Automedicación en pacientes mayores de 60 con enfermedades neurológicas / Self-Medication in Patients Older than Sixty Years and with Neurologic Diseases

Introducción: La automedicación es un fenómeno creciente y ha sido considerado un problema de salud pública en la actualidad. Objetivo: Estimar el nivel de automedicación relacionado con el retraso diagnóstico de pacientes con enfermedades neurológicas y los factores asociados a esta táctica de autocuidado. Métodos: Se proyectó un estudio observacional de corte transversal, en el que se incluyeron 102 pacientes y 100 familiares pertenecientes al municipio Plaza de la Revolución, atendidos en consulta de Neurología del Instituto de Neurología y Neurocirugía, con diagnóstico de enfermedades neurológicas, durante el período de un año (junio 2018-junio2019). Resultados: Del total de pacientes, 45,1 por ciento manifestó automedicarse, fue más frecuente en mujeres (63,1 por ciento), con predominio en pacientes no universitarios (90 por ciento) y amas de casa (54,3 por ciento). El síntoma principal que motivó la automedicación fue la cefalea (30,4 por ciento), y los analgésicos no opioides fue el grupo de mayor consumo (23,9 por ciento). La latencia al diagnóstico de enfermedades neurológicas en el grupo de automedicados fue entre 10 a 19 meses mayor que en los no automedicados. Conclusiones: La automedicación constituye una práctica muy frecuente, lo cual produjo el retraso diagnóstico y terapéutico de diversas enfermedades neurológicas de baja incidencia, dando al traste con una evolución adecuada de ellas(AU)

Introduction: Self-medication is a growing phenomenon and, today, has been considered a public health concern. Objective: To estimate the level of self-medication related to the diagnostic delay of patients with neurological diseases and the factors associated with this self-care tactic. Methods: An observational and cross-sectional study was designed, in including 102 patients and one hundred relatives from Plaza de la Revolución Municipality, who received attention, during a one-year period (June 2018-June 2019), in the neurology consultation of the Institute of Neurology and Neurosurgery, and had a diagnosis of neurological diseases. Results: Of the total number of patients, 45.1 percent manifested to medicate themselves; it was more frequent in women (63.1 percent), with a predominance in non-university patients (90 percent) and housewives (54.3 percent). The main symptom that motivated self-medication was headache (30.4 percent), while nonopioid analgesics made up the group with the highest consumption (23.9 percent). Latency regarding the diagnosis of neurological diseases in the self-medicated group was between ten and nineteen months higher than in the non-self-medicated group. Conclusions: Self-medication is a very frequent practice, which caused the diagnostic and therapeutic delay of various neurological diseases of low incidence, ruining their adequate evolution(AU)

An outbreak of compressive myelopathy due to pyogranulomatous reaction to the oily adjuvant of the foot-and-mouth disease vaccine - case report / Surto de mielopatia compressiva associada à reação piogranulomatosa ao adjuvante oleoso da vacina contra Febre Aftosa em Minas Gerais - relato de caso

Cases of compressive myelopathy syndrome associated with post vaccinal pyogranulomas were diagnosed post mortem in three cows from a farm in Minas Gerais state, Brazil. These cows presented ataxia and bilateral paresis of the pelvic limbs, which evolved to paralysis, and sternal recumbence. On necropsy, locally extensive areas of the longissimus dorsi muscle were replaced by pyogranulomas supported by moderate amounts of fibrous connective tissue. On the cut surface, some nodules contained yellowish and viscous fluid (purulent exudate) or whitish fluid (interpreted as the oily adjuvant of a vaccine). In the spinal canal of the subjacent vertebrae, compressing the spinal cord, were pyogranulomas identical to those described in the skeletal muscle. Histologically, the pyogranulomas were composed of a central clear vacuole (consistent with the space left by the oil adjuvant droplets), surrounded by neutrophils and, more externally, by large numbers of epithelioid macrophages and fewer multinucleated giant cells. In the white matter of the spinal cord were numerous well-defined, clear vacuoles (Wallerian degeneration). The association of the clinical history and pathological findings allowed the diagnosis of compressive myelopathy associated with pyogranulomatous reaction to the oily adjuvant of the foot-and-mouth disease vaccine, in this case, due to its inadequate application.(AU)

São descritos casos de síndrome de compressão medular, associada a granulomas pós-vacinais, em bovinos Nelore, provenientes de uma propriedade em Minas Gerais. Esses bovinos apresentavam ataxia e paresia bilateral dos membros pélvicos, que evoluiu para paralisia e decúbito esternal. Na necropsia, áreas focalmente extensas da musculatura na região torácica dorsal (músculo longissimus dorsi) eram substituídas por numerosos piogranulomas, separados por tecido brancacento e firme (tecido conjuntivo fibroso). Ao corte, alguns nódulos continham material amarelado e viscoso (exsudato purulento) ou material esbranquiçado e fluido (sugestivo de adjuvante de vacina). No canal medular das vértebras subjacentes, havia granulomas idênticos aos observados no tecido muscular. Histologicamente, os piogranulomas continham, no centro, vacúolo, bem delimitado e arredondado (consistente com o espaço deixado pela gotícula de lipídio do adjuvante), circundado por variável quantidade de neutrófilos degenerados e íntegros e, mais externamente, por numerosos macrófagos epitelioides e algumas células gigantes multinucleadas. Nas áreas da medula espinhal, circundadas pelos granulomas, numerosos vacúolos, bem definidos, eram observados na substância branca (degeneração walleriana). A associação do histórico clínico e de achados patológicos permitiu o diagnóstico de mielopatia compressiva associada à reação granulomatosa ao adjuvante oleoso da vacina contra febre aftosa, no caso, induzida pela aplicação inadequada da vacina.(AU)

Diagnóstico diferencial das doenças neurológicas dos bovinos no estado do Paraná / Differential diagnosis of neurologic diseases of cattle in the state of Paraná

O objetivo deste trabalho foi identificar as doenças neurológicas que acometeram bovinos no estado do Paraná entre os anos de 2009 e 2015. A investigação aconteceu, preferencialmente, nas propriedades rurais onde os casos ocorreram. Foram registradas as informações sobre a evolução das doenças nos bovinos afetados do rebanho, e os prováveis fatores de risco foram identificados. Todos os procedimentos de exame físico geral e neurológico foram realizados sistematicamente para a caracterização da síndrome neurológica presente. Amostras de sangue e de líquor foram colhidas para a realização de exames laboratoriais. De acordo com o tempo de evolução e com a gravidade dos sinais clínicos observados, os bovinos doentes eram mantidos vivos para acompanhamento da evolução ou da resposta ao tratamento, ou eram submetidos à eutanásia seguida de necropsia. Fragmentos do sistema nervoso e dos demais órgãos foram colhidos para exame histopatológico. O exame de imunofluorescência direta e a prova biológica em camundongos foram realizados em todos os bovinos que morreram, com a finalidade de confirmar ou descartar o diagnóstico de raiva. Métodos laboratoriais específicos das rotinas de virologia, bacteriologia e toxicologia foram empregados, como complementares, para o estabelecimento do diagnóstico diferencial. Foram investigados 236 bovinos com doença neurológica, sendo 85 casos de ocorrência individual e 151 casos distribuídos por surtos que ocorreram em 79 rebanhos. As encefalopatias (180/236; 76,2%) predominaram sobre as mielopatias (27/236; 11,4%). As doenças inflamatórias determinadas por infecções (98/236; 41,5%) e as doenças tóxicas (91/236; 38,6%) foram as principais, enquanto as causas degenerativas (10/236; 4,2%), metabólicas (9/236; 3,8%), físicas (9/236; 3,8%), neoplásicas (4/236; 1,7%), e os defeitos congênitos (1/236; 0,4%) ocorreram menos frequentemente. Os casos inconclusivos somaram 5,9% (14/236). A meningoencefalite por BoHV-5 e a raiva foram as doenças de frequência maior e podem ser consideradas as mais importantes. Dentre as causas tóxicas, as intoxicações por plantas se destacaram (63/91; 69,2%) e foram responsáveis por 26,6% de todos os casos. Destacaram-se ainda a polioencefalomalácia, a meningoencefalite trombótica por Histophilus somni e o botulismo. Essas informações contribuem para que os médicos veterinários adotem condutas mais efetivas de diagnóstico e de prevenção, e são valiosas para o sistema oficial de vigilância epidemiológica do estado.(AU)

The aim of this study was to identify the neurological diseases that affected cattle in Paraná state between the years 2009 and 2015. The investigation took place, preferably, in the farms where cases occurred. Information on the evolution of the diseases in the affected cattle of the herd was recorded, and the probable risk factors were identified. All general and neurological examination procedures were performed systematically for the characterization of the neurological syndrome in each case. Samples of blood and CSF for laboratory exams were also collected. According to the evolution features and the severity of the observed clinical signs, the diseased cattle were kept alive to follow the progress of the disease, or were submitted to euthanasia followed by necropsy. Fragments of tissues from nervous system and other organs were collected for histopathological examination. Direct immunofluorescence test and biological test were performed on all the cattle that died, in order to confirm or rule out the diagnosis of rabies. Specific virology, bacteriology and toxicology laboratory methods were used as complementary exams in order to establish differential diagnosis. A total of 236 cattle with neurological disease were investigated, 85 cases of individual occurrence and 151 cases distributed by outbreaks that occurred in 79 herds. Encephalopathies (180/236, 76.2%) predominated over mielopathies (27/236, 11.4%). Inflammatory diseases caused by infections (98/236, 41.5%) and the toxic diseases (91/236, 38.6%) were the main causes, while degenerative (10/236, 4.2%), metabolic (9/236; 3.8%), physical (9/236, 3.8%), neoplastic (4/236, 1.7%), and congenital defects (1/236, 0.4%) occurred less often. The inconclusive cases were 5.9% (14/236). BoHV-5 meningoencephalitis and rabies were diseases of higher frequency and may be considered the most important. Among the toxic causes, plant poisonings were highlighted (63/91, 69.2%) and were responsible for 26.6% of all cases. Polioencephalomalacia, thrombotic meningoencephalitis caused by Histophilus somni and botulism were also highlighted. This information helps veterinarians to adopt more effective diagnostic and preventive approaches and is valuable to the state's official epidemiological surveillance system.(AU)

Depression as the middle-and long-term impact for pre-symptomatic testing of late-onset neurodegenerative disorders / A depressão como indicador do impacto psicológico a médio e longo prazo do teste pré-sintomático de doenças neurodegenerativas de início tardio / La depresión como el indicador de impacto psicológico a la media y largo plazo de la prueba pre-sintomática para enfermedades de aparición tardía

This cross-sectional study investigated depression as the middle- (4 years) and long-term (7 and 10 years) psychological impact of pre-symptomatic testing (PST) for 3 autosomal dominant late-onset diseases: Huntington's disease (HD), Machado-Joseph disease (MJD) and familial amyloidotic polyneuropathy (FAP) TTR V30M. It included 203 subjects: 170 (83.7%) underwent the PST for FAP, 29 (14.3%) for HD and 4 (2%) for MJD. Of these 203, 73 were still asymptomatic carriers, 29 (14.5%) were symptomatic, 9 (4.5%) were FAP liver transplanted patients and 89 (44.5%) were non-carriers. Subjects were mainly women (58.1%) and married (66.5%). The Beck Depression Inventory (BDI) was used to evaluate depression. Scores were higher for symptomatic carriers and for those who have made one or more psychological support consultations over the years. For the formers, the mean scores pointed to mild depression. Asymptomatic carriers and non-carriers had similar scores but it was impossible to differentiate the psychological impact between the medium and long-term. For symptomatic carriers, there were significant differences between the middle- and long-term. The study indicates that depression occurs only when subjects had previously manifested the first symptoms of their neurologic disease.

Este estudo transversal investigou a depressão como indicador do impacto psicológico do teste pré-sintomático (TPS) a médio (quatro anos) e longo prazo (de 7 a 10 anos) de doenças neurológicas de início tardio: a doença de Huntington (DH), doença de Machado-Joseph (DMJ) e polineuropatia amiloidótica familiar PAF (TTR V30M). 203 sujeitos participaram no estudo: 170 (83,7%) submetidos ao TPS para PAF, 29 (14,3%) para o DH e 4 (2%) para DMJ. Destes 203, 73 eram portadores assintomáticos, 29 (14,5%) já eram sintomáticos, 9 (4,5%) pacientes com PAF, já tinham realizado o transplante hepático e 89 (44,5%) eram não-portadores. A amostra era constituída maioritariamente por mulheres (58,1%) e por sujeitos casados (66,5%). Utilizou-se o Inventário da Depressão de Beck (BDI). Os scores mais elevados foram observados nos portadores sintomáticos e nos sujeitos que tinham realizado consultas de psicologia com scores indicadores de depressão leve. Os portadores assintomáticos e os não-portadores apresentaram médias semelhantes. Para os portadores sintomáticos, encontrámos diferenças significativas entre o médio e o longo prazo. Este estudo conclui que a depressão pode ocorrer nos indivíduos que já manifestam os primeiros sintomas da respectiva doença neurológica.

Este estudio transversal investigó la depresión a la media (4 años) y largo plazo (7 y 10 años) del impacto psicológico de la prueba pre-sintomática (PPS) para 3 enfermedades autosómicos, dominantes, de aparición tardía: la enfermedad de Huntington (EH), la enfermedad de Machado-Joseph (EMJ) y la polineuropatia amiloide familiare (PAF) o polineuropatia amiloide da transtiretina FAP (TTR V30M). Participaron 203 sujetos: 170 (83,7%) para PPS para PAF, 29 (14,3%) para EH y 4 (2%) para EMJ. De estos 203, 73 estaban todavía portador asintomático, 29 (14,5%) eran sintomáticos, 9 (4,5%) fueron PAF pacientes con trasplante hepático y 89 (44,5%) eran no-portadores. Eran en su mayoría mujeres (58,1%) y casados (66,5%). Se utilizó el Inventario de Depresión de Beck (IDB). Los puntajes fueron mayores para las portadoras sintomáticas y para aquellos que han hecho consultas de apoyo psicológico con puntuaciones medias de depresión leve. Los portadores asintomáticos y no portadores tuvieron puntajes similares. Para portadores sintomáticos, hubo diferencias significativas entre el medio y largo plazo. Este estudio concluye que la depresión puede ocurrir en personas que ya muestran los primeros síntomas de la enfermedad neurológica.

Os filmes no ensino das doenças neurológicas em idosos / Cinema in teaching of geriatrics: neurological diseases / El cine en la enseñanza de las enfermedades neurológicas en los ancianos

Ao expor a humanidade e favorecer reflexões críticas, o cinema desempenha seu papel de suprir experiências que nem todos podem vivenciar. Dessa forma, constitui-se como valiosa fonte de recurso para a educação médica. Os filmes ampliam as possibilidades de promoção de uma formação mais ampla e integrada, pois envolvem habilidades e competências que vão além do conhecimento biomédico, o que é essencial no contexto da abordagem ao paciente idoso. Neste artigo são referidos filmes de longa-metragem que didaticamente focam pacientes idosos portadores de doenças neurológicas, como doença de Alzheimer, acidente vascular encefálico e demência vascular, doença de Parkinson e esclerose lateral amiotrófica.

By exposing humanity and promoting critical thinking, cinema plays your part by supplying experiences that not everyone can see. In this way, constitutes a valuable source of resource for medical education. Films expand the possibilities of promoting a more comprehensive and integrated training, involving skills and competencies that go beyond biomedical knowledge, which is essential in the context of approach to elderly patient. This article describes some didactic films that shows elderly patients with neurological diseases like Alzheimer's, stroke and vascular dementia, Parkinson's disease and amyotrophic lateral sclerosis.

Al exponer la humanidad y favorecer reflexiones críticas, el cine desempeña su papel de suplir experiencias que no todos pueden vivenciar. De esa forma, se constituye como valiosa fuente de recurso para la educación médica. El cine amplia las posibilidades de promoción de una formación más amplia e integrada, pues involucra habilidades y competencias que van más allá del conocimiento biomédico, lo que es esencial en el contexto del abordaje del paciente anciano. En este artículo se refieren largometrajes que didácticamente se centran en pacientes ancianos portadores de enfermedades neurológicas, como enfermedad de Alzheimer, accidente vascular encefálico y demencia vascular, enfermedad de Parkinson y esclerosis lateral amiotrófica.

Frida Kahlo: a arte como desafio à deficiência e à dor, com enfoque napoliomielite anterior aguda / Frida Kahlo: the art as challenge to deficiency and pain, with focus on acute anterior poliomyelitis

Introdução: Frida Kahlo, pintora mexicana e revolucionária, aos 6 anos de idade apresentou poliomielite anterior aguda que a deixou com seqüelas permanentes no membro inferior. Aos 20 anos sofreu grave acidente de ônibus que culminou em lesões músculo-esqueléticas que causaram dores e problemas por toda a sua trajetória de vida. A sua pintura é única e quase uma biografia de paixão e dor. Objetivos: Descrever e discutir as pinturas e comentários da biografia de Frida Kahlo, que se relacionam principalmente à neurologia: anormalidades congênitas (espinha bífida), poliomielite anterior aguda, injúrias da coluna vertebral e dor neuropática. Método: Foram analisadas bibliografias quearticulassem neurologia, psicologia e arte e, contemplassem o panorama histórico e cultural dos períodos de produção da pintora. Resultados: A vida de Frida Kahlo esteve marcada pela dor, tragédias e sofrimentos. Para Frida a pintura foi uma maneira de inventar a si mesma, mas também um modo de exorcizar e dor e de fazer tolerável o desespero das inúmeras convalescenças que teve que defrontar ao longo de sua vida. Conclusão: Frida insiste em que a vida deva ser bem vivida mesmo que não seja longa. Sua vida foi influenciada profundamente por doenças crônicas e neurológicas. Seu trabalho é a melhor ilustração de sua vida.

Introduction: Frida Kahlo was a painter and a revolutionary Mexican woman that at 6 years of age had acute anterior poliomyelitis with permanent sequels in lower limbs. At the age of 20, she suffered a serious bus accident that culminated in muscle-skeletal injuries thatcaused pains and problems all her life. Her painting is unique and almost a biography of passion and pain. Objective: To describe and discuss the paintings and comments of the Frida Kahlo?s biography related to neurology: congenital abnormalities (spina bifida), acute anterior poliomyelitis, spinal cord injuries, and neuropathic pain. Method: We analysed the literature about the painter that articulated neurology, psychology, and art and contemplated the cultural and historical panorama. Results: The life of Frida Kahlo was marked by pain, tragedies, and sufferings. For Frida, the painting was a way to invent herself, but also a way of exorcize the pain and making tolerable the desperationof the countless convalescences that she had to confront throughout her life. Conclusion: Frida insists on that the life should be well even though not too long. Her life was deeply influenced by chronic and neurological illnesses. Her work is the best illustration of her life.

The Baiscs and the Prospect of Stem Cells for Pediatric Neurologic Diseases

Stem cells are a special kind of cells that have a unique capacity to renew themselves and to give rise to specialized cell types. Researchers have for years looked for ways to use stem cells in order to replace cells and tissues that are damaged or diseased. In 1998, for the first time, it became possible to derive this kind of pluripotent stem cells from early human embryos and grow them in culture. Nearly at the same time scientists were beginning to explore human pluripotent stem cells from fetal and adult tissues, so-called adult stem cells. This promising area of science is also leading neurologists to investigate the possibility of cell-based therapies to repair damaged brain cells. Among the pediatric neurologic diseases, infarcted brain, leukodystrophy, inherited metabolic diseases and neurotransmitter diseases are the immediate candidates of the stem cell therapy. This document covers a basic information about stem cells and a potential use of the stem cell therapy for pediatric neurologic diseases.

Mortalidad hospitalaria en el Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" (1995-2001) / Hospital Mortality at the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery (1995-2001)

Determinar las causas de muerte en cualquier institución de salud contribuye a la toma de decisiones encaminadas a mejorar los servicios de salud, así como para conocer el perfil de la población que acude a recibir atención médica. Objetivo: analizar la mortalidad hospitalaria y su tendencia durante el periodo de 1995-2001 en el Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" (INNN-MVS). Material y métodos: se utilizó la base de datos con la que cuenta el Departamento de Epidemiología del INNN-MVS, que se encuentra codificada de acuerdo a la Clasificación Internacional de Enfermedades décima versión (CIÉ-10). Se calcularon las diferentes tasas de mortalidad y se determinó su tendencia a través del período de siete años. Resultados: las principales causas de mortalidad durante el periodo de estudio fueron las hemorragias intraencefálicas y las subaracnoideas. En general se encontró una tendencia a la disminución en las principales causas de mortalidad. Conclusiones: la tendencia a la disminución concuerda con el incremento en la esperanza de vida de nuestra población, situación que se ha presentado por el progreso en los conocimientos médicos y a las nuevas técnicas diagnósticas y terapéuticas con las que cuenta una institución de tercer nivel de salud, como lo es el INNN-MVS.

To improve health policies directed toward ameliorating quality and also to characterize the profile of patients who attend medical centers, it is necessary to determine causes of mortality in any healthcare organization. Objective: To analyze time-trend hospital mortality at the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery (MVS-NINN) between 1995 and 2001. Methods: Data were taken from database of morbidity and mortality of MVS-NINN. All cases were coded by the International Classification of Disease (10th edition). We calculated specific rates of mortality and time-trends during a 7-year-period. Results: When main causes of mortality were included in these analyzes, rates of hospital mortality at MVS-NINN showed a non-significant tendency to decrease during this period. Conclusions: Decline of mortality time-trend is generally in accordance with increasing life expectancy of Mexican population; this increase is due to progress in medical knowledge and to new technological and therapeutic advances, especially in the third level institutions such as this institute.

The Effect of Actigan Treatment in Neurologic Diseases

20 patients who were diagnosis neurologic diseases were treated deproteinized extract Actigen for 1-2 weeks. Comparing before and after treatment, clinical state, EEG, MEP, CT Scan and CBF have been improved to postmedicated state. According to above findings, it is indirectly confirmed that Actigen is improve brain motabolism, cerebral blood flow and peripheral blood flow. During medication there are no side effects and complications.