ABSTRACT
Resumen: acorde a las fuentes epidemiológicas de la Organización Mundial de la Salud, en la última década, entre las principales causas de mortalidad más del 55 % resultaban de enfermedades no transmisibles, predominando la isquemia cardiaca y el accidente cerebrovascular como causales. En el 2019, con la aparición del nuevo coronavirus, COVID-19, como etiología de la pandemia que ha impactado tanto en salud como económica y socialmente al mundo, las cifras de la curva de las causas usuales de mortalidad han cambiado no solo a causa del efecto directo de la enfermedad en los múltiples órganos, sino también por los efectos indirectos en relación con falta de acceso a atención médica en enfermedades crónicas. Dado que es una enfermedad transmisible, el COVID-19 produce alteraciones, principalmente respiratorias y vasculares, sin embargo, el mayor conocimiento de los aspectos fisiopatológicos de la enfermedad ha revelado el compromiso de múltiples sistemas, destacando el sistema nervioso central como un objetivo del virus que impacta en las secuelas y los desenlaces de los pacientes, de modo que se documentan manifestaciones neurológicas hasta en un 55 %. El objetivo de esta revisión es caracterizar una serie de casos de pacientes en el Hospital Militar Central, mediante la descripción de aspectos fisiopatológicos y clínicos del compromiso neurológico.
Summary: according to the epidemiological sources of the World Health Organization, In the last decade, among the leading causes of mortality, more than 55 % resulted from non-communicable diseases, predominating cardiac ischemia, and stroke as the leading causes. In 2019, with the appearance of the new coronavirus, COVID-19, as an etiology of the pandemic that has Impacted health, economy, and society, the familiar figures of the mortality curve have changed, not only because of the direct effect of the disease on multiple organs, but also because of the Indirect effects, concerning lack of access to medical care in chronic diseases. Since it is a communicable disease, COVID-19 produces alterations, mainly respiratory and vascular; however, the greater knowledge of the pathophysiological aspects of the disease has revealed the involvement of multiple systems, highlighting the central nervous system as a target of the virus that impacts on the sequelae and outcomes of patients, so neurological manifestations are documented up to 55 %. The objective of this review Is to characterize a series of cases of patients in Hospital Militar Central, by the description of pathophysiological and clinical aspects of the neurological compromise.
Resumo: de acordo com fontes epidemiológicas da Organização Mundial da Saúde, na última década, entre as principais causas de mortalidade, mais de 55 % resultavam de doenças não transmissíveis, com predominância da Isquemia cardíaca e do acídente cerebrovascular como causais. Em 2019, com o surgimento no novo coronavirus (COVID-19), como etiologia da pandemia que vem Impactando tanto em saúde quanto económica e socialmente o mundo inteiro, as cifras da curva das causas usuais de mortalidade vêm mudando não somente devido ao efeito direto da doença nos múltiplos órgãos, mas também aos efeitos indiretos com relação à falta de acesso à atenção médica em doenças crónicas. Tendo em vista que é uma doença transmissível, a COVID-19 produz alterações principalmente respiratórias e vasculares, contudo o maior conhecimento dos aspectos fisiopatológicos da doença revela o comprometimento de vários sistemas, destacando o nervoso central como um objetivo do vírus, que Impacta nas sequelas e nos desenlaces dos pacientes, de modo que são registradas manifestações neurológicas de até 55 %. O objetivo desta revisão é caracterizar uma série de casos de pacientes no Hospital Militar Central, mediante a descrição de aspectos flsiopatológicos e clínicos do comprometimento neurológico.
ABSTRACT
RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.
ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes' disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.
Subject(s)
Humans , Male , Female , Patients , Therapeutics , Guillain-Barre Syndrome , Cerebrospinal Fluid , Plasmapheresis , Giant Axonal Neuropathy , HospitalsABSTRACT
RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.
ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes' disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.
Subject(s)
Humans , Male , Female , Patients , Plasma Exchange , Therapeutics , Guillain-Barre Syndrome , Cerebrospinal Fluid , Plasmapheresis , Giant Axonal NeuropathyABSTRACT
The aim of the study was to analyze the epidemiologic, clinical, laboratory and development profile of Guillain-Barré syndrome series studied at the Child Institute, between 1989 and 2000. From the 61 patients that fulfilled the selection criteria, aged between 7 months and 13 years old, no sexual or seasonal variation was observed. Clinical events prior to neurological symptoms (with an average time gap of 20.7 days) were observed in 62.3 percent, 55 percent had cranial nerve disturbances, 27.9 percent dysautonomic symptoms, and 27.9 percent respiratory dysfunction. Installation time varied from 2-40 days, plateau from 0-28 days and recuperation from 30-480 days; 94 percent of patients had a complete clinical recuperation. Electrophysiology in 20 patients disclosed an abnormal demyelination pattern in 15, an exclusively motor axonal pattern in 4 and a mixed pattern in 1 patient. The results obtained did not differ from those in the literature but it was observed that boys and older children had a longer recuperation time. It was not possible to correlate electroneurography with clinical abnormalities and evolution due to the reduced number of patients.
O objetivo do estudo foi analisar retrospectivamente, quanto ao perfil clínico, laboratorial, epidemiológico e evolutivo a casuística da síndrome de Guillain-Barré no Instituto da Criança, entre 1989 e 2000. Preencheram os critérios de seleção 61 pacientes, com idades entre 7 meses e 13 anos, e não se observou variação entre sexos nem sazonal. Em 62,3 por cento houve uma afecção precedendo o quadro neurológico, num tempo médio de 20,7 dias; 55 por cento apresentaram acometimento de nervos cranianos, 27,9 por cento distúrbios disautonômicos e 27,9 por cento comprometimento respiratório. A fase de progressão variou de 2 a 40 dias, a de platô de 0 a 28 dias e a de recuperação de 30 a 480 dias e 94 por cento tiveram recuperação total. A eletroneurografia, em 20 pacientes, mostrou padrão desmielinizante em 15, padrão axonal puramente motor em 4 e padrão misto em 1. Os resultados não diferiram dos encontrados na literatura, mas os meninos e os pacientes na faixa etária superior apresentaram maior tempo de recuperação total. Não foi possível estabelecer relação entre resultados da ENMG e o quadro clínico e evolutivo em vista do pequeno numero de pacientes com esse exame.