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González-Alvarez F, Estañol B, González-Hermosillo JA, Gómez-Pérez FJ, Tamez-Torres KM, Peña E, Cantú C, Chiquete E, Sifuentes-Osornio J, Alba-Lorenzo MDC, Celestino-Montelongo DA, Salazar-Calderón GE, Aceves Buendia JDJ. Complete remission with histamine blocker in a patient with intractable hyperadrenergic postural orthostatic tachycardia syndrome secondary to long coronavirus disease syndrome. J Hypertens 2024; 42:928-932. [PMID: 38526146 PMCID: PMC10990027 DOI: 10.1097/hjh.0000000000003669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 03/26/2024]
Abstract
The COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), has emerged as a global public health concern and its sequels have barely started to outcrop. A good percentage of patients who suffered from COVID-19 are prone to develop long-COVID or post-COVID condition (PCC), a multisystemic, heterogeneous, chronic disorder. Patients with PCC may experience diverse manifestations, of which cardiovascular and neurological symptoms are among the most frequently reported. Indeed, dysautonomia presented as orthostatic intolerance has gained room following recent reports linking postural orthostatic tachycardia syndrome (POTS) with PCC. Disturbances in heart rate (HR) and blood pressure (BP) during postural changes are the cornerstones of orthostatic intolerance seen in patients suffering from PCC. A subtype of POTS, hyperadrenergic POTS, has been widely studied because of its association with mast cell activation syndrome (MCAS). Although a causative relationship between PCC, hyperadrenergic POTS, and MCAS remains unrevealed, these syndromes can overlap. We want to propose here a correlation produced by a close-loop mechanism with positive feedback established after SARS-CoV-2 infection in a previously healthy young patient.
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Affiliation(s)
- Felipe González-Alvarez
- Laboratory of Autonomic Nervous System, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Bruno Estañol
- Laboratory of Autonomic Nervous System, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | | | | | - Eduardo Peña
- Laboratory of Autonomic Nervous System, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Carlos Cantú
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Erwin Chiquete
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | | | | | | | | | - Jose de Jesus Aceves Buendia
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
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San-Juan D, Velez-Jimenez K, Hoffmann J, Martínez-Mayorga AP, Melo-Carrillo A, Rodríguez-Leyva I, García S, Collado-Ortiz MÁ, Chiquete E, Gudiño-Castelazo M, Juárez-Jimenez H, Martínez-Gurrola M, Marfil A, Nader-Kawachi JA, Uribe-Jaimes PD, Darío-Vargas R, Villareal-Careaga J. Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment. Front Pain Res (Lausanne) 2024; 5:1373528. [PMID: 38524268 PMCID: PMC10957682 DOI: 10.3389/fpain.2024.1373528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Cluster headache (CH) is one of the worst primary headaches that remain underdiagnosed and inappropriately treated. There are recent advances in the understanding of this disease and available treatments. This paper aims to review CH's recent clinical and pathophysiological findings, diagnosis, and treatment. We performed a narrative literature review on the socio-demographics, clinical presentations, pathophysiological findings, and diagnosis and treatment of CH. CH affects 0.1% of the population with an incidence of 2.07-9.8/100,00 person-years-habitants, a mean prevalence of 53/100,000 inhabitants (3-150/100,000 inhabitants). The male-to-female ratio remains inconclusive, as the ratio of 4.3:1 has recently been modified to 1.3-2.6, possibly due to previous misdiagnosis in women. Episodic presentation is the most frequent (80%). It is a polygenetic and multifactorial entity that involves dysfunction of the trigeminovascular system, the trigeminal autonomic reflex, and the hypothalamic networks. An MRI of the brain is mandatory to exclude secondary etiologies. There are effective and safe pharmacological treatments oxygen, sphenopalatine, and great occipital nerve block, with the heterogeneity of clinical trial designs for patients with CH divided into acute, transitional, or bridge treatment (prednisone) and preventive interventions. In conclusion, CH remains underdiagnosed, mainly due to a lack of awareness within the medical community, frequently causing a long delay in reaching a final diagnosis. Recent advances in understanding the principal risk factors and underlying pathophysiology exist. There are new therapeutic possibilities that are effective for CH. Indeed, a better understanding of this challenging pathology will continue to be a subject of research, study, and discoveries in its diagnostic and therapeutic approach.
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Affiliation(s)
- Daniel San-Juan
- Epilepsy Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Jan Hoffmann
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Agustín Melo-Carrillo
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ildefonso Rodríguez-Leyva
- Department of Neurology, Hospital Central “Dr. Ignacio Morones Prieto”, and Faculty of Medicine, Universidad Autonoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Silvia García
- Clinical Research Department, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City, Mexico
| | | | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Alejandro Marfil
- Headache and Chronic Pain Clinic, Neurology Service, Hospital Universitario “Dr. J. E. González” of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - Rubén Darío-Vargas
- Department of Neurology and Psychiatry, Clínica de Mérida, Merida, Mexico
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Arauz A, Barboza MA, Quintero LC, Cantu C, Chiquete E, Serrano F. Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy. Neurologia 2023; 38:617-624. [PMID: 37996212 DOI: 10.1016/j.nrleng.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/04/2021] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
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Affiliation(s)
- A Arauz
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - M A Barboza
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico; Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica.
| | - L C Quintero
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - E Chiquete
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - F Serrano
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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Rodriguez-Leyva I, Velez-Jimenez MK, García S, Nader-Kawachi JA, Martínez-Mayorga AP, Melo-Carrillo A, Juárez-Jimenez H, Martinez-Gurrola M, Gudiño-Castelazo M, Chiquete E, Villareal-Careaga J, Marfil A, Uribe-Jaimes PD, Vargas-García RD, Collado-Ortiz MA, San-Juan D. Cluster headache: state of the art in treatment. Front Pain Res (Lausanne) 2023; 4:1265540. [PMID: 37965210 PMCID: PMC10641784 DOI: 10.3389/fpain.2023.1265540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
Cluster headache (CH) is the most common and devastating autonomic headache with multiple and recent advances in treatment. However, it usually goes unrecognized and is found to have a delayed and inappropriate treatment. This paper aims to review the current therapeutic options for patients with CH. We conducted a narrative literature review on the treatments available for this condition using the American Academy of Neurology (AAN) classification of therapeutic evidence. We found effective and safe pharmacological and non-pharmacological therapies with heterogeneity of clinical trial designs for patients with CH, and they are divided into three phases, namely, transitional, acute, and preventive interventions. Prednisone (A) is the most studied treatment in the transitional phase; acute attacks are treated using triptans (A), oxygen (A), and non-invasive transcutaneous vagal nerve stimulation (A). Verapamil (A) and monoclonal antibodies (possible A) are considered the first options in preventive treatments, followed by multiple pharmacological and non-pharmacological options in prophylactic treatments. In conclusion, numerous effective and safe treatments are available in treating patients with episodic, chronic, and pharmacoresistant CH according to the clinical profile of each patient.
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Affiliation(s)
- Ildefonso Rodriguez-Leyva
- Department of Neurology, Faculty of Medicine, Central Hospital “Dr. Ignacio Morones Prieto,”Universidad Autónoma de San Luis Potosi, San Luis Potosi, Mexico
| | | | - Silvia García
- Clinical Research Department, Centro Médico Nacional “20 de Noviembre,” ISSSTE, Mexico City, Mexico
| | | | | | - Agustín Melo-Carrillo
- Anesthesia Department, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | | | | | | | - Erwin Chiquete
- Department of Neurology and Psychiatry, National Institute of Medical Science and Nutrition “Salvador Zubirán,”Mexico City, Mexico
| | | | - Alejandro Marfil
- Headache and Chronic Pain Clinic, Neurology Service, Hospital Universitario “Dr. J. E. González” of the Universidad Autónoma de Nuevo Leon, Monterrey, Mexico
| | | | | | | | - Daniel San-Juan
- Epilepsy Clinic of the National Institute of Neurology and Neurosurgery Manuel Velazco Suarez, Mexico City, Mexico
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Acosta-Galeana I, Hernández-Martínez R, Reyes-Cruz T, Chiquete E, Aceves-Buendia JDJ. RNA-binding proteins as a common ground for neurodegeneration and inflammation in amyotrophic lateral sclerosis and multiple sclerosis. Front Mol Neurosci 2023; 16:1193636. [PMID: 37475885 PMCID: PMC10355071 DOI: 10.3389/fnmol.2023.1193636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
The neurodegenerative and inflammatory illnesses of amyotrophic lateral sclerosis and multiple sclerosis were once thought to be completely distinct entities that did not share any remarkable features, but new research is beginning to reveal more information about their similarities and differences. Here, we review some of the pathophysiological features of both diseases and their experimental models: RNA-binding proteins, energy balance, protein transportation, and protein degradation at the molecular level. We make a thorough analysis on TDP-43 and hnRNP A1 dysfunction, as a possible common ground in both pathologies, establishing a potential link between neurodegeneration and pathological immunity. Furthermore, we highlight the putative variations that diverge from a common ground in an atemporal course that proposes three phases for all relevant molecular events.
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Affiliation(s)
| | | | - Tania Reyes-Cruz
- Laboratorio de Biología Molecular, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Erwin Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jose de Jesus Aceves-Buendia
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Cahuana-Hurtado L, Gómez-Dantés H, De la Cruz-Góngora V, Chiquete E, Cantú-Brito C. Unveiling the Burden of Miscoding and Misclassification in Stroke Mortality: Analysis of Multiple Cause-of-Death Data in Mexico. Neuroepidemiology 2023; 57:284-292. [PMID: 37399787 DOI: 10.1159/000531537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/04/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The prevalence of risk factors for cerebrovascular diseases in Mexico is increasing although stroke mortality declined from 1990 to 2010, without meaningful changes afterward. While improving access to adequate prevention and care could explain this trend, miscoding and misclassification in death certificates need to be assessed to unveil the true burden of stroke in Mexico. Practices in death certification along with the presence of multi-morbidity could contribute to this distortion. Analyses of multiple causes of death could reveal ill-defined stroke deaths, providing a glimpse of this bias. METHODS Cause-of-death information from 4,262,666 death certificates in Mexico from 2009 to 2015, was examined to determine the extent of miscoding and misclassification on the true burden of stroke. Age-standardized mortality rates per 100,000 inhabitants (ASMR) were calculated for stroke as underlying and multiple causes of death, by sex and state. Deaths were classified following international standards as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and unspecified, which were kept as an independent category to measure miscoding. To approximate misclassification, we compared ASMR under three misclassification scenarios: (1) current (the status quo); (2) moderate, which includes deaths from selected causes mentioning stroke; and (3) high which includes all deaths mentioning stroke. National and subnational data were analyzed to search for geographical patterns. RESULTS The burden of stroke in Mexico is underreported due to miscoding and misclassification. Miscoding is an important issue since almost 60% of all stroke deaths are registered as unspecified. Multiple cause analysis indicates that stroke ASMR could increase 39.9%-52.9% of the current ASMR under moderate and high misclassification scenarios, respectively. Both problems indicate the need to improve death codification procedures and cause-of-death classification. CONCLUSIONS Miscoding and misclassification lead to underestimation of the burden of stroke in Mexico. Stroke deaths are underreported when other important causes coexist, being diabetes the most frequent.
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Affiliation(s)
- Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Héctor Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Santa María Ahuacatitlán, Cuernavaca, Mexico
| | - Vanessa De la Cruz-Góngora
- Center for Evaluation and Survey Research, National Institute of Public Health, Santa María Ahuacatitlán, Cuernavaca, Mexico
| | - Erwin Chiquete
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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7
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Espinosa-Juárez JV, Chiquete E, Estañol B, Aceves JDJ. Optogenetic and Chemogenic Control of Pain Signaling: Molecular Markers. Int J Mol Sci 2023; 24:10220. [PMID: 37373365 DOI: 10.3390/ijms241210220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Pain is a complex experience that involves physical, emotional, and cognitive aspects. This review focuses specifically on the physiological processes underlying pain perception, with a particular emphasis on the various types of sensory neurons involved in transmitting pain signals to the central nervous system. Recent advances in techniques like optogenetics and chemogenetics have allowed researchers to selectively activate or inactivate specific neuronal circuits, offering a promising avenue for developing more effective pain management strategies. The article delves into the molecular targets of different types of sensory fibers such as channels, for example, TRPV1 in C-peptidergic fiber, TRPA1 in C-non-peptidergic receptors expressed differentially as MOR and DOR, and transcription factors, and their colocalization with the vesicular transporter of glutamate, which enable researchers to identify specific subtypes of neurons within the pain pathway and allows for selective transfection and expression of opsins to modulate their activity.
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Affiliation(s)
- Josue Vidal Espinosa-Juárez
- Escuela de Ciencias Químicas Sede Ocozocoautla, Universidad Autónoma de Chiapas, Ocozocoautla de Espinosa 29140, Mexico
| | - Erwin Chiquete
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Bruno Estañol
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - José de Jesús Aceves
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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8
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García-Grimshaw M, Jiménez-Ruiz A, Ruiz-Sandoval JL, Cantú-Brito C, Chiquete E. Osmotic demyelination syndrome in patients with non-Hodgkin lymphoma: a case report and literature review. Int J Neurosci 2023; 133:233-237. [PMID: 33765889 DOI: 10.1080/00207454.2021.1909009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Amado Jiménez-Ruiz
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - José Luis Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
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Gnatiuc Friedrichs L, Wade R, Alegre‐Díaz J, Ramirez‐Reyes R, Garcilazo‐Ávila A, Gonzáles‐Carballo C, Santacruz‐Benitez R, Chiquete E, Herrington W, Collins R, Peto R, Clarke R, Berumen J, Emberson JR, Kuri‐Morales P, Tapia‐Conyer R. Body Composition and Risk of Vascular-Metabolic Mortality Risk in 113 000 Mexican Men and Women Without Prior Chronic Disease. J Am Heart Assoc 2023; 12:e028263. [PMID: 36695315 PMCID: PMC9973642 DOI: 10.1161/jaha.122.028263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Abstract
Background Body-mass index is the sum of fat mass index (FMI) and lean mass index (LMI), which vary by age, sex, and impact on disease outcomes. We investigated the separate and joint relevance of FMI and LMI with vascular-metabolic causes of death in Mexican adults. Methods and Results A total of 113 025 adults aged 35 to 74 years and free from diabetes or other chronic diseases when recruited into the Mexico City Prospective Study were followed for 19 years. Cox models estimated sex-specific death rate ratios from vascular-metabolic causes after adjustment for confounders and exclusion of the first 5 years of follow-up. To account for the strong correlation between FMI and LMI, additional models estimated rate ratios associated with "residual FMI" and "residual LMI" (ie, the residuals from linear regression analyses of FMI on LMI, or vice versa). In both sexes, higher FMI and LMI were associated with higher risks of vascular-metabolic mortality. For a given (ie, fixed) level of LMI, the rate ratio (95% CI) for vascular-metabolic mortality per 1 kg/m2 higher residual FMI strengthened and was higher in women (1.52 [1.38-1.68]) than in men (1.19 [1.13-1.25]). By contrast, for a given level of FMI, higher residual LMI was inversely associated with vascular-metabolic mortality (rate ratio per 1 kg/m2 0.67 [0.56-0.80] in women and 0.94 [0.90-0.98] in men). Conclusions In this study, higher residual FMI was more strongly associated with vascular-metabolic mortality in women than in men. Conversely, higher residual LMI was inversely associated with vascular-metabolic mortality, particularly in women.
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Affiliation(s)
- Louisa Gnatiuc Friedrichs
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Rachel Wade
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Jesus Alegre‐Díaz
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Raúl Ramirez‐Reyes
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Adrián Garcilazo‐Ávila
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Carlos Gonzáles‐Carballo
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Rogelio Santacruz‐Benitez
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Erwin Chiquete
- Instituto Nacional de Ciencias Médicas y de la Nutrición, Salvador Zubirán HospitalMexico CityMexico
| | - William Herrington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Jaime Berumen
- Experimental Research Unit from the Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Jonathan R. Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
- MRC Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordUnited Kingdom
| | - Pablo Kuri‐Morales
- School of MedicineNational Autonomous University of MexicoMexico CityMexico
- Instituto Tecnológico y de Estudios Superiores de MonterreyMonterreyMexico
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Rene Moran Morales M, Daniel Perez Baldioceda C, Guerrero Fuentes C, Chiquete E, Leonor Rivera A, Israel Gallegos Rios C. TU-218. Decreased heart rate variability and increased systolic blood pressure variability in patients with Guillain-Barré syndrome. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toapanta-Yanchapaxi L, Chiquete E, Ávila-Rojo E, López-Yánez S, Luna Del Villar Velasco S, Rivera Monroy S, López Gómez T, Andrés Aguilar JB, Balcázar Antonio DF, Alcaraz-Fuerte C, García Baysa M, López Jiménez JL, Márquez-Guillén E, Vilatobá M, Cruz-Martínez R, Carpinteyro-Espin P, Chávez-Villa M, Romero Morelos RD, Torres-Del Real D, Uscanga-Domínguez LF, García-Alanis M, Tapia Sosa R, Servín-Rojas M, Valdez-Echeverria RD, García-Juárez I. Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients. Vaccine 2022; 40:5621-5630. [PMID: 36028456 PMCID: PMC9393170 DOI: 10.1016/j.vaccine.2022.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/17/2022] [Accepted: 08/15/2022] [Indexed: 12/12/2022]
Abstract
Background The safety and efficacy data of the different types of available vaccines is still needed. The goal of the present analysis was to evaluate the humoral response to the COVID-19 vaccines in orthotopic liver transplant (OLT) recipients. Methods Participants were included from February to September 2021. No prioritized vaccination roll call applied for OLT patients. Controls were otherwise healthy people. Blood samples were drawn after 15 days of the complete vaccine doses. The samples were analyzed according to the manufacturer's instructions using the Liaison XL platform from DiaSorin (DiaSorin S.p.A., Italy), and SARS-COV-2 IgG II Quant (Abbott Diagnostics, IL, USA). Results A total of 187 participants (133 OLT, 54 controls, median age: 60 years, 58.8% women) were included for the analysis; 74.3% had at least one comorbidity. The serologic response in OLT patients was lower than in controls (median 549 AU/mL vs. 3450 AU/mL, respectively; p = 0.001). A positive humoral response was found in 133 OLT individuals: 89.2% with BNT162b2 (Pfizer-BioNTech), 60% ChAdOx1 nCOV-19 (Oxford-AstraZeneca), 76.9% with CoronaVac (Sinovac, Life Sciences, China), 55.6% Ad5-nCov (Cansino, Biologics), 68.2% Gam-COVID-Vac (Sputnik V) and 100% with mRNA-1273. In controls the serological response was 100%, except for Cansino (75%). In a multivariable model, personal history of COVID-19 and BNT162b2 inoculation were associated with the serologic response, while the use of prednisone (vs. other immunosuppressants) reduced this response. Conclusion The serologic response to COVID-19 vaccines in OLT patients is lower than in healthy controls. The BNT162b2 vaccine was associated with a higher serologic response.
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Affiliation(s)
- Liz Toapanta-Yanchapaxi
- Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Erwin Chiquete
- Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Esmeralda Ávila-Rojo
- Liver Transplant Unit and Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Silvia López-Yánez
- Liver Transplant Unit and Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | | | - Sergio Rivera Monroy
- Clinical Pathology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Tomás López Gómez
- Clinical Pathology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Juan Bruno Andrés Aguilar
- Clinical Pathology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | | | - Carlos Alcaraz-Fuerte
- Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Magdalena García Baysa
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - José Luis López Jiménez
- Nursing Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Ernesto Márquez-Guillén
- Liver Transplant Unit and Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Mario Vilatobá
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Rodrigo Cruz-Martínez
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | | | - Mariana Chávez-Villa
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | | | - Daniel Torres-Del Real
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Luis F Uscanga-Domínguez
- Liver Transplant Unit and Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Mario García-Alanis
- Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Ramiro Tapia Sosa
- Liver Transplant Unit and Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Maximiliano Servín-Rojas
- Liver Transplant Unit and Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | | | - Ignacio García-Juárez
- Liver Transplant Unit and Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico.
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García-Grimshaw M, Galnares-Olalde JA, Bello-Chavolla OY, Michel-Chávez A, Cadena-Fernández A, Briseño-Godínez ME, Antonio-Villa NE, Nuñez I, Gutiérrez-Romero A, Hernández-Vanegas L, Saniger-Alba MDM, Carrillo-Mezo R, Ceballos-Liceaga SE, Carbajal-Sandoval G, Flores-Silva FD, Díaz-Ortega JL, Cortes-Alcalá R, Pérez-Padilla JR, López-Gatell H, Chiquete E, Reyes-Terán G, Arauz A, Valdés-Ferrer SI. Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines. Eur J Neurol 2022; 29:3368-3379. [PMID: 35841212 PMCID: PMC9349509 DOI: 10.1111/ene.15504] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Information on Guillain–Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS‐CoV‐2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti‐SARS‐CoV‐2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. Methods Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA‐based (mRNA‐1273 and BNT162b2), adenovirus‐vectored (ChAdOx1 nCov‐19, rAd26‐rAd5, Ad5‐nCoV, and Ad26.COV2‐S), and inactivated whole‐virion‐vectored (CoronaVac) vaccines. Results We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33–60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97–1.45), with incidence higher among Ad26.COV2‐S (3.86/1,000,000 doses, 95% CI 1.50–9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36–2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3–17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID‐19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy‐five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. Conclusions Guillain–Barré syndrome was an extremely infrequent AEFI against SARS‐CoV‐2. The protection provided by these vaccines outweighs the risk of developing GBS.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Hospital General Tijuana, Tijuana, Mexico
| | | | | | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Cadena-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Eugenia Briseño-Godínez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Isaac Nuñez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alonso Gutiérrez-Romero
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Laura Hernández-Vanegas
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - María Del Mar Saniger-Alba
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roger Carrillo-Mezo
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | | | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Luis Díaz-Ortega
- Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud, Mexico City, Mexico
| | | | | | | | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad
| | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Feinstein Institutes for Medical Research, Manhasset, NY, USA
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13
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Aguilar-Salas E, Rodríguez-Aquino G, García-Domínguez K, Garfias-Guzmán C, Hernández-Camarillo E, Oropeza-Bustos N, Arguelles-Castro R, Mitre-Salazar A, García-Torres G, Reynoso-Marenco M, Morales-Andrade E, Gervacio-Blanco L, García-López V, Valiente-Herves G, Martínez-Marino M, Flores-Silva F, Chiquete E, Cantú-Brito C. Acute Stroke Care in Mexico City: The Hospital Phase of a Stroke Surveillance Study. Brain Sci 2022; 12:brainsci12070865. [PMID: 35884672 PMCID: PMC9312700 DOI: 10.3390/brainsci12070865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Acute stroke care has greatly improved in recent decades. However, the increasing stroke mortality in low-to-middle income countries suggests that progress has not been reached completely by these populations. Here we present the analysis of the hospital phase of the first population-based stroke surveillance study. Methods: A daily hospital surveillance method was used to identify adult patients with acute stroke during 18 months in six hospitals. We abstracted data on demographics, vascular risk factors, neuroimaging-confirmed stroke types, and clinical data. Results: A total of 1361 adults with acute stroke were identified (mean age 69.2 years; 52% women) with transient ischemic attack (5.5%), acute ischemic stroke (68.6%), intracerebral hemorrhage (23.1%), cerebral venous thrombosis (0.2%), and undetermined stroke (2.6%). The main risk factors were hypertension (80.7%) and diabetes mellitus (47.6%). The usage rate of thrombolysis was 3.6%, in spite of the fact that 37.2% of acute ischemic stroke patients arrived in <4.5 h. The 30-day case fatality rate was 32.6%, higher in hemorrhagic than ischemic stroke. Conclusion: We identified limitations in acute stroke care in the Mexico City, including neuroimaging availability and thrombolysis usage. The door-to-door phase will help to depict the acute stroke burden in Mexico.
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Affiliation(s)
- Emmanuel Aguilar-Salas
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Guadalupe Rodríguez-Aquino
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Katya García-Domínguez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Catalina Garfias-Guzmán
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Erika Hernández-Camarillo
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Nayeli Oropeza-Bustos
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Rubí Arguelles-Castro
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Ameyalli Mitre-Salazar
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Gloria García-Torres
- Department of Neurology, Hospital de Especialidades “Dr. Belisario Domínguez”, Mexico City 09930, Mexico;
| | - Marco Reynoso-Marenco
- Department of Internal Medicine, Hospital General “Dr. Darío Fernández Fierro”, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City 03900, Mexico;
| | - Eduardo Morales-Andrade
- Department of Epidemiology, Hospital General “Dr. Darío Fernández Fierro”, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City 03900, Mexico;
| | - Luis Gervacio-Blanco
- Department of Emergencies, Hospital General “Dr. Darío Fernández Fierro”, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City 03900, Mexico;
| | - Víctor García-López
- Department of Internal Medicine, Hospital General Tlahuac, Mexico City 13250, Mexico;
| | - Gabriel Valiente-Herves
- Department of Internal Medicine, Hospital General de Zona 47, Instituto Mexicano del Seguro Social, Mexico City 09200, Mexico;
| | - Manuel Martínez-Marino
- Department of Neurology, Hospital General de Zona 32, Instituto Mexicano del Seguro Social, Mexico City 04980, Mexico;
| | - Fernando Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
- Correspondence: (E.C.); (C.C.-B.); Tel.: +52-55-5487-0900 (ext. 2522) (E.C. & C.C.-B.)
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (E.A.-S.); (G.R.-A.); (K.G.-D.); (C.G.-G.); (E.H.-C.); (N.O.-B.); (R.A.-C.); (A.M.-S.); (F.F.-S.)
- Correspondence: (E.C.); (C.C.-B.); Tel.: +52-55-5487-0900 (ext. 2522) (E.C. & C.C.-B.)
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Dominguez-Moreno R, Venegas-Gómez VA, Zepeda-Gutiérrez LA, De La Rosa-Cuevas JJ, Hernández-Félix JH, Martos-Armendariz EO, Chiquete E, Vega-Boada F, Flores-Silva F, Cantú-Brito C. Headache related to personal protective equipment in healthcare workers during COVID-19 pandemic in Mexico: baseline and 6-month follow-up. Int Arch Occup Environ Health 2022; 95:1945-1954. [PMID: 35716173 PMCID: PMC9206092 DOI: 10.1007/s00420-022-01895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
Background and aim Headaches related to the use of personal protective equipment (PPE) could affect performance at work in healthcare personnel. Our aim was to describe the prevalence and risk factors for headaches related to PPE, in the personnel of a specialized coronavirus disease 2019 (COVID-19) tertiary hospital. Methods In this cross-sectional survey study, we invited healthcare workers from COVID-19 referral center in Mexico (May 22–June 19, 2020) to answer a standardized structure questionnaire on characteristics of new-onset PPE-related headache or exacerbation of primary headache disorder. Participants were invited regardless of whether they had a current headache to avoid selection bias. This is the primary analysis of these data. Results Two hundred and sixty-eight subjects were analyzed, 181/268 (67.5%) women, 177/268 (66%) nurses, mean age 28 years. The prevalence of PPE-related headache was 210/268 (78.4%). Independent risk factors were occupation other than physician (OR 1.59, 95% CI 1.20–2.10), age > 30 years (OR 2.54, 95% CI 1.25–5.14), and female sex (OR 3.58, 95% CI 1.86–6.87). In the 6-month follow-up, 13.1% of subjects evolve to chronic headache, with stress as predictive risk factor. Conclusion The frequency of PPE-associated headache is high, and a subgroup could evolve to chronic headache. More studies are necessary to improve the knowledge about this condition.
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Affiliation(s)
- Rogelio Dominguez-Moreno
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México.
| | - Venny A Venegas-Gómez
- Department of Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Luis Asdruval Zepeda-Gutiérrez
- Department of Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Juan José De La Rosa-Cuevas
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Jorge Humberto Hernández-Félix
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Edgar Omar Martos-Armendariz
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Erwin Chiquete
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Felipe Vega-Boada
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Fernando Flores-Silva
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
| | - Carlos Cantú-Brito
- Department of Neurology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de Mexico, México
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15
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Cruz-Góngora VDL, Chiquete E, Gómez–Dantés H, Cahuana-Hurtado L, Cantú-Brito C. Trends in the burden of stroke in Mexico: A national and subnational analysis of the global burden of disease 1990-2019. Lancet Reg Health Am 2022; 10:100204. [PMID: 36777683 PMCID: PMC9904132 DOI: 10.1016/j.lana.2022.100204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Scarce epidemiological information on stroke in Mexico impedes evidence-based decisions and debilitates the design of effective prevention programmes at the local level. Methods Ecological and secondary analysis of Global Burden of Disease national and subnational data for Mexico, from 1990 to 2019. We analysed the incidence, prevalence, deaths, premature mortality, disability, and DALYs due to cerebrovascular disease included to identify the differences in the burden of stroke in Mexico by type of stroke (ischaemic [IS], intracerebral haemorrhage [ICH] and subarachnoid haemorrhage [SAH]), sex, age groups, and state levels ordered by quartiles of Sociodemographic Index (SDI). Means and 95% uncertainty intervals are reported. Findings Reductions in all metrics of total stroke occurred during the 1990 to 2005 period; however, this declining trend was followed up by stagnation of progress from 2006 to 2019, except for premature mortality. This pattern of the declining trend was observed also for IS and to a lesser extent for ICH, while SAH showed no major changes during the 1990-2019 period. The magnitude of decline was higher in females for total stroke for incidence, prevalence and YLDs rates. The less developed states by SDI exhibited the lowest improvements during the period, particularly for ICH metrics. Interpretation The reduction in stroke burden in Mexico did not follow the same pace for all types of stroke, with regional differences by SDI and by sex. Study findings reveal the need for strengthening prevention policies to address health disparities in the burden of stroke by sex and states, within the fragmented Mexican Healthcare System. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
| | - Héctor Gómez–Dantés
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Mexico
| | - Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Cantú-Brito
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México,Corresponding author at: Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI, Tlalpan. Ciudad de México, México.
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Lee-Chen L, Williams-de-Roux R, Chiquete E, Aceves-Buendía JJ, Ruiz-Ruiz E, Portillo-Valle J, Bliskunova T, Rodríguez-Perea E, Toapanta-Yanchapaxi L, García-Ramos G, Cantú-Brito C, Estañol B. Clinical and neurophysiological description of patients with POEMS syndrome. GAC MED MEX 2022; 157:466-472. [DOI: 10.24875/gmm.m21000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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García-Grimshaw M, Posadas-Pinto DR, Jiménez-Ruiz A, Valdés-Ferrer SI, Cadena-Fernández A, Torres-Ruiz JJ, Barrientos-Guerra JD, Amancha-Gabela M, Chiquete E, Flores-Silva FD, Cantú-Brito C. Antiphospholipid syndrome-mediated acute cerebrovascular diseases and long-term outcomes. Lupus 2022; 31:228-237. [PMID: 35042376 DOI: 10.1177/09612033221074178] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The antiphospholipid syndrome (APS) is an autoimmune disease associated with thrombotic and non-thrombotic neurologic manifestations. APS is classified as primary (PAPS) or secondary (SAPS) when it co-exists with another autoimmune disease. We aim to describe the spectrum of acute cerebrovascular disease among patients with APS, their differences between stroke subtypes, and long-term functional outcomes. METHODS Retrospective cohort study including adult (≥18 years) patients with APS followed in the stroke clinic of a tertiary-care reference center for autoimmune diseases in Mexico from 2009 to 2019. RESULTS We studied 120 cases; 99 (82.5%) women; median age 43 years (interquartile range 35-52); 63.3% with SAPS. Demographics, comorbidities, and antiphospholipid antibodies (aPL) positivity were similar between APS type and stroke subtypes. Amongst index events, we observed 84 (70%) acute ischemic strokes (AIS), 19 (15.8%) cerebral venous thromboses (CVT), 11 (9.2%) intracerebral hemorrhages (ICH), and six (5%) subarachnoid hemorrhages (SAH). Sixty-seven (55.8%) were known patients with APS; the median time from APS diagnosis to index stroke was 46 months (interquartile range 12-96); 64.7% of intracranial hemorrhages (ICH or SAH) occurred ≥4 years after APS was diagnosed (23.5% anticoagulation-related); 63.2% of CVT cases developed before APS was diagnosed or simultaneously. Recurrences occurred in 26 (22.8%) patients, AIS, in 18 (69.2%); intracranial hemorrhage, in eight (30.8%). Long-term functional outcomes were good (modified Rankin Scale ≤2) in 63.2% of cases, during follow-up, the all-cause mortality rate was 19.2%. CONCLUSION We found no differences between stroke subtypes and APS types. aPL profiles were not associated with any of the acute cerebrovascular diseases described in this cohort. CVT may be an initial thrombotic manifestation of APS with low mortality and good long-term functional outcome.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diego Rubén Posadas-Pinto
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amado Jiménez-Ruiz
- Stroke, Dementia & Heart Disease Laboratory, 6221Western University, London, ON, Canada
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,88982Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Arturo Cadena-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Jiram Torres-Ruiz
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Domingo Barrientos-Guerra
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margarita Amancha-Gabela
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Ruiz-Sandoval JL, Aceves-Montoya J, Chiquete E, López-Valencia G, Lara-López A, Sánchez-González M, Jiménez-Ruiz A, Barinagarrementería F, Murillo-Bonilla L, Arauz-Góngora A, Flores-Silva FD, Cantú-Brito C. Hospital Arrival and Functional Outcome after Intracerebral Hemorrhage. Rev Invest Clin 2022; 74:51-60. [PMID: 34851574 DOI: 10.24875/ric.21000471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is associated with an ominous outcome influenced by the time to hospital presentation. OBJECTIVE This study aims to identify the factors that influence an early hospital arrival after ICH and the relationship with outcome. METHODS In this multicenter registry, patients with confirmed ICH on CT scan and well-known time of symptoms onset were studied. Clinical data, arrival conditions, and prognostic scores were analyzed. Multivariate models were built to find independent predictors of < 6 h arrival (logistic regression) and in-hospital death (Cox proportional-hazards model). RESULTS Among the 473 patients analyzed (51% women, median age 63 years), the median delay since onset to admission was 6.25 h (interquartile range: 2.5-24 h); 7.8% arrived in < 1 h, 26.3% in < 3 h, 45.3% in < 6 h, and 62.3% in < 12 h. The in-hospital, 30-day and 90-day case fatality rates were 28.8%, 30.0%, and 32.6%, respectively. Predictors of arrival in < 6 h were hypertension treatment (odds ratios [OR]: 1.675, 95% confidence intervals [CI]: 1.030-2.724), ≥ 3 years of schooling (OR: 1.804, 95% CI: 1.055-3.084), and seizures at ICH onset (OR: 2.416, 95% CI: 1.068-5.465). Predictors of death (56.9% neurological) were systolic blood pressure > 180 mmHg (hazards ratios [HR]: 1.839, 95% CI: 1.031-3.281), ICH score ≥ 3 (HR: 2.302, 95% CI: 1.300-4.074), and admission Glasgow Coma Scale < 8 (HR: 4.497, 95% CI: 2.466-8.199). Early arrival was not associated with outcome at discharge, 30 or 90 days. CONCLUSIONS In this study, less than half of patients with ICH arrived to the hospital in < 6 h. However, early arrival was not associated with the short-term outcome in this data set.
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Affiliation(s)
- José L Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal.; Department of Neurosciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal.; Mexico
| | | | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Germán López-Valencia
- Department of Neurosciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., Mexico
| | - Alejandro Lara-López
- Department of Physiology, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jal., Mexico
| | - Manuel Sánchez-González
- Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., Mexico
| | - Amado Jiménez-Ruiz
- Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., Mexico
| | | | - Luis Murillo-Bonilla
- Department of Neurology, Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara, Jal., Mexico
| | | | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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19
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García-Grimshaw M, Chiquete E, Jiménez-Ruiz A, Vidal-Mayo JDJ, Grajeda-González SL, Vargas-Martínez MDLÁ, Toapanta-Yanchapaxi LN, Valdés-Ferrer SI, Chávez-Martínez OA, Marché-Fernández OA, Jiménez-Ávila AI, Cantú-Brito C, Flores-Silva FD. Delirium and Associated Factors in a Cohort of Hospitalized Patients With Coronavirus Disease 2019. J Acad Consult Liaison Psychiatry 2022; 63:3-13. [PMID: 34242847 PMCID: PMC8259046 DOI: 10.1016/j.jaclp.2021.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic dramatically increased the number of patients requiring treatment in an intensive care unit or invasive mechanical ventilation worldwide. Delirium is a well-known neuropsychiatric complication of patients with acute respiratory diseases, representing the most frequent clinical expression of acute brain dysfunction in critically ill patients, especially in those undergoing invasive mechanical ventilation. Among hospitalized patients with COVID-19, delirium incidence ranges from 11% to 80%, depending on the studied population and hospital setting. OBJECTIVE To determine risk factors for the development of delirium in hospitalized patients with COVID-19 pneumonia. METHODS We retrospectively studied consecutive hospitalized adult (≥18 y) patients with confirmed COVID-19 pneumonia from March 15 to July 15, 2020, in a tertiary-care hospital in Mexico City. Delirium was assessed by the attending physician or trained nurse, with either the Confusion Assessment Method for the Intensive Care Unit or the Confusion Assessment Method brief version, according to the appropriate diagnostic tool for each hospital setting. Consultation-liaison psychiatrists and neurologists confirmed all diagnoses. We calculated adjusted hazard ratios (aHR) with 95% confidence interval (CI) using a Cox proportional-hazards regression model. RESULTS We studied 1017 (64.2% men; median age, 54 y; interquartile range 44-64), of whom 166 (16.3%) developed delirium (hyperactive in 75.3%); 78.9% of our delirium cases were detected in patients under invasive mechanical ventilation. The median of days from admission to diagnosis was 14 (interquartile range 8-21) days. Unadjusted mortality rates between delirium and no delirium groups were similar (23.3% vs. 24.1; risk ratio 0.962, 95% CI 0.70-1.33). Age (aHR 1.02, 95% CI 1.01-1.04; P = 0.006), an initial neutrophil-to-lymphocyte ratio ≥9 (aHR 1.81, 95% CI 1.23-2.65; P = 0.003), and requirement of invasive mechanical ventilation (aHR 3.39, 95% CI 1.47-7.84; P = 0.004) were independent risk factors for in-hospital delirium development. CONCLUSIONS Delirium is a common in-hospital complication of patients with COVID-19 pneumonia, associated with disease severity; given the extensive number of active COVID-19 cases worldwide, it is essential to detect patients who are most likely to develop delirium during hospitalization. Improving its preventive measures may reduce the risk of the long-term cognitive and functional sequelae associated with this neuropsychiatric complication.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amado Jiménez-Ruiz
- Stroke, Dementia & Heart Disease Laboratory, Western University, London, ON, Canada
| | - José de Jesús Vidal-Mayo
- Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samara Lissete Grajeda-González
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Liz Nicole Toapanta-Yanchapaxi
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY
| | - Oswaldo Alan Chávez-Martínez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Osvaldo Alexis Marché-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Itiel Jiménez-Ávila
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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20
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García-Grimshaw M, Ceballos-Liceaga SE, Michel-Chávez A, García-Alanis M, Cadena-Fernández A, Galnares-Olalde JA, Carbajal-Sandoval G, Carrillo-García DA, Hernández-Valdivia N, Hernández-Vanegas LE, Saniger-Alba MDM, Gutierrez-Romero A, Díaz-Ortega JL, Reyes-Terán G, López-Gatell H, Flores-Silva FD, Cantú-Brito C, Chiquete E, Arauz A, Valdés-Ferrer SI. Transient sensory symptoms among first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine: A case-control study. Vaccine 2021; 39:6975-6979. [PMID: 34742595 PMCID: PMC8554108 DOI: 10.1016/j.vaccine.2021.10.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/16/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
mRNA-based COVID-19 vaccines are effective; however, persistent vaccine hesitancy is partly due to a misperception of their potential adverse events. Non-specific sensory symptoms (NSSS) following immunization are thought to be mediated by stress-related responses. In this case-control study, we evaluated NSSS from a cohort of 7,812,845 BNT162b2 first-dose recipients, of whom 10,929 reported an adverse event following immunization (AEFI). We found an overall frequency of 3.4% (377 cases) or 4.8 cases per 100,000 doses administered. Anatomically, the arms (61%) and face/neck region (36.2%) were the most commonly affected sites. The control group had significantly higher rates of reactogenicity-associated symptoms, suggesting that NSSS are reactogenicity-independent; in multivariable analysis, healthcare workers reported sensory symptoms less frequently (aOR 0.54; 95% CI 0.40-0.72;p < 0.001). This is the first study describing the topography and associated factors for developing NSSS among BNT162b2 recipients. The benign nature of these symptoms may help dissipate hesitation towards this vaccine.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mario García-Alanis
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Cadena-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | - Laura E Hernández-Vanegas
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - María Del Mar Saniger-Alba
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alonso Gutierrez-Romero
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - José Luis Díaz-Ortega
- Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | | | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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21
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Lee-Chen L, Williams-de-Roux R, Chiquete E, Aceves-Buendía JJ, Ruiz-Ruiz E, Portillo-Valle J, Bliskunova T, Rodríguez-Perea E, Toapanta-Yanchapaxi L, García-Ramos G, Cantú-Brito C, Estañol B. Descripción clínica y neurofisiológica de pacientes con el síndrome POEMS. GAC MED MEX 2021. [DOI: 10.24875/gmm.21000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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22
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García-Grimshaw M, Flores-Silva FD, Chiquete E, Cantú-Brito C, Michel-Chávez A, Vigueras-Hernández AP, Domínguez-Moreno R, Chávez-Martínez OA, Sánchez-Torres S, Marché-Fernández OA, González-Duarte A. Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients. Auton Neurosci 2021; 235:102855. [PMID: 34293703 PMCID: PMC8285214 DOI: 10.1016/j.autneu.2021.102855] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 01/16/2023]
Abstract
Background An intriguing feature recently unveiled in some COVID-19 patients is the “silent hypoxemia” phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea. Objective To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients. Methods We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia). Results We studied 470 cases (64.4% men; median age 55 years, interquartile range 46–64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO2 in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101–7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024–9.89; P = 0.045). Conclusions Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alma Poema Vigueras-Hernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rogelio Domínguez-Moreno
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Oswaldo Alan Chávez-Martínez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samantha Sánchez-Torres
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Osvaldo Alexis Marché-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandra González-Duarte
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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23
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Arauz A, Barboza MA, Quintero LC, Cantu C, Chiquete E, Serrano F. Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy. Neurologia 2021; 38:S0213-4853(21)00072-4. [PMID: 34253412 DOI: 10.1016/j.nrl.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
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Affiliation(s)
- A Arauz
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - M A Barboza
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico; Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica.
| | - L C Quintero
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - E Chiquete
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - F Serrano
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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24
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Ruiz-Sandoval JL, Salvatella-Gutiérrez AP, López-Valencia G, Chiquete E, Ruiz-Herrera V, Pérez-Gómez HR, Adrián MGL, Jiménez-Ruiz A, Rodríguez-Hinojosa J, Quintero-Reyes Á, González-Jaime JDJ, Villaseñor Cabrera TDJ. Clinical Characteristics and Predictors of Short-Term Outcome in Mexican Adult Patients with Guillain-Barré Syndrome. Neurol India 2021; 69:107-114. [PMID: 33642280 DOI: 10.4103/0028-3886.310063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Information regarding the clinical presentation and outcome of Guillain-Barré Syndrome (GBS) in adults from Latin America is limited. Objective To identify clinical characteristics and short-term outcome predictors in adult Mexican patients with GBS. Patients and Methods We included adult patients with clinical and electrophysiological data with confirmed GBS, admitted to a tertiary hospital in Western Mexico, from January 2002 to February 2011. A good outcome at hospital discharge was considered if patients had a Hughes score of 0-2 and at 3 and 6 months, a Hughes score of 0-1. Results A total of 115 patients were analyzed (68% men, mean age 44 years old, range 18-84). Previous infection occurred in 63% of cases. Descendent pattern of weakness was observed in 40 (35%) patients. GBS subtypes were: acute motor axonal neuropathy in 31%, acute inflammatory demyelinating polyneuropathy in 29%, sensory axonal neuropathy (AMSAN) in 18%, and equivocal in 22%. A total of 73 (63%) patients received induction therapy: 50 (68%) received plasmapheresis and 13 (18%) received intravenous immunoglobulin (IVIG). In-hospital mortality occurred in 14 (12%) patients. Early gait complaints and emergency room admission with mild Hughes score (0-2) were predictors for a good outcome at hospital discharge (P < 0.05); meanwhile, age >75 years; dysarthria and higher Hughes score were associated with a poor outcome(P < 0.05). Conclusions Axonal pattern, motor involvement, and the descendent pattern of presentation were the main clinical GBS findings in our cohort. Higher Hughes scale scores at hospital admission were a strong predictor for a bad outcome at hospital discharge and short-term follow-up, independently of treatment type or in-hospital management. GBS in Mexico still carries considerable mortality.
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Affiliation(s)
- Jose Luis Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara; Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | | | - Germán López-Valencia
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Erwin Chiquete
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Vida Ruiz-Herrera
- Department of Infectology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Héctor Raúl Pérez-Gómez
- Department of Infectology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Miranda-García Luis Adrián
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara; Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Amado Jiménez-Ruiz
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Jorge Rodríguez-Hinojosa
- Department of Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Ángeles Quintero-Reyes
- Department of Blood Bank and Transfusional Center, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - José de Jesús González-Jaime
- Department of Physical Medicine and Rehabilitation, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Teresita de Jesús Villaseñor Cabrera
- Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Department of Neuropsychology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
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Flores-Silva FD, García-Grimshaw M, Valdés-Ferrer SI, Vigueras-Hernández AP, Domínguez-Moreno R, Tristán-Samaniego DP, Michel-Chávez A, González-Duarte A, Vega-Boada FA, Reyes-Melo I, Jiménez-Ruiz A, Chávez-Martínez OA, Rebolledo-García D, Marché-Fernández OA, Sánchez-Torres S, García-Ramos G, Cantú-Brito C, Chiquete E. Neurologic manifestations in hospitalized patients with COVID-19 in Mexico City. PLoS One 2021; 16:e0247433. [PMID: 33831042 PMCID: PMC8031187 DOI: 10.1371/journal.pone.0247433] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/05/2021] [Indexed: 12/23/2022] Open
Abstract
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, history of ischemic stroke: eight, migraine: six, multiple sclerosis: one, Parkinson disease: one), and 163 (15.2%) developed a new neurologic complication. Headache (41.7%), myalgia (38.5%), dysgeusia (8%), and anosmia (7%) were the most common neurologic symptoms at hospital presentation. Delirium (13.1%), objective limb weakness (5.1%), and delayed recovery of mental status after sedation withdrawal (2.5%), were the most common new neurologic syndromes. Age, headache at presentation, preexisting neurologic disease, invasive mechanical ventilation, and neutrophil/lymphocyte ratio ≥9 were independent predictors of new in-hospital neurologic complications. CONCLUSIONS Even after excluding initial clinical features and pre-existing comorbidities, new neurologic complications in hospitalized patients with COVID-19 are frequent and can be predicted from clinical information at hospital admission.
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Affiliation(s)
- Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY, United States of America
| | - Alma Poema Vigueras-Hernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rogelio Domínguez-Moreno
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandra González-Duarte
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Felipe A. Vega-Boada
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Isael Reyes-Melo
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amado Jiménez-Ruiz
- Stroke, Dementia & Heart Disease Laboratory, Western University, London, ON, Canada
| | - Oswaldo Alan Chávez-Martínez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniel Rebolledo-García
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Osvaldo Alexis Marché-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samantha Sánchez-Torres
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guillermo García-Ramos
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Lino-Silva LS, Guzmán-López JC, Salazar-García JA, Chávez-Hernández JD, Gamboa-Domínguez A, Chiquete E, Mohar A, Morales-Soto J, Salcedo-Hernández RA. Interobserver Variability in Assessing Pathologic Response to Preoperative Treatment in Rectal Cancer: Standardization of an Evaluation Method and Comparisons Between Published Scales. J Gastrointest Cancer 2021; 51:709-713. [PMID: 31760577 DOI: 10.1007/s12029-019-00331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Evaluating tumor response of rectal cancer to preoperative chemoradiotherapy (NCRT) has a prognostic value on overall survival; however, grading tumor response is a controversial issue due to lack of reproducibility and the lack of information about the standardization of the evaluation. METHODS We performed this study to examine the variability between observers' assessment of the pathological responses to NCRT using a systematic quantitative grading system based on a percentage of tumor response against the proportion of residual tumor burden. As a secondary aim, we classified the tumor response according to six published systems to determine the correlation between the observers into each grading system. RESULTS From 70 cases, the mean age was 60.6 ± 11.78 years, 36 (51.47%) patients were female, the pathological T stage was pT3 in 48.6% of cases, pT2 in 32.9%, pT1 in 11.4% and 7.1% in pT4, whereas 40% had lymph node metastasis. The median lymph node count was ten lymph nodes (range 6-43). Our method of tumor regression evaluation has a good intraclass correlation (ICC) value. From the scales compared regarding interobserver agreement, the Ryan's and Royal College of Pathologists showed fair agreement (but good ICC); the scales from Dworak, Becker, and Rizk showed substantial agreement (and good to excellent ICC values); and the scale from Rödel showed almost-perfect agreement. RESULTS All the evaluated systems showed good interobserver agreement, but the best interobserver agreement was reached with the Rödel's scale.
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Affiliation(s)
- Leonardo S Lino-Silva
- AFINES program, Medicine Faculty, Mexico's National Autonomus University (UNAM), Mexico City, Mexico.
- Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, CP 14080, Mexico city, Mexico.
| | - Janet C Guzmán-López
- Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, CP 14080, Mexico city, Mexico
| | - Jenny A Salazar-García
- AFINES program, Medicine Faculty, Mexico's National Autonomus University (UNAM), Mexico City, Mexico
| | - Jazmín D Chávez-Hernández
- Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, CP 14080, Mexico city, Mexico
| | - Armando Gamboa-Domínguez
- Surgical pathology, Medical Sciences and Nutrition National Institute "Salvador Zubirán", Mexico City, Mexico
| | - Erwin Chiquete
- Neurology división, Medical Sciences and Nutrition National Institute "Salvador Zubirán", Mexico City, Mexico
| | - Alejandro Mohar
- Biomedics Research Institute, Mexico's National Autonomus University (UNAM), Mexico City, Mexico
| | - Jonathan Morales-Soto
- AFINES program, Medicine Faculty, Mexico's National Autonomus University (UNAM), Mexico City, Mexico
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27
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Salazar-Orellana JLI, García-Grimshaw M, Valdés-Ferrer SI, Alday-Ramírez SM, Ríos-Argaiz E, Vásquez-Ortiz ZY, Rivero-Sigarroa E, Jiménez-Ruiz A, Chiquete E, Cantú-Brito C, Flores-Silva FD. Detection of Pulmonary Shunts by Transcranial Doppler in Hospitalized Non-mechanically Ventilated Coronavirus Disease-19 Patients. Rev Invest Clin 2021; 73. [PMID: 33428609 DOI: 10.24875/ric.20000569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/07/2021] [Indexed: 11/17/2022]
Abstract
In severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated disease coronavirus disease 2019 (COVID-19), hypoxemia mechanisms differ from those observed in acute respiratory distress syndrome. Hypoxemia and respiratory failure in COVID- 19 are attributed to pulmonary angiopathy, increasing physiological pulmonary shunting1-3.
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Affiliation(s)
- Jaime L I Salazar-Orellana
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico
| | - Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico
| | - Sergio I Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico; Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | | | | | | | - Amado Jiménez-Ruiz
- Stroke, Dementia & Heart Disease Laboratory, Western University, London, Ontario, Canada
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico
| | - Fernando D Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyNSZ), Mexico City, Mexico
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García-Grimshaw M, Jiménez-Ruiz A, Peña-Andrade E, Flores-Silva F, Cantú-Brito C, Chiquete E. Ischemic stroke during the puerperium presenting as a bilateral anterior opercular (Foix-Chavany-Marie) syndrome. Clin Neurol Neurosurg 2021; 202:106476. [PMID: 33484952 DOI: 10.1016/j.clineuro.2021.106476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amado Jiménez-Ruiz
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eduardo Peña-Andrade
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Tristán-Samaniego DP, Chiquete E, Treviño-Frenk I, Rubalcava-Ortega J, Higuera-Calleja JA, Romero-Sánchez G, Espinoza-Alvarado L, Barrera-Vargas A, Flores-Silva F, González-Duarte A, Vega-Boada F, Cantú-Brito C. COVID-19-related diffuse posthypoxic leukoencephalopathy and microbleeds masquerades as acute necrotizing encephalopathy. Int J Neurosci 2020; 132:1123-1127. [DOI: 10.1080/00207454.2020.1865346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irene Treviño-Frenk
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Johnatan Rubalcava-Ortega
- Department of Neuroradiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesús Antonio Higuera-Calleja
- Department of Neuroradiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Griselda Romero-Sánchez
- Department of Neuroradiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lissett Espinoza-Alvarado
- Department of Neuroradiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Barrera-Vargas
- Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Flores-Silva
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alejandra González-Duarte
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Felipe Vega-Boada
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Chiquete E, Alegre-Díaz J, Ochoa-Guzmán A, Toapanta-Yanchapaxi LN, González-Carballo C, Garcilazo-Ávila A, Santacruz-Benitez R, Ramírez-Reyes R, Wong-Chew RM, Guerrero G, Schmulson M, Berumen J, Sandoval-Rodríguez V, Ruiz-Ruiz E, Cantú-Brito C. Ethnicity and other COVID-19 death risk factors in Mexico. Arch Med Sci 2020; 18:711-718. [PMID: 35591829 PMCID: PMC9103400 DOI: 10.5114/aoms.2020.101443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop coronavirus disease 2019 (COVID-19). Risk factors associated with death vary among countries with different ethnic backgrounds. We aimed to describe the factors associated with death in Mexicans with confirmed COVID-19. Material and methods We analysed the Mexican Ministry of Health's official database on people tested for SARS-CoV-2 infection by real-time reverse transcriptase-polymerase chain reaction (rtRT-PCR) of nasopharyngeal fluids. Bivariate analyses were performed to select characteristics potentially associated with death, to integrate a Cox-proportional hazards model. Results As of May 18, 2020, a total of 177,133 persons (90,586 men and 86,551 women) in Mexico received rtRT-PCR testing for SARS-CoV-2. There were 5332 deaths among the 51,633 rtRT-PCR-confirmed cases (10.33%, 95% CI: 10.07-10.59%). The median time (interquartile range, IQR) from symptoms onset to death was 9 days (5-13 days), and from hospital admission to death 4 days (2-8 days). The analysis by age groups revealed that the significant risk of death started gradually at the age of 40 years. Independent death risk factors were obesity, hypertension, male sex, indigenous ethnicity, diabetes, chronic kidney disease, immunosuppression, chronic obstructive pulmonary disease, age > 40 years, and the need for invasive mechanical ventilation (IMV). Only 1959 (3.8%) cases received IMV, of whom 1893 were admitted to the intensive care unit (96.6% of those who received IMV). Conclusions In Mexico, highly prevalent chronic diseases are risk factors for death among persons with COVID-19. Indigenous ethnicity is a poorly studied factor that needs more investigation.
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Affiliation(s)
- Erwin Chiquete
- Instituto Nacional de Ciencias Médicas y de la Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Jesus Alegre-Díaz
- Unidad de Investigación en Medicina Experimental, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Ana Ochoa-Guzmán
- Instituto Nacional de Ciencias Médicas y de la Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | | | - Carlos González-Carballo
- Instituto Nacional de Ciencias Médicas y de la Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Adrián Garcilazo-Ávila
- Instituto Nacional de Ciencias Médicas y de la Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | | | - Raúl Ramírez-Reyes
- Instituto Nacional de Ciencias Médicas y de la Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | | | - Guadalupe Guerrero
- Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico City, Mexico
| | - Max Schmulson
- Unidad de Investigación en Medicina Experimental, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Jaime Berumen
- Unidad de Investigación en Medicina Experimental, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico City, Mexico
| | | | - Eduardo Ruiz-Ruiz
- Instituto Nacional de Ciencias Médicas y de la Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Instituto Nacional de Ciencias Médicas y de la Nutrición “Salvador Zubirán”, Mexico City, Mexico
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31
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Chiquete E, Jiménez-Ruiz A, García-Grimshaw M, Domínguez-Moreno R, Rodríguez-Perea E, Trejo-Romero P, Ruiz-Ruiz E, Sandoval-Rodríguez V, Gómez-Piña JJ, Ramírez-García G, Ochoa-Guzmán A, Toapanta-Yanchapaxi L, Flores-Silva F, Ruiz-Sandoval JL, Cantú-Brito C. Prediction of acute neurovascular syndromes with prehospital clinical features witnessed by bystanders. Neurol Sci 2020; 42:3217-3224. [PMID: 33241535 DOI: 10.1007/s10072-020-04929-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prompt recognition of an acute neurovascular syndrome by the patient or a bystander witnessing the event can directly influence outcome. We aimed to study the predictive value of the medical history and clinical features recognized by the patients' bystanders to preclassify acute stroke syndromes in prehospital settings. METHODS We analyzed 369 patients: 209 (56.6%) with acute ischemic stroke (AIS), 107 (29.0%) with intracerebral hemorrhage (ICH), and 53 (14.4%) with subarachnoid hemorrhage (SAH). All patients had neuroimaging as diagnostic gold standard. We constructed clinical prediction rules (CPRs) with features recognized by the bystanders witnessing the stroke onset to classify the acute neurovascular syndromes before final arrival to the emergency room (ER). RESULTS In all, 83.2% cases were referred from other centers, and only 16.8% (17.2% in AIS, 15% in ICH, and 18.9% in SAH) had direct ER arrival. The time to first assessment in ≤ 3 h occurred in 72.4% (73.7%, 73.8%, and 64.2%, respectively), and final ER arrival in ≤ 3 h occurred in 26.8% (32.1%, 15.9%, and 28.3%, respectively). Clinical features referred by witnesses had low positive predictive values (PPVs) for stroke type prediction. Language or speech disorder + focal motor deficit showed 63.3% PPV, and 77.0% negative predictive value (NPV) for predicting AIS. Focal motor deficit + history of hypertension had 35.9% PPV and 78.8% NPV for ICH. Headache alone had 27.9% PPV and 95.3% NPV for SAH. In multivariate analyses, seizures, focal motor deficit, and hypertension increased the probability of a time to first assessment in ≤ 3 h, while obesity was inversely associated. Final ER arrival was determined by age and a direct ER arrival without previous referrals. CONCLUSION CPRs constructed with the witnesses' narrative had only adequate NPVs in the prehospital classification of acute neurovascular syndromes, before neuroimaging confirmation.
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Affiliation(s)
- Erwin Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Amado Jiménez-Ruiz
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Miguel García-Grimshaw
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Rogelio Domínguez-Moreno
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Elizabeth Rodríguez-Perea
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Paola Trejo-Romero
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Eduardo Ruiz-Ruiz
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Valeria Sandoval-Rodríguez
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Juan José Gómez-Piña
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Guillermo Ramírez-García
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Ana Ochoa-Guzmán
- Unidad de Biología Molecular, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Liz Toapanta-Yanchapaxi
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - Fernando Flores-Silva
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico
| | - José Luis Ruiz-Sandoval
- Servicio de Neurología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.,Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Carlos Cantú-Brito
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI Belisario Domínguez, Tlalpan, C. P, 14080, Ciudad de México, Mexico.
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Rodríguez-Reyes H, Lara-Vaca S, Ochoa-Guzmán A, Chiquete E. Obesity Paradox and 12 Month Outcome in Patients with Atrial Fibrillation. Arch Med Res 2020; 52:233-239. [PMID: 33160753 DOI: 10.1016/j.arcmed.2020.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/10/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Obesity increases the risk of atrial fibrillation (AF) while it may impact the outcome of patients with AF. The clinical implications of this relationship are not completely clear. We aimed to analyze the association of traditional anthropometric measures of excessive adiposity with 12 month case fatality rate (CFR) in patients with AF. METHODS This was a multicenter, longitudinal, observational study on adults with documented AF, excluding records of AF secondary to reversible causes. Anthropometric variables were registered at baseline, and a central committee validated the 12 month outcomes. RESULTS We studied 1193 patients (median age: 69.14 years, 55.2% women). At baseline, rhythm control was established for 476 (39.9%) subjects, while frequency control was offered to 717 (60.1%) participants. The 12 month all-cause CFR was 8.9%. A high basal body mass index (BMI), waist-to-height ratio (WHtR) and waist circumference (WC) were associated with lower CFR in bivariate analyses. In a Cox-proportional hazards model, variables associated with 12 month all-cause CFR were BMI categories (HR: 0.736, 95% CI: 0.584-0.928), chronic heart failure (HR: 1.738, 95% CI: 1.127-2.680), chronic kidney disease (HR: 2.269, 95% CI: 1.162-4.429) and carotid stenosis >50% (HR: 5.342, 95% CI: 1.661-17.181). CONCLUSION The risk of death at one year in patients with AF is inversely associated with a high BMI and directly associated with the presence of chronic kidney disease, carotid stenosis, and chronic heart failure in this cohort of patients with AF. The causes and implications of this apparent obesity paradox should be addressed in the future.
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Affiliation(s)
| | - Susano Lara-Vaca
- Departamento de Cardiología, Unidad Médica de Alta Especialidad T-1 IMSS, León, Guanajuato, México
| | - Ana Ochoa-Guzmán
- Unidad de Biología Molecular, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Erwin Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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Mendoza-Olivas L, Niembro-Ortega MD, Sierra-Madero J, Soto-Ramírez LE, Rodríguez-Díaz R, Fuentes-Romero LL, Hernández-Flores M, Hernández-Martínez MC, Treviño-Frenk I, Chiquete E. Opsoclonus-myoclonus-ataxia syndrome associated with central nervous system HIV-1 escape phenomenon. Rev Neurol 2020; 71:335-339. [PMID: 33085078 DOI: 10.33588/rn.7109.2020243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Opsoclonus-myoclonus-ataxia (OMA) syndrome is a rare neurological disorder characterized by involuntary conjugate saccadic eye movements, myoclonus, and ataxia. Few reports exist on patients with HIV and OMA. CASE REPORT A 41-year-old man diagnosed with HIV-1 infection in 1997 coursed with multiple anti-retroviral schemes as a consequence of poor adherence. In 2008 he presented an HIV-1 viral load of 100,000 copies/mL and a CD4+ T cell count of 10 cells/mm3. In 2013 our patient arrived with an 11-month history of progressive opsoclonus and ataxia. He had undetectable plasma HIV-1 RNA load and CD4+ of 606 cells/mm3. No opportunistic infections were found. Cerebrospinal fluid analysis showed mildly elevated protein concentration and HIV-1 viral load of 534 copies/mL. Cerebrospinal fluid co-receptor tropism test showed selective CCR5 usage. A brain magnetic resonance imaging showed hippocampal atrophy and T2-weighted hyperintensities. Our patient exhibited a dramatic recovery and cerebrospinal fluid HIV clearance after adjustment of anti-retroviral treatment based on genotyping resistance and tropism analyses. CONCLUSIONS In patients with HIV presenting cengral nervous system dysfunction without opportunistic infections, cerebro-spinal fluid and plasma HIV-1 viral load, resistance and tropism tests should be performed to assess a potential viral escape and to design the appropriate anti-retroviral therapy in an individual patient basis.
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Affiliation(s)
- L Mendoza-Olivas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - M D Niembro-Ortega
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - J Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - L E Soto-Ramírez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - R Rodríguez-Díaz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - L L Fuentes-Romero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - M Hernández-Flores
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | | | - I Treviño-Frenk
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
| | - E Chiquete
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México
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Blanco-López A, Antillón-Ferreira C, Saavedra-Castillo E, Barrientos-Pérez M, Rivero-Escalante H, Flores-Caloca O, Calzada-León R, Rosas-Guerra CC, Koledova E, Chiquete E, Ayala-Estrada A. Adherence to treatment in children with growth hormone deficiency, small for gestational age and Turner syndrome in Mexico: results of the Easypod™ connect observational study (ECOS). J Endocrinol Invest 2020; 43:1447-1452. [PMID: 32239476 PMCID: PMC7481146 DOI: 10.1007/s40618-020-01218-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Assessing adherence to growth hormone (GH) is challenging. The Easypod™ connect device delivers pre-set doses of recombinant human GH (r-hGH) and stores a digital record of adherence that can be shared with healthcare provider. We assessed adherence to r-hGH delivered with Easypod™ according to the approved pediatric indications for r-hGH: growth hormone deficiency (GHD), born small for gestational age (SGA) who failed to show catch-up growth and Turner syndrome (TS). METHODS ECOS (NCT01555528) was a multicenter (24 countries), 5-year, longitudinal, observational study, which aimed to evaluate country-specific adherence to r-hGH therapy prescribed via the Easypod™ electronic injection device. The primary endpoint was yearly adherence. Secondary endpoints were height velocity, height velocity standard deviation scores (SDS), height, height SDS and IGF-1 concentrations. Clinical and auxological data were obtained from medical records and adherence from Easypod™ logs. RESULTS This study included 147 Easypod™-naïve Mexican children assessed during 3 years (mean age: 9.96 ± 3.41 years, 56.8% boys, mean height SDS at baseline: - 2.17 ± 0.97): 118 with GHD, 24 SGA and 5 with TS. A total of 105 (71.4%) patients were GH naïve. Overall median adherence was > 90% over the first year of treatment and > 80% at 3 years. Adherence was not different by r-hGH indication or between GH-naïve or experienced patients. At 1-year follow-up, mean change in height SDS was 0.57 ± 0.34, whereas mean height velocity SDS was 2.85 ± 2.51. In all, 84.7% patients had normal IGF-1 concentrations at 1-year follow-up. Adherence was associated with change in height SDS (r = 0.239, p = 0.005) and height velocity SDS (r = 0.194, p = 0.027). CONCLUSION Adherence rates with the Easypod™ device are high and maintained over time in GHD, SGA and TS Easypod™-naïve Mexican patients. High adherence is associated with better outcomes. Easypod™ assists physicians in monitoring adherence to r-hGH.
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Affiliation(s)
- A Blanco-López
- Hospital Ángeles Interlomas and Hospital Español, Mexico City, Mexico
| | | | | | | | | | | | - R Calzada-León
- Servicio de Endocrinología, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - C C Rosas-Guerra
- Merck Biopharma Distribution S.A. de C.V, Naucalpan de Juárez, Mexico
| | - E Koledova
- Merck Healthcare KGaA, Darmstadt, Germany
| | - E Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Delegacion Tlalpan, C.P. 14080, Ciudad de Mexico, México.
| | - A Ayala-Estrada
- Servicio de Pediatría, Hospital ISSEMyM, Toluca, Estado de México, México.
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Cantú-Brito C, Chiquete E, Antezana-Castro JF, Toapanta-Yanchapaxi L, Ochoa-Guzmán A, Ruiz-Sandoval JL. Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk. Vascular 2020; 29:92-99. [PMID: 32638661 DOI: 10.1177/1708538120938921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. METHODS We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). RESULTS ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. CONCLUSIONS Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.
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Affiliation(s)
- Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | - Liz Toapanta-Yanchapaxi
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Ana Ochoa-Guzmán
- Molecular Biology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - José Luis Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico
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Chiquete E, Sandoval-Rodríguez V, García-Grimshaw M, Jiménez-Ruiz A, Gómez-Piña JJ, Ruiz-Ruiz E, Ramírez-García G, Flores-Silva F, Cantú-Brito C, Ochoa-Guzmán A, Ruiz-Sandoval JL. Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings. Rev Invest Clin 2020; 73. [PMID: 33057320 DOI: 10.24875/ric.20000238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022]
Abstract
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-door time <6 h, even when the first medical assessment had occurred in ≤1 h in 75% of cases. Clinical features noticed by the patients' bystanders had low positive predictive values (PPV) for any stroke type. The CPR "language or speech disor- der + focal motor deficit" had 93% sensitivity and a negative predictive value (NPV) of 84% to distinguish AIS. In SAH, head- ache alone showed a sensitivity of 84% and NPV of 97%. No CPR had an adequate performance on ICH. CPRs were not as- sociated with final onset-to-door time. Altered consciousness, age ≥65 years, indirect arrival with stops before final referral, and atrial fibrillation increased in-hospital mortality. CONCLUSION Clinical features referred by the witness of a neurovascular emergency have limited PPV, but adequate NPV in ruling-out AIS and SAH among stroke types. The use of CPRs had no impact on onset-to-door time or in-hospital mortality when the final arrival to a third-level center occurs with previous medical refer- rals.
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Affiliation(s)
- Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Valeria Sandoval-Rodríguez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amado Jiménez-Ruiz
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan J Gómez-Piña
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eduardo Ruiz-Ruiz
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guillermo Ramírez-García
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Ochoa-Guzmán
- Molecular Biology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - José L Ruiz-Sandoval
- Neurology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal.; Department of Neuroscience, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., Mexico
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Guraieb-Chahín P, Cantú-Brito C, Soto-Mota A, Guerrero-Torres L, Flores-Silva F, Chiquete E, Fragoso-Loyo H, González-Duarte A, Valdés-Ferrer SI. Stroke in systemic lupus erythematosus: epidemiology, mechanism, and long-term outcome. Lupus 2020; 29:437-445. [DOI: 10.1177/0961203320908947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine stroke prevalence, mechanisms, and long-term outcome in a cohort of Hispanic patients with systemic lupus erythematosus (SLE). Methods We analyzed demographical data, the timing between SLE diagnosis and stroke onset, stroke type, recurrence, and outcomes from an institutional database of 4451 patients with SLE followed from 1993 to 2018. Results We observed 139 strokes (3.1%), for an incidence rate of 1.25 per 1000 person-years: 81 (58.3%) acute ischemic stroke (AIS), 19 (13.7%) subarachnoid hemorrhage (SAH), 17 (12.2%) cerebral venous thrombosis, 13 (9.4%) intracerebral hemorrhage (ICH), and 9 (6.5%) transient ischemic attack. Median time from SLE diagnosis to acute stroke was 60 months (interquartile range 12–132 months). AIS had a bimodal presentation with 26% occurring within the first year and 30% >10 years after SLE diagnosis. In contrast, 75% of ICH cases occurred >3 years (and 34% >10 years) after SLE diagnosis. The most important cause of AIS was secondary antiphospholipid syndrome (48%). Hypertension was associated with 69% of ICH cases, while aneurysmal rupture was observed in 78% of SAH cases. Excellent recovery at hospital discharge was observed in 65%. Stroke recurrence was observed in 7%. The long-term all-cause fatality rate was 8%. Conclusions The prevalence of stroke in this cohort was 3.1%. Ischemic strokes had a bimodal presentation, occurring either early after SLE diagnosis or after a several-year delay. Half of the hemorrhagic strokes occurred >10 years after the diagnosis of SLE. Clinical outcome was usually good with a relatively low recurrence rate.
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Affiliation(s)
- P Guraieb-Chahín
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - C Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Soto-Mota
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - L Guerrero-Torres
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - F Flores-Silva
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - E Chiquete
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - H Fragoso-Loyo
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A González-Duarte
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - SI Valdés-Ferrer
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, USA
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Barrientos-Guerra JD, Flores-Silva F, Cantú-Brito C, Chiquete E. Evaluation of Cerebral Hemodynamics with Color-Coded Duplex Sonography: Normative Values with Correction of Insonation Angles. J Stroke Cerebrovasc Dis 2020; 29:104595. [PMID: 31917090 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022] Open
Abstract
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.
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Affiliation(s)
- José Domingo Barrientos-Guerra
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Cantu-Brito C, Chiquete E, Ruiz-Sandoval JL, Flores-Silva F. Abstract WP244: Applicability of the Compass Trial Criteria Among Stable Outpatients With Established Atherothrombotic Disease or Major Risk Factors. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The objective of this study were to describe the proportion of patients eligible for the COMPASS trial among stable outpatients with either established atherothrombotic disease or major vascular risk factors, and to analyze 6-month incident stroke risk according vascular risk factors at baseline.
Methods:
We prospectively recruited 5,101 stable outpatients in 172 sites, within the Mexican INDAGA cohort study. Inclusion criteria were age >18 years and established atherothrombotic disease [history of either acute coronary syndromes (ACS), acute ischemic stroke (AIS)/transient ischemic attack (TIA) or peripheral artery disease (PAD)] or major vascular risk factors (age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors). Among these patients, we applied the selection criteria of the COMPASS trial for analysis, dividing the population in no COMPASS criteria met and COMPASS criteria met, and this last group subdivided among patients with previous AIS/TIA and without this antecedent, in order to stratify the risk for stroke during 6-month follow-up (incident AIS/TIA).
Results:
Among 5,101 stable outpatients with either established atherothrombotic disease (n=2,827) or major vascular risk factors (n=2,274), a total of 1,927 (37.8%) met COMPASS trial criteria: 1,054 (54.7%) with established cerebrovascular disease (past history of AIS/TIA) and 873 (45.3%) without. During 6-month follow-up, there were 89 incident AIS/TIA (39 AIS and 54 TIA): 1.7% among the whole population and 2.2% among the COMPASS subgroup. AIS/TIA occurred in a similar frequency among the COMPASS subgroup with established cerebrovascular disease (1.6%) and COMPASS without cerebrovascular disease (0.9%) (P=0.18). After a Cox-proportional hazards model, independent predictors of incident AIS/TIA were age ≥65 years (HR: 1.99, 95% CI: 1.29-3.07) and established cerebrovascular disease at baseline (HR: 1.61, 95% CI: 1.02-2.53).
Conclusions:
The majority of stable outpatients at vascular risk met COMPASS selection criteria and could be good candidates for low-dose rivaroxaban in addition to aspirin. Short-term predictors of AIS/TIA were old age and history of cerebrovascular disease
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Affiliation(s)
| | - Erwin Chiquete
- NEUROLOGY, Instituto Nacional CM Nutricion SZ, Mexico, Mexico
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Chiquete E, Ramirez-Garcia G, Sandoval-Rodriguez V, Flores-Silva F, Ruiz-Sandoval JL, Cantu-Brito C. Abstract 162: 12-Month Epilepsy Outcomes in Patients With Acute Ischemic Stroke 12-Month Epilepsy Outcomes in Patients With Acute Ischemic Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and purpose:
Acute ischemic stroke (AIS) is the leading cause of adult-onset epilepsy. In the context of current guidelines, AIS patients presenting with seizures are considered at high risk for seizure recurrence and as a consequence, this patients are deemed as nowadays affected by epilepsy. We aimed to describe the factors associated with acute seizures, epilepsy and seizure recurrence after AIS, as well as their impact on the functional outcome at 12-month follow-up.
Methods:
This is a cohort study on 1,246 non-epileptic patients with AIS included in a multicenter Mexican registry; who received 12-month follow-up after a first-ever or recurrent AIS. Multivariate analyses were performed to evaluate factors associated with acute seizures and the functional outcome at 12 months of follow-up.
Results:
The frequency of acute seizures (within 7 days after stroke onset) after AIS was 8.1% [95% confidence interval (CI): 6.7% to 9.8%]. In all, 12-month seizure recurrence rate was 4.8% (95% CI: 3.7% to 6.1%). In a binary logistic regression model, risk factors significantly associated with seizures were >10 scoring of the National Institutes of Health Stroke Scale (NIHSSS, US) [odds ratio (OR): 2.21, 95% CI: 1.40-3.47], recurrent ischemic stroke (OR: 2.17, 95% CI: 1.34-3.53) and age <65 years (OR: 1.69, 95% CI: 1.09-2.62). After a Cox-proportional hazards model and Kaplan-Meier actuarial analyses, the presence of acute seizures was significantly associated with the risk of functional disability or death (a modified Rankin scale >3) at 12 months of follow-up [hazard ratio (HR): 1.37, 95% CI: 1.04-1.83], as well as NIHSS >10 (HR: 4.47, 95% CI: 3.53-5.65), age ≥65 years (HR: 1.74, 95% CI: 1.38-2.20), heart failure (HR: 1.61, 95% CI: 1.22-2.13) and atrial fibrillation (HR: 1.35, 95% CI: 1.05-1.74).
Conclusions:
The frequency of provoked seizures after acute ischemic stroke in this cohort was 8%. Age <65 years and severity of the brain infarction are the main factors associated with seizures, which in turn represent an important risk factor for functional disabilities or death one year after the acute event.
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Affiliation(s)
- Erwin Chiquete
- Neurology, Instituto Nacional Ciencias Medicas Y Nutricion, Mexico, Mexico
| | | | | | | | | | - Carlos Cantu-Brito
- Neurology, Instituto Nacional Ciencias Medicas Y Nutricion, Mexico, Mexico
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Chiquete E, Gómez-Piña JJ, Ramírez-García G, Ruiz-Ruiz E, Barrientos-Guerra JD, Toapanta-Yanchapaxi L, Flórez-Cardona JA, Flores-Silva F, Reyes-Melo I, García-Ramos G, Higuera-Calleja J, Cantú-Brito C. Atherosclerotic carotid artery disease and white matter disease in subjects without a history of cerebral infarction or transient cerebral ischemia. GAC MED MEX 2020. [DOI: 10.24875/gmm.m19000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gnatiuc L, Alegre-Diaz J, Garcilazo-Avila A, Ramirez R, Gonzales-Carballo C, Solano-Sanchez M, Chiquete E, Wade R, Clarke R, Herrington WG, Collins R, Peto R, Tapia-Conyer R, Kuri-Morales P, Emberson J. P3824Body composition and mortality from vascular or metabolic causes among 150,000 participants in the Mexico City Prospective Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Higher body-mass index is associated with increased mortality from vascular disease, renal disease and other metabolic causes. However, body mass reflects both fat and lean mass, which may have very different effects on risk. We investigated the individual and joint relevance of fat and lean mass to mortality from these causes, using data from the Mexico City Prospective Study.
Methods
Between 1998 and 2004, 150,000 adults from Mexico City were recruited into a prospective study and tracked for cause-specific mortality for 14 years. Fat and lean mass at recruitment were predicted using Mexican-specific anthropometric equations, validated in a subset of participants with additional bio-impedance measures. Cox regression was used to assess the relevance of fat and lean mass at recruitment to mortality from a vascular, renal, or other metabolic cause at ages 35–74 years. Analyses were adjusted for age at risk, sex, residential district, education, recreational physical activity, smoking and alcohol consumption. To avoid reverse causality, analyses excluded those with diabetes or other chronic diseases at recruitment, and deaths in the first 5 years of follow-up. Mortality rate ratios (RRs) relate to the differences per SD of the usual values of various factors or the differences between the top tenth and bottom fifth of the values.
Results
Among 112,923 participants aged 35–74 years, mean (SD) fat mass in men and women was 22.0 (6.4) kgs and 29.4 (7.8) kgs respectively, while mean (SD) lean mass was 54.9 (7.2) kgs and 39.2 (5.0) kgs respectively. In both men and women, equation-predicted fat and lean mass closely matched the bio-impedance values (all r>0.86). Both fat and lean mass were positively and approximately log-linearly associated with mortality from a vascular or metabolic cause. However, the association of lean mass with mortality was more than accounted for by the correlation of lean with fat mass. Hence, after adjustment for fat mass, lean mass was inversely associated with risk. For a given amount of fat mass, the RR for vascular/metabolic mortality comparing those in the top tenth versus bottom fifth of the predicted lean mass was 0.35 (95% CI 0.24–0.52). Conversely, for a given amount of lean mass, the RR comparing those in the top tenth versus bottom fifth of the predicted fat mass was 4.06 (3.06–5.39). The RRs associated with each SD higher fat mass (1.51, 1.40–1.63) or lean mass (0.79, 0.73–0.86) appeared to be little affected by age, sex, or levels of other confounders, and were broadly similar for the major vascular, renal, and other metabolic mortality. The height-adjusted RRs were 1.41 (1.30–1.53) for fat mass and 0.91 (0.82–1.00) for lean mass.
Conclusions
In this Mexican cohort, predicted fat and lean mass had opposing effects on vascular and other metabolic deaths, with no evidence of any thresholds throughout the ranges studied.
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Affiliation(s)
- L Gnatiuc
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - J Alegre-Diaz
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - A Garcilazo-Avila
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Ramirez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - C Gonzales-Carballo
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - M Solano-Sanchez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - E Chiquete
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Wade
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - W G Herrington
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Collins
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R Peto
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R Tapia-Conyer
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - P Kuri-Morales
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - J Emberson
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
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Gnatiuc L, Alegre-Díaz J, Wade R, Ramirez-Reyes R, Tapia-Conyer R, Garcilazo-Ávila A, Chiquete E, Gonzáles-Carballo C, Solano-Sanchez M, Clarke R, Collins R, Herrington WG, Hill M, Lewington S, Peto R, Emberson JR, Kuri-Morales P. General and Abdominal Adiposity and Mortality in Mexico City: A Prospective Study of 150 000 Adults. Ann Intern Med 2019; 171:397-405. [PMID: 31404923 PMCID: PMC6949137 DOI: 10.7326/m18-3502] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Some reports suggest that body mass index (BMI) is not strongly associated with mortality in Hispanic populations. OBJECTIVE To assess the causal relevance of adiposity to mortality in Mexican adults, avoiding reverse causality biases. DESIGN Prospective study. SETTING 2 Mexico City districts. PARTICIPANTS 159 755 adults aged 35 years and older at recruitment, followed for up to 14 years. Participants with a hemoglobin A1c level of 7% or greater, diabetes, or other chronic diseases were excluded. MEASUREMENTS BMI, waist-to-hip ratio, waist circumference, and cause-specific mortality. Cox regression, adjusted for confounders, yielded mortality hazard ratios (HRs) after at least 5 years of follow-up and before age 75 years. RESULTS Among 115 400 participants aged 35 to <75 years at recruitment, mean BMI was 28.0 kg/m2 (SD, 4.1 kg/m2) in men and 29.6 kg/m2 (SD, 5.1 kg/m2) in women. The association of BMI at recruitment with all-cause mortality was J-shaped, with the minimum at 25 to <27.5 kg/m2. Above 25 kg/m2, each 5-kg/m2 increase in BMI was associated with a 30% increase in all-cause mortality (HR, 1.30 [95% CI, 1.24 to 1.36]). This association was stronger at ages 40 to <60 years (HR, 1.40 [CI, 1.30 to 1.49]) than at ages 60 to <75 years (HR, 1.24 [CI, 1.17 to 1.31]) but was not materially affected by sex, smoking, or other confounders. The associations of mortality with BMI and waist-to-hip ratio were similarly strong, and each was weakened only slightly by adjustment for the other. Waist circumference was strongly related to mortality and remained so even after adjustment for BMI and hip circumference. LIMITATION Analyses were limited to mortality. CONCLUSION General, and particularly abdominal, adiposity were strongly associated with mortality in this Mexican population. PRIMARY FUNDING SOURCE Mexican Health Ministry, Mexican National Council of Science and Technology, Wellcome Trust, Medical Research Council, and Kidney Research UK.
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Affiliation(s)
- Louisa Gnatiuc
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Jesus Alegre-Díaz
- National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
| | - Rachel Wade
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Raúl Ramirez-Reyes
- National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
| | - Roberto Tapia-Conyer
- National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
| | - Adrián Garcilazo-Ávila
- National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
| | - Erwin Chiquete
- Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico (E.C.)
| | - Carlos Gonzáles-Carballo
- National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
| | - Martha Solano-Sanchez
- National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
| | - Robert Clarke
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Rory Collins
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - William G Herrington
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Michael Hill
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Sarah Lewington
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Richard Peto
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Jonathan R Emberson
- University of Oxford, Oxford, United Kingdom (L.G., R.W., R.C., R.C., W.G.H., M.H., S.L., R.P., J.R.E.)
| | - Pablo Kuri-Morales
- National Autonomous University of Mexico, Mexico City, Mexico (J.A., R.R., R.T., A.G., C.G., M.S., P.K.)
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Chiquete E, Gómez-Piña JJ, Ramírez-García G, Ruiz-Ruiz E, Barrientos-Guerra JD, Toapanta-Yanchapaxi L, Flórez-Cardona JA, Flores-Silva F, Reyes-Melo I, García-Ramos G, Higuera-Calleja J, Cantú-Brito C. Enfermedad carotídea aterosclerosa y enfermedad de sustancia blanca en sujetos sin historia de infarto cerebral o isquemia cerebral transitoria. GAC MED MEX 2019; 155:350-356. [PMID: 31486781 DOI: 10.24875/gmm.19004494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. Method Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. Results One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. Conclusions In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.
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Affiliation(s)
- Erwin Chiquete
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - Juan José Gómez-Piña
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - Guillermo Ramírez-García
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - Eduardo Ruiz-Ruiz
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - José Domingo Barrientos-Guerra
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - Liz Toapanta-Yanchapaxi
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | | | - Fernando Flores-Silva
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - Isael Reyes-Melo
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - Guillermo García-Ramos
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
| | - Jesús Higuera-Calleja
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurorradiología, Ciudad de México, México
| | - Carlos Cantú-Brito
- Instituto Nacional de Ciencias Médicas y de la Nutrición "Salvador Zubirán", Departamento de Neurología y Psiquiatría, Ciudad de México, México
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Galván-Ramírez ML, Sánchez-Orozco LV, Andrade-Sierra J, Mendoza-Cabrera S, Evangelista-Carrillo LA, Rodríguez Pérez LR, Chiquete E, Armendáriz-Borunda J. Toxoplasma infection in kidney donors and transplant recipients from Western Mexico: A one-year follow-up. Transpl Infect Dis 2019; 21:e13139. [PMID: 31271696 DOI: 10.1111/tid.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Solid organ transplant recipients are highly susceptible to Toxoplasma gondii infection. We aimed to describe the 12-month follow-up risk of seroconversion in renal transplant recipients. METHODOLOGY Anti-T gondii antibodies were investigated in donors and recipients of renal transplants. In donors, anti-T gondii were evaluated before transplantation. In recipients, anti-T gondii were monitored over a 12-month period to evaluate potential seroconversion or reactivation. IgG and IgM anti-T gondii antibodies were investigated through enzyme immunoassay and Western blot. Molecular diagnosis was performed on peripheral blood leukocytes using PCR to amplify fragments corresponding to the T gondii B1 gene and the repetitive 529-bp element. RESULTS The basal frequency of seropositive IgG anti-T gondii antibodies was higher in donors than in recipients (38.4% vs 25.2%; P = .03). During the 12-month follow-up, the accumulated seroconversion to IgG and IgM antibodies was 3/99 (3.0%), and the accumulated reactivation was 11/99 (11.0%). None of the samples exhibited positivity to T gondii DNA. CONCLUSIONS This study showed that there is an increased risk of seroconversion or reactivation in renal transplant recipients over a 12-month follow-up. Our data suggest that prophylaxis with trimethoprim and sulfamethoxazole effectively prevented toxoplasmosis, since neither T gondii DNA nor clinical toxoplasmosis was detected.
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Affiliation(s)
- María Luz Galván-Ramírez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, México
| | - Laura V Sánchez-Orozco
- Institute for Molecular Biology in Medicine, Health Sciences University Center, University of Guadalajara, Guadalajara, México
| | - Jorge Andrade-Sierra
- Department of Nephrology, and Transplant, Western National Medical Center of the Mexican Social Security Institute, Guadalajara, Mexico
| | - Salvador Mendoza-Cabrera
- Department of Nephrology, and Transplant, Western National Medical Center of the Mexican Social Security Institute, Guadalajara, Mexico
| | - Luis Alberto Evangelista-Carrillo
- Department of Nephrology, and Transplant, Western National Medical Center of the Mexican Social Security Institute, Guadalajara, Mexico
| | - Laura R Rodríguez Pérez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, México
| | - Erwin Chiquete
- Departments of Neurology and Psychiatry, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Juan Armendáriz-Borunda
- Institute for Molecular Biology in Medicine, Health Sciences University Center, University of Guadalajara, Guadalajara, México.,Tecnologico de Monterrey, Campus Guadalajara, Guadalajara, Mexico
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Lam C, Ruiz E, Ramírez G, Gómez-Piña JJ, Toapanta-Yanchapaxi L, Gomez-Perez FJ, Chiquete E. SAT-089 Statin Use Associated with Symptomatic and Asymptomatic Hyperckemia: A Retrospective Cohort Study. J Endocr Soc 2019. [PMCID: PMC6551922 DOI: 10.1210/js.2019-sat-089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Statins are the most commonly used cholesterol-lowering drugs to reduce cardiovascular risks. Elevation of serum creatine kinase (CK) activity with or without myopathy constitutes the most common forms of statin intolerance. We aimed to examine the frequency of statin-associated symptomatic and asymptomatic myopathy among consecutive patients with hyperCKemia. Methods We performed a retrospective review of electronic and paper medical records and selected 1,278 consecutive patients with hyperCKemia who were treated from 2013 to 2016 at the (undisclosed). We evaluated potential causes of hyperCKemia and analyzed specifically records of statin users by collecting demographic data, medical history, neuromuscular examination and biochemical profiles. Results In all, 290 (22.7%) patients with hyperCKemia were statin users, and among them, 79 (43.9%, or 6.2% of total) were considered to be due to statin exposure after normalization of serum CK activity with statin discontinuation (88.6% were asymptomatic). The mean age was 58.6 years (range 26-95) and 26.6% were women. Only 9 (11.4%) patients had symptomatic hyperCKemia with myopathy syndrome. The mean serum CK activity with statin exposure was 326.3±150 IU/L (normal reference: 30-223 IU/L) and 198.6±82.9 IU/L after statin discontinuation. Atorvastatin (74.7%) was the most commonly used statin, followed by pravastatin (11.4%) and simvastatin (7.6%). In all, 41 (51.9%) patients had type 2 diabetes mellitus (T2D), 55 (69.6%) had chronic kidney disease (CKD), 7 (8.9%) had chronic liver disease, 15 (19%) hypothyroidism and 4 (5.1%) had HIV infection. Conclusion Our study suggests that statins exposure is a common cause of hyperCKemia, but that the great majority of cases are asymptomatic. Further studies are necessary to clarify whether T2D and CKD are independent risk factors for hyperCKemia or epiphenomena to statins indications. Reference Chatzizisis, Y.S., Koskinas, K.C., Misirli, G. et al. Drug-Safety (2010) 33: 171.
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Affiliation(s)
- Cesar Lam
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, , Mexico
| | - Eduardo Ruiz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, , Mexico
| | - Guillermo Ramírez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, , Mexico
| | - Juan Jose Gómez-Piña
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, , Mexico
| | | | | | - Erwin Chiquete
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, , Mexico
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Flores-Silva FD, Chiquete E, Martinez-Carrillo F, Gomez-Brockmann P, Montes-Ramirez JE, Echeverria-Vargas JA, Cordova-López P, Perezfigueroa-Olivas V, Zacarías-Mateos E, Salama-Frisbie R, Cantú-Brito C. Abstract WP236: Trends in Antithrombotic Therapy Use and Clinical Outcome in Acute Ischemic Stroke and Atrial Fibrillation in a Hispanic Population in the Era of Direct Oral Anticoagulants. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction and Purpose:
Guidelines strongly recommend oral anticoagulation (OAC) for stroke prevention for individuals with atrial fibrillation (AF). Before introduction of direct oral anticoagulants (DOAs) in 2011, we demonstrated that in our Hispanic population most of the patients with AF admitted with an acute stroke were receiving antiplatelets or no antithrombotic therapy. This study examined the trends in antithrombotic use in AF after the introduction of DOAs.
Methods:
Patients with transient ischemic attack [TIA] and ischemic stroke [IS] enrolled in Mexican national registries of general public hospitals (n=4172) were analyzed to select patients with previous AF (n=534). Hemorrhagic stroke was excluded. Primary end points were (1) to compare pre-stroke antithrombotic treatment between patients who had a stroke from 2002-2010 versus 2011-2018, and (2) to compare short-term outcome regarding pre-stroke treatment and between both time periods.
Results:
Prevalence of AF was 12.8% (534/4172), age 73.8 ±13.3; 170 (31.8%) had had a previous IS/TIA. CHA
2
DS
2
-VASc 3.89 ±1.8, HAS-BLED 2.3 ± 1.1. When comparing antithrombotic therapy between both time periods we found: no anticoagulant therapy 71.8% vs 66.9%, subtherapeutic levels of those receiving vitamin-K antagonists (VKAs) 20.2% vs 10.5%, therapeutic VKA 8% vs 14.3%, and DOAs use of 14.3% (only last period). OAC effective therapy was lower in patients without previous IS/TIA (9.9% versus 17.1%). Patients using OAC in therapeutic range or DOAs at the time of stroke had better outcome when compared with individuals taking antiplatelets or no antithrombotics (P <0.05). Short-term modified Rankin Scale (mRS) between both time periods were mRS 0-2: 36.9% vs 40.6%, mRs 3-5: 36.4% vs 46.6%, and death 26.7% vs 12.8% (
p
= 0.003).
Conclusions:
In our Hispanic population underuse of effective anticoagulant therapy is still prevalent even in the new DOAs era (more >70%). VKA in therapeutic ranges or DOAs use had less disability and mortality on short-term outcome. There is a low frequency of DOAs in our public general hospital population.
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Affiliation(s)
| | - Erwin Chiquete
- Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico city, Mexico
| | | | - Pedro Gomez-Brockmann
- Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico city, Mexico
| | | | | | - Patricio Cordova-López
- Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico city, Mexico
| | | | | | - Richard Salama-Frisbie
- Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico city, Mexico
| | - Carlos Cantú-Brito
- Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico city, Mexico
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Ruiz-Sandoval JL, Chiquete E, Parra-Romero G, Carrillo-Loza K, Parada-Garza JD, Pérez-Gómez HR, Ochoa-Plascencia MR, Aguirre-Portillo L. Hypertensive thalamic hemorrhage: analysis of short-term outcome. Int J Neurosci 2018; 129:189-194. [DOI: 10.1080/00207454.2018.1518905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- José L. Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, México
- Traslational Neurociences Institute, Department of Neurosciences, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Erwin Chiquete
- Deparment of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Ciudad de México, México
| | - Gustavo Parra-Romero
- Department of Neurology, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, México
| | - Karina Carrillo-Loza
- Department of Neurology, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, México
| | - Juan D. Parada-Garza
- Department of Neurology, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, México
| | - Héctor R. Pérez-Gómez
- Deparment of Infectology, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, México
| | - Miguel R. Ochoa-Plascencia
- Department of Neurosurgery, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, México
| | - Leonardo Aguirre-Portillo
- Department of Neurosurgery, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, Guadalajara, Jalisco, México
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Barboza MA, Chiquete E, Arauz A, Merlos-Benitez M, Quiroz-Compeán A, Barinagarrementería F, Cantú-Brito C. A Practical Score for Prediction of Outcome After Cerebral Venous Thrombosis. Front Neurol 2018; 9:882. [PMID: 30405516 PMCID: PMC6204492 DOI: 10.3389/fneur.2018.00882] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Most patients with cerebral venous thrombosis (CVT) have independent survival in the short term. However, identification of high-risk individuals with an unfavorable outcome is a challenging task. We aimed to develop a CVT grading scale (CVT-GS) to aid in the short-term clinical decision-making. Methods: We included 467 consecutive patients with CVT who were hospitalized from 1981 to 2015 in two third-level referral hospitals. Factors associated with 30-day mortality were selected with bivariate analyses to integrate a Cox proportional-hazards model to determine components of the final scoring. After the scale was configured, the prognostic performance was tested for prediction of short-term death or moderately impaired to death [modified Rankin scale (mRS) > 2]. CVT-GS was categorized as mild, moderate or severe for the prediction of 30-day fatality rate and a probability of mRS > 2. Results: The 30-day case fatality rate was 9.0%. The CVT-GS (0–13 points; more points predicting poorer outcomes) was composed of parenchymal lesion size > 6 cm (3 points), bilateral Babinski signs (3 points), male sex (2 points), parenchymal hemorrhage (2 points), and level of consciousness (coma: 3 points, stupor: 2, somnolence: 1, and alert: 0). CVT was categorized as mild (0–2 points, 0.4% fatality rate), moderate (3–7 points, 9.9% fatality rate), or severe (8–13 points, 61.4% fatality rate). The CVT-GS had an accuracy of 91.6% for the prediction of 30-day mortality and 85.3% for mRS > 2. Conclusions: CVT-GS is a practical clinical tool for prediction of outcome after CVT. This score may aid in clinical decision-making and could serve to stratify patients enrolled in clinical trials.
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Affiliation(s)
- Miguel A Barboza
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.,Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, San José, Costa Rica
| | - Erwin Chiquete
- Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | | | | | - Carlos Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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López-Esparza J, Castillo CD, Verduzco P, Santos M, Flores F, Chiquete E, Lopez-R M, Pech O, Tobón H, Cantú-Brito C. Síndrome Foix-Chavany-Marie vascular: abordaje del constructo de ESUS. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.neuarg.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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