los estudios necesarios en un brote para identificar los agentes desencadenantes del cuadro.
Guillain Barré syndrome is a disease derived from compromise in neurons of the peripheral nervous system by an uncontrolled response from the immune system that leads to axonal damage and/or demyelination. The objective of this report was to describe the first 10 suspected cases of Guillain Barre Syndrome in Piura. It was possible to identify the presence of Campylobacter jejuni in the stool samples of 80% of the reported patients. It is very important to quickly and opportunely recognize the patient with a suspected diagnosis of Guillain Barré, and to carry out the necessary studies in an outbreak to identify the triggering agents of the condition.
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The rheological behavior of aqueous solutions of polyvinyl alcohol at 4, 6, 8 and 10% by weight has been studied and evaluated at temperatures of 20, 25, 30 and 35 °C, using five non-Newtonian fluid models independent of time: Ferrys, Robertson-Stiff, Williamson, Sisko, and Ellis de Haven. The classical method consists in carrying out regression analysis. Using a comparative procedure of determination coefficients and variances, the model that most appropriately adjusts the experimental data to said model is selected. From the statistical point of view, the Sisko and Robertson-Stiff models present better regression parameters; to better specify the choice of the respective rheological model, a new factor has been proposed in the literature, the viscosity factor (VF), which expresses the relationship between apparent and dynamic viscosity. The analysis of this factor for the five models confirms the greater stability of the Ellis de Haven model in terms of the coefficient of variation of the VF. The value of VF fluctuates between 1 and 2 for all ranges of temperature and concentration experienced for vinyl alcohol solutions. As a consequence of the above, for the choice of the non-Newtonian fluid model associated with the rheology of the aqueous solution of polyvinyl alcohol, it is necessary to analyze the statistical parameters and the VF factor simultaneously.
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BACKGROUND: Lupin is a protein-rich legume with a growing presence in the food market worldwide. With increased consumption, lupin allergy (LA) reports are also rising. Uncertainties exist on the cross-reactivity between peanut and lupin, the allergenic potential of different lupin species, and sensitization patterns among different populations. OBJECTIVE: To evaluate the molecular basis of LA and to determine lupin allergens from 3 different species that may be involved in peanut allergy (PA) cross-reactivity. METHODS: A total of 43 subjects with PA, those with LA, or controls without food allergy were evaluated with skin prick tests (SPTs) and specific IgEs (sIgEs). Lupin-sensitized subjects were offered a lupin oral food challenge (OFC). Immunoblots and enzyme-linked immunosorbent assays were performed on sera from lupin-sensitized subjects. RESULTS: In this study, 44% of the PA subjects were confirmed to have LA by OFC. Anaphylaxis was the most frequent manifestation after lupin consumption, with a minimal eliciting dosage of 1 g lupin flour. There was no difference in lupin sIgE or SPT wheal size between lupin-sensitized and confirmed LA subjects or in the severity of symptoms among confirmed LA subjects. Sera from lupin-sensitized subjects uniformly reacted to all 3 different lupin species. Immunoblotting and enzyme-linked immunosorbent assays revealed immunoglobulin E binding to α- and γ-conglutin in all analyzed sera, whereas α- and ß-conglutin recognition was variable. CONCLUSION: Our findings reveal a high prevalence of LA among PA subjects, emphasizing lupin must be labeled as an allergen in foods. Owing to high variability in lupin-sIgE and lupin-SPT results, LA diagnosis may require OFC. In our population, γ-conglutin is the major allergen of lupin.
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Hipersensibilidade Alimentar , Lupinus , Hipersensibilidade a Amendoim , Humanos , Hipersensibilidade a Amendoim/diagnóstico , Hipersensibilidade a Amendoim/epidemiologia , Alérgenos , Prevalência , Imunoglobulina E , Lupinus/efeitos adversos , Arachis , Testes Cutâneos/métodosRESUMO
BACKGROUND: Strongyloidiasis is a disease of great public health significance, caused by the parasitic nematodes Strongyloides stercoralis, Strongyloides fuelleborni, and Strongyloides fuelleborni subsp. kellyi. This systematic review and meta-analysis aimed to assess the prevalence of Strongyloides stercoralis infection in Peru. METHODS: The review was based on a literature search in PubMed, SciELO and Google Scholar using the key words or root words "strongyl*" AND "Peru" on 15 July 2020. Eligible studies were published from 1 January 1981 to 15 July 2020 and written in English, Spanish, Italian, or French. RESULTS: We included 21 papers in the analysis. Studies were heterogeneous in terms of study population and diagnostic methods (e.g. Baermann technique, agar, Dancescu or charcoal cultures, serology, string capsule). Prevalence of S. stercoralis ranged from 0.3 to 45%. The pooled proportion of Strongyloides in the general population was 7.34% (95% CI 4.97 to 10.13%). Half the studies were designed to detect parasites in general. In studies designed to detect S. stercoralis, the most widely used diagnostic method was the Baermann technique. CONCLUSION: Prevalence of S. stercoralis in Peru was high but varied by geographic area, techniques for stool examination, and participant characteristics.
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Strongyloides stercoralis , Estrongiloidíase , Animais , Fezes , Humanos , Peru/epidemiologia , Prevalência , Estrongiloidíase/diagnóstico , Estrongiloidíase/epidemiologiaRESUMO
INTRODUCTION: The prevalence of peanut allergy (PA) has increased, affecting approximately 1.1% of children in Western countries. PA causes life-threatening anaphylaxis and frequently persists for life. There are no standardized curative therapies for PA, and avoidance of peanuts remains the main therapeutic option. A better understanding of the pathogenesis of PA is essential to identify new treatment strategies. Intestinal dendritic cells (DCs) are essential in the induction and maintenance of food tolerance because they present dietary allergens to T cells, thereby directing subsequent immune responses. Areas covered: In this review, we discuss the factors related to the acquisition of oral tolerance to peanut proteins. We focus on intestinal DC-related aspects, including the latest advances in the biology of intestinal DC subtypes, effect of tolerance-inducing factors on DCs, effect of dietary components on oral tolerance, and role of DCs in peanut sensitization. Expert commentary: Given the increasing prevalence of PA, difficulty of avoiding peanut products, and the potentially serious accidental reactions, the development of novel therapies for PA is needed. The ability of DCs to trigger tolerance or immunity makes them an interesting target for new treatment strategies against PA.
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Alérgenos/imunologia , Apresentação de Antígeno , Células Dendríticas/imunologia , Mucosa Intestinal/imunologia , Hipersensibilidade a Amendoim/imunologia , Linfócitos T/imunologia , Criança , Pré-Escolar , Células Dendríticas/patologia , Feminino , Humanos , Mucosa Intestinal/patologia , Masculino , Hipersensibilidade a Amendoim/epidemiologia , Hipersensibilidade a Amendoim/patologia , Prevalência , Linfócitos T/patologiaRESUMO
BACKGROUND: Both environmental pollution and smoking affect the respiratory epithelium, causing cellular adaptation changes. Therefore, this work explores the presence of metaplasia in smokers compared with non-smokers from Mexico City. METHODS: A prospective cohort study was performed. The sample was performed through a home interview covering the five Mexico City zones delimited to the study and monitoring of air quality. We searched metaplastic cells and inflammation in sputum cytology stained with Papanicolaou technique, and we assessed the air quality in Mexico City. We calculated relative risk (RR) and attributable risk (AR) in relation to the presence of metaplasia and smoking. RESULTS: We performed 1897 home interviews obtaining a final sample of 30 participants. There were no significant differences between smokers and non-smokers with the presence of metaplastic cells (p = 0.269), although the association of metaplastic cells and inflammation showed a significant difference in the non-smokers group (p = 0.010). The RR in association with the presence of metaplasia in sputum cytology and smoking was 1.6, and the RA was 0.2. CONCLUSIONS: The air quality in this city has led the population to undergo changes of cellular adaptation in the respiratory epithelium by the simple fact of being exposed to environmental pollution. Metaplastic changes in non-smokers suggest strongly that pollution causes the same effect as smoking.
INTRODUCCIÓN: la contaminación ambiental y el tabaquismo afectan el epitelio respiratorio y provocan cambios de adaptación celular. Se buscó explorar la presencia de metaplasias en sujetos fumadores y no fumadores, residentes de la Ciudad de México (CDMX) y expuestos desde su nacimiento a la contaminación ambiental de esta ciudad. MÉTODOS: estudio de cohorte prospectivo cuya muestra se seleccionó con base en entrevistas a domicilio que cubrieron las cinco zonas de la CDMX en las que se monitorea la calidad del aire. Se buscaron células con cambios metaplásicos e inflamatorios en citologías de esputo teñidas con la técnica Papanicolaou, además de valorar la calidad del aire de la CDMX. Se calculó riesgo relativo (RR) y riesgo atribuible (RA) en relación con la presencia de metaplasias y tabaquismo. RESULTADOS: se realizaron 1897 entrevistas; se obtuvo una muestra final de 30 personas en las que no hubo diferencias significativas entre sujetos con hábito tabáquico y no fumadores en cuanto a presencia de células metaplásicas (p = 0.269); la relación de células metaplásicas e inflamación tuvo una diferencia significativa en el grupo de no fumadores (p = 0.010). El RR en relación con la presencia de metaplasias en las citologías de esputo y tabaquismo fue de 1.6, y el RA fue de 0.2. CONCLUSIONES: la calidad del aire en la CDMX ha llevado a la población a sufrir cambios de adaptación celular en el epitelio respiratorio solo por estar expuestos a la contaminación ambiental. Los cambios metaplásicos en los no fumadores indican que la contaminación causa el mismo efecto que fumar.
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Poluição Ambiental/efeitos adversos , Mucosa Respiratória/patologia , Fumar/efeitos adversos , Escarro/citologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Metaplasia , México , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
Hypothyroxinemia (Hpx) is a highly frequent condition characterized by low thyroxine (T4) and normal 3,3',5'-triiodothyronine (T3) and thyroid stimulating hormone (TSH) levels in the blood. Gestational Hpx is closely related to cognitive impairment in the human offspring. In animal models gestational Hpx causes impairment at glutamatergic synapsis, spatial learning, and the susceptibility to suffer strong autoimmune diseases like experimental autoimmune encephalomyelitis (EAE). However, the mechanisms underlying these phenotypes are unknown. On the other hand, it has been shown that astrocytes and microglia affect the outcome of EAE. In fact, the activation of astrocytes and microglia in the central nervous system (CNS) contributes to EAE progression. Thus, in this work, the reactivity of astrocytes and microglia from rats gestated in Hpx was evaluated aiming to understand whether these cells are targets of gestational Hpx. Interestingly, microglia derived from the offspring gestated in Hpx were less reactive compared to microglia derived from offspring gestated in euthyroidism. Instead, astrocytes derived from the offspring gestated in Hpx were significantly more reactive than the astrocytes from the offspring gestated in euthyroidism. This work contributes with novel information regarding the effects of gestational Hpx over astrocytes and microglia in the offspring. It suggests that astrocyte could react strongly to an inflammatory insult inducing neuronal death in the CNS.
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Astrócitos/patologia , Inflamação/sangue , Inflamação/patologia , Microglia/patologia , Tiroxina/sangue , Animais , Apoptose/efeitos dos fármacos , Astrócitos/efeitos dos fármacos , Astrócitos/metabolismo , Células Cultivadas , Quimiocina CXCL2/metabolismo , Feminino , Proteína Glial Fibrilar Ácida/metabolismo , Interleucina-1beta/metabolismo , Masculino , Microglia/efeitos dos fármacos , Microglia/metabolismo , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Gravidez , Ratos Sprague-Dawley , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Fator de Necrose Tumoral alfa/farmacologiaRESUMO
Abstract Neuropsychiatry is a specialized clinical, academic and scientific discipline with its field located in the borderland territory between neurology and psychiatry. In this article, we approach the theoretical definition of neuropsychiatry, and in order to address the practical aspects of the discipline, we describe the profile of a neuropsychiatric liaison service in the setting of a large hospital for neurological diseases in a middle-income country. An audit of consecutive in-patients requiring neuropsychiatric assessment at the National Institute of Neurology and Neurosurgery of Mexico is reported, comprising a total of 1212 patients. The main neurological diagnoses were brain infections (21%), brain neoplasms (17%), cerebrovascular disease (14%), epilepsy (8%), white matter diseases (5%), peripheral neuropathies (5%), extrapyramidal diseases (4%), ataxia (2%), and traumatic brain injury and related phenomena (1.8%). The most frequent neuropsychiatric diagnoses were delirium (36%), depressive disorders (16.4%), dementia (14%), anxiety disorders (8%), frontal syndromes (5%), adjustment disorders (4%), psychosis (3%), somatoform disorders (3%), and catatonia (3%). The borderland between neurology and psychiatry is a large territory that requires the knowledge and clinical skills of both disciplines, but also the unique expertise acquired in a clinical and academic neuropsychiatry program.
Resumen La neuropsiquiatría es una disciplina médica cuyo campo clínico, académico y científico se localiza en el territorio fronterizo entre la neurología y la psiquiatría. En este artículo se aborda la definición teórica de la neuropsiquiatría y, con el objetivo de tratar los aspectos prácticos de la neuropsiquiatría, se describe el perfil de un servicio de interconsulta neuropsiquiátrica en el contexto de un hospital dedicado a las enfermedades del sistema nervioso, en un país de ingreso económico medio. Se incluyó a 1.212 pacientes evaluados consecutivamente en el Instituto Nacional de Neurología y Neurocirugía de México. Los diagnósticos principales fueron infecciones cerebrales (21%), neoplasias del sistema nervioso (17%), enfermedad cerebrovascular (14%), epilepsia (8%), enfermedades de la sustancia blanca (5%), neuropatías periféricas (5%), enfermedades extrapiramidales (4%), ataxias (2%) y traumatismos craneoencefálicos (1,8%). Los diagnósticos neuropsiquiátricos más frecuentes fueron síndrome confusional (36%), depresión (16,4%), demencia (14%), ansiedad (8%), síndromes frontales (5%), reacciones de ajuste (4%), psicosis (3%), trastornos somatoformes (3%) y catatonia (3%). El territorio fronterizo entre la neurología y la psiquiatría es extenso y requiere los conocimientos y fortalezas de ambas disciplinas, pero también la pericia entrenada mediante un programa clínico, científico y académico especializado.
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Humanos , Psiquiatria , Neuropsiquiatria , Neurologia , Transtornos de Ansiedade , Transtornos Cerebrovasculares , Doença , Neoplasias do Sistema NervosoRESUMO
Neuropsychiatry is a specialized clinical, academic and scientific discipline with its field located in the borderland territory between neurology and psychiatry. In this article, we approach the theoretical definition of neuropsychiatry, and in order to address the practical aspects of the discipline, we describe the profile of a neuropsychiatric liaison service in the setting of a large hospital for neurological diseases in a middle-income country. An audit of consecutive in-patients requiring neuropsychiatric assessment at the National Institute of Neurology and Neurosurgery of Mexico is reported, comprising a total of 1212 patients. The main neurological diagnoses were brain infections (21%), brain neoplasms (17%), cerebrovascular disease (14%), epilepsy (8%), white matter diseases (5%), peripheral neuropathies (5%), extrapyramidal diseases (4%), ataxia (2%), and traumatic brain injury and related phenomena (1.8%). The most frequent neuropsychiatric diagnoses were delirium (36%), depressive disorders (16.4%), dementia (14%), anxiety disorders (8%), frontal syndromes (5%), adjustment disorders (4%), psychosis (3%), somatoform disorders (3%), and catatonia (3%). The borderland between neurology and psychiatry is a large territory that requires the knowledge and clinical skills of both disciplines, but also the unique expertise acquired in a clinical and academic neuropsychiatry program.
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Transtornos Mentais/terapia , Doenças do Sistema Nervoso/terapia , Neuropsiquiatria/organização & administração , Adulto , Competência Clínica , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/fisiopatologia , México , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologiaRESUMO
Thyroid hormones (THs) during pregnancy contribute significantly to cellular differentiation and development in several tissues of the offspring, principally the central nervous system (CNS). TH deficiencies, such as hypothyroidism or hypothyroxinemia, are highly frequent during pregnancy worldwide and known to be detrimental for the development of the fetus. The function of CNS in the offspring gestated under TH deficiency will be irreversible impaired, causing low intellectual quotient, attention deficit, and mental retardation. On the other hand, little is known about the effects of TH deficiency in the offspring immune system, being the prevalent notion that the effects are reversible and only for a while will affect the number of B and T cells. Recent studies have shown that maternal hypothyroidism can altered the function of immune system in the offspring, rendering the female offspring more susceptible to suffer autoimmune-inflammatory diseases, such as experimental autoimmune encephalomyelitis (EAE) and to be more resistant to a bacterial infection. In this article we discuss these recent findings, as well as the possible mechanisms underlying these effects and the potential implications for human health.
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Sistema Nervoso Central/fisiologia , Filho de Pais com Deficiência , Encefalomielite Autoimune Experimental , Hipotireoidismo/imunologia , Fatores Sexuais , Hormônios Tireóideos/metabolismo , Animais , Diferenciação Celular , Suscetibilidade a Doenças , Feminino , Humanos , Hipotireoidismo/genética , Camundongos , Mães , Gravidez , Complicações na Gravidez/genética , Hormônios Tireóideos/genéticaRESUMO
Introducción: Existen pacientes que, después de lesiones cerebrales o periféricas, pierden alguna función sensorial, como la vista o el oído. Paradójicamente, después de perder esta función, presentan alucinaciones complejas relacionadas con la función perdida. Se sabe que este fenómeno puede presentarse ante lesiones en cualquier nivel de la vía visual, especialmente en el nivel de la retina.Objetivo: Revisar la bibliografía existente acerca del síndrome de Charles Bonnet para conocer los últimos avances con respecto a este fenómeno.Método: Se revisaron las bases de datos de PubMed y PsychInfo con las siguientes palabras clave: síndrome de Charles Bonnet; alucinaciones visuales; alucinosis peduncular; Charles Bonnet; privación sensorial. Se incluyeron aquellos artículos que efectivamente trataran del tema. Asimismo, se revisaron los textos clásicos referentes a este síndrome y los artículos mencionados en la bibliografía encontrada.Resultados: En el presente artículo se describe la historia del síndrome, el fenómeno clínico, los factores de riesgo, los criterios diagnósticos, los tratamientos empleados, otros fenómenos similares y las teorías propuestas para explicarlo.Discusión y conclusión: A la fecha continúan siendo controvertidos los criterios diagnósticos del síndrome de Charles Bonnet, en especial en lo referente a la preservación absoluta del insight como condición sine qua non. Descrito desde el siglo XVIII, el síndrome de Charles Bonnet corresponde al prototipo de alucinaciones visuales en pacientes con privación visual, si bien, de acuerdo con la presente revisión, la fenomenología de éste es bastante variada, siendo cuestionable si resulta también el prototipo de las alucinaciones con insight preservado.
Introduction: Some patients, after brain or peripheral injuries, lose a sensory function, such as sight or hearing, but paradoxically experience complex hallucinations related to the function they have lost. It is known that this phenomenon may appear with injuries at any level in the visual pathway, especially in the retina.Objective:To review the existent bibliography on the Charles Bonnet syndrome to establish the state of the art with regards to this phenomenon.Method: The databases PubMed and PsychInfo were searched for articles containing the following keywords: Charles Bonnet syndrome; visual hallucinations; peduncular hallucinosis; Charles Bonnet; sensory deprivation. We included those related to the subject. We also included the classic texts referring to this phenomenon and the articles mentioned in the literature.Results: In the present study, we describe the history of Charles Bonnet syndrome, clinical presentation, risk factors, diagnostic criteria, treatment employed, similar conditions and the theories seeking to explain it.Discussion and conclusion: To date, the diagnostic criteria for Charles Bonnet syndrome remain controversial, especially those concerning the absolute preservation of insight as a sine qua non factor to establish the diagnosis. Conclusion: Described since the 18th century, the Charles Bonnet syndrome corresponds to the prototype of visual hallucinations in patients with visual deprivation, although, according to the present review, its phenomenology is vast, remaining unclear if it corresponds to the prototype of hallucinations with preserved insight.
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A young woman with Westphal variant (juvenile) Huntington disease (HD) also developed catatonia. Catatonia is an underdiagnosed psychomotor syndrome often associated with neurological and psychiatric disorders, but it has rarely been documented in patients with HD. Catatonia usually responds to standard treatment with benzodiazepines and electroconvulsive therapy; however, this patient's catatonic syndrome did not improve until we augmented the standard treatment with amantadine and levodopa. The underlying pathophysiology and a neurochemical hypothesis of HD and catatonia can explain their comorbidity and the refractoriness of catatonia to treatment. Both conditions are linked to dysregulation of neurotransmitters in the striatocortical and corticocortical pathways. This understanding may serve as a guide for the use of nonstandard treatments. Our evidence also suggests that electroconvulsive therapy can be useful and safe in the treatment of HD.
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Catatonia/tratamento farmacológico , Catatonia/terapia , Terapia Combinada/psicologia , Dopaminérgicos/uso terapêutico , Eletroconvulsoterapia/psicologia , Doença de Huntington/psicologia , Adulto , Amantadina/uso terapêutico , Carbidopa/administração & dosagem , Carbidopa/uso terapêutico , Catatonia/complicações , Terapia Combinada/métodos , Dopaminérgicos/administração & dosagem , Combinação de Medicamentos , Resistência a Medicamentos , Eletroconvulsoterapia/métodos , Feminino , Humanos , Doença de Huntington/complicações , Doença de Huntington/tratamento farmacológico , Doença de Huntington/terapia , Levodopa/administração & dosagem , Levodopa/uso terapêuticoRESUMO
The authors describe the frequency and characteristics of Cotard syndrome among neurological and psychiatric inpatients at a tertiary referral center. All inpatients from the National Institute of Neurology of Mexico (March 2007-May 2009) requiring neuropsychiatric consultation were reviewed. Among 1,321 inpatient consultations, 63.7% had neurological disease and one (0.11%) had viral encephalitis and Cotard syndrome. Of inpatients, 36.2% had pure psychiatric disorders and three (0.62%) had Cotard syndrome, associated with psychotic depression, depersonalization, and penile retraction (koro syndrome). This review discusses potential mechanisms for Cotard syndrome, including the role of a perceptual-emotional dissociation in self-misattribution in the deliré des negations.
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Delusões/complicações , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/psicologia , Adolescente , Adulto , Idoso , Delusões/diagnóstico , Delusões/terapia , Eletrochoque/métodos , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Observação , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: Brain pathologies are frequent sources of mental and behavioral disorders. In order to analyze the boundary between neurology and psychiatry, we analyzed all neuropsychiatric consultations seen at the inpatient Neurology, Neurosurgery, Critical Medicine and Neurological Emergencies clinics of the National Institute of Neurology and Neurosurgery of Mexico between 2007 and 2009. RESULTS: A total of 506 neuropsychiatric visits were included, patient mean age was 44.2 years (SD 17 years) 240 patients were female (47.4%). The main neurological disorders for which patients sought medical care at the neuropsychiatry service, were: brain tumors (14.2%), viral encephalitis (8.7%), ischaemic cerebrovascular disorders (7.1%), epilepsy (6.5%) and haemorragic cerebrovascular disorders (4.7%). The most common DSM-IV psychiatric diagnoses included: delirium (38.5%), depressive disorders (15%), dementia (7.7%), cognitive decline, without fulfilling criteria for dementia (6.5%), and anxiety disorders (6.9%). Delirium was the most common neuropsychiatric condition among the etiological groups. Catatonic syndrome was more frequent among patients with brain infections (p < 0.001), and pathological laughter and crying were more frequent among atients with cerebrovascular disorders (p = 0.012). CONCLUSIONS: Our study highlights the clinical relevance of delirium, depression, anxiety, dementia, frontal syndromes and catatonia among neurologic and neurosurgical in-patients attending a tertiary care reference center in Mexico.