Crystal storing histiocytosis forming a mass lesion in temporal lobe

Crystal storing histiocytosis is a disorder characterized by local or diffuse infiltration of histiocytes containing crystalline inclusions. This entity has been reported in several organs, however the involvement of the central nervous system (CNS) is extremely rare and to date only 7 cases of crystal storing histiocytosis (CSH) of CNS have been reported in the English literature. More than 90% patients with CSH had an underlying lymphoproliferative or plasma cell disorders, especially multiple myeloma, lymphoplasmacytic lymphoma or monoclonal gammopathy. Radiologically and intraoperatively, CSH may mimic an infectious process or neoplasm, hence its histopathological confirmation is important to facilitate appropriate treatment. In this report, we describe an additional case of crystal storing histiocytosis in a 48 year old female who presented with a mass lesion in the right temporal lobe of the cerebrum.

Primary central nervous system lymphoma: Comprehension of cell-of-origin subtypes

Primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) is an uncommon extranodal lymphoma that accounts for more than 95% of all the CNS lymphomas. Unlike its systemic/nodal counterpart, which is currently subtyped into cell-of origin (COO) subtypes, its feasibility and utility are largely debatable in PCNS-DLBCL. Objectives: To classify PCNS-DLBCL into COO-subtypes based on immunohistochemical algorithms by Hans and Choi and evaluate concordance between the two. A further aim is to investigate the clinicoradiological and histomorphological parameters of the subtypes thus obtained. Materials and Methods: As many as 143 cases of primary CNS lymphoma were evaluated by immunohistochemistry for CD10, BCL6, MUM1, GCET, and FOXP1 and based on which the said 143 cases were further classified into COO subtypes using Hans and Choi algorithms. Results: Mean age was 53.8 years with marginal male preponderance and predominantly centroblastic morphology (75.5%). CD 10 was positive in 8.9% of the cases, BCL6 in 58.6%, MUM1 in 89.9%, GCET in 32.9%, and FOXP1 in 79.5%. As much as 84.9% cases were of non-germinal center B-cell (GCB) subtype and 15.1% cases were of GCB subtype as determined based on Hans algorithm. Furthermore, 90.7% cases were of activated B-cell (ABC) subtype and 9.3% cases were of GCB subtype according to Choi algorithm. A 91.8% concordance was observed between Hans and Choi algorithms. Among the 6 discordant cases, 5 cases were subtyped as GCB by Hans and ABC by Choi and 1 case as ABC by Hans and GCB by Choi. Conclusion: Most of PCNS-DLBCLs are of non-GCB/ABC COO subtype, but inconsistences abound in the utility of IHC algorithms in PCNS-DLBCL COO subtypes.

The 2021 World Health Organization classification of gliomas: an imaging approach / Nova classificação das neoplasias gliais segundo a Organização Mundial da Saúde 2021, com enfoque radiológico

Abstract The purpose of this pictorial essay is to describe the recommendations of the 2021 World Health Organization classification for adult-type and pediatric-type gliomas and to discuss the main modifications in relation to the previous (2016) classification, exemplified by imaging, histological, and molecular findings in nine patients followed at our institutions. In recent years, molecular biomarkers have gained importance in the diagnosis and classification of gliomas, mainly because they have been shown to correlate with the biological behavior and prognosis of such tumors. It is important for neuroradiologists to familiarize themselves with this new classification of central nervous system tumors, so that they can use this knowledge in evaluating and reporting the imaging examinations of patients with glioma.

Resumo O propósito deste ensaio iconográfico é descrever e discutir as novas recomendações da Organização Mundial da Saúde de 2021, referente aos gliomas dos tipos adulto e infantil, e suas principais diferenças com a classificação anterior (2016), exemplificadas com imagens de nove casos de pacientes atendidos nas nossas instituições. Recentemente, há uma crescente significância dos marcadores moleculares no diagnóstico e classificação dos gliomas e tumores do sistema nervoso central, principalmente pela correlação com o comportamento biológico e o prognóstico. É importante que os neurorradiologistas estejam familiarizados com a nova classificação dos tumores do sistema nervoso central para a prática clínica, na avaliação e emissão de laudos e opiniões nas imagens dos pacientes com gliomas.

Vasculitis del sistema nervioso central

La vasculitis primaria del Sistema Nervioso Central (VPSNC) se refiere a un grupo de enfermedades que resultan de la inflamación y destrucción de los vasos sanguíneos de la médula espinal, encéfalo y meninges, tanto en el sector venoso como arterial, esto puede conducir a la oclusión o formación de aneurismas, con las consiguientes alteraciones isquémico-hemorrágicas.1 La presentación es heterogénea y poco sistematizable. El diagnóstico se establece con un cuadro clínico compatible, una angiografía o biopsia del parénquima encefálico y/o meninges que evidencien vasculitis. Presentamos el caso de un paciente portador de retrovirus con probable VPSNC con clínica compatible, hallazgos imagenológicos sugestivos, con escasa alteración de LCR y EEG.2

Primary vasculitis of the Central Nervous System (VPSNC) refers to a group of diseases that result from inflammation and destruction of the blood vessels of the spinal cord, brain and meninges, both in the venous and arterial sector, this can lead to the occlusion or formation of aneurysms, with the consequent ischemic-hemorrhagic alterations.1 The presentation is heterogeneous and little systematizable. The diagnosis is established with a compatible clinical picture, an angiography or biopsy of the brain parenchyma and/or meninges that show vasculitis. We present the case of a patient with a retrovirus with probable NCPSV with compatible symptoms, suggestive imaging findings, with little CSF and EEG alteration.2

Transición en las enfermedades crónicas gastrointestinales. Del cuidado pediátrico al del adulto / Transition in chronic gastrointestinal diseases. From pediatric to adult care

Los avances tecnológicos y del conocimiento hicieron que un mayor número de pacientes con enfermedad crónica gastrointestinal pasen de ser atendidos por el pediatra al control por los médicos de adultos durante una de las etapas más vulnerables de la vida: la adolescencia. El Grupo de Trabajo de Transición del Comité de Gastroenterología de la Sociedad Argentina de Pediatría realizó una búsqueda de literatura exhaustiva y convocó a especialistas referentes del país, con el objeto de unificar los criterios basados en la evidencia y la experiencia. De esta manera, se proponen una serie de recomendaciones para todo el equipo de salud (pediatra, gastroenterólogo infantil, nutricionista, gastroenterólogo de adultos, psicólogo, enfermería), incluso para pacientes y familias, que faciliten el proceso de transición y optimicen el seguimiento, el control, la prevención de complicaciones y la calidad de vida de los pacientes con enfermedades crónicas gastrointestinales

Technological advances and the globalization of knowledge have led to a considerable increase in the number of patients with chronic gastrointestinal disease who transition from pediatric to adult care during one of the most vulnerable life stages: adolescence. The Transition Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría conducted an exhaustive literature search and summoned leading specialists in the most frequent chronic pathologies from all over the country to unify criteria based on evidence and experience. As a result, a series of recommendations are proposed for the whole health team (pediatrician, pediatric gastroenterologist, nutritionist, adult gastroenterologist, psychologist, and nurse) including patients and families, to facilitate the transition process, optimize follow-up, prevent complications, and improve the quality of life of patients with chronic gastrointestinal diseases.

Cerebellar ataxia after a single day of metronidazole use: Case report

Cerebellar ataxic syndromes, although uncommon, have been reported previously in patients taking metronidazole. However, almost all cases describe instances where patients were taking prolonged or high doses of the drug. We report a 65-year-old man who consumed 400 mg of metronidazole 3 times over 1 day and presented with slurring of speech, imbalance while walking and diplopia. The symptoms developed the day after consumption of metronidazole. Examination showed slurring of speech, gaze-evoked nystagmus, and dysmetria in all limbs. MRI brain revealed symmetric hyperintense lesions in the dentate nucleus and pons on T2-weighted imaging and FLAIR, which have a well-established association with metronidazole-induced central nervous system (CNS) toxicity. On discontinuation of the drug, symptoms improved, and complete recovery was noted at follow-up 2 weeks later. This case indicates that CNS side effects of metronidazole may not necessarily occur only at high doses or after prolonged courses of metronidazole, but may occur as an idiosyncratic reaction to the drug. Reasons for variable susceptibility require further investigation.

Study of Central Nervous System Malformations of Perinatal Autopsies

Background: Congenital malformations remain a common cause of perinatal deaths accounting for 10-15% in developing countries like India. They are the most severe disorders of the central nervous system. Although antenatal screening for congenital anomalies has been improved over the years, fetal autopsy remains the gold standard for the iden?fica?on and confirma?on of congenital malforma?ons. The present study emphasizes the importance of perinatal autopsy for understanding the cause of death and also conforma?on of the antenatal diagnosis of the spectrum of various congenital CNS malforma?ons. Methods: We studied 644 perinatal autopsies conducted in our hospital. The dura?on of the study was 5 years, from 1st August 2015 to 31st July 2020 that included all perinatal autopsies with gesta?onal age of 22 weeks to less than 7 days. Results: Out of 644 perinatal autopsies 125 cases (19.4%) had congenital anomalies, of which 62 cases (9.6%) showed CNS malforma?ons. The most common CNS anomalies encountered were anencephaly 14 cases (22.6%) followed by 10 cases (16.1%) each of spina bifida and meningocele, and 8 cases (12.9%) of meningomyelocele. In the present study, 6 (9.7%) cases of CNS malforma?ons were associated with known syndromes namely Edward syndrome, Potter’s syndrome, and KlippelFeil syndrome. Along with CNS in 21 (33.9%) cases we observed associated malforma?ons of other systems with 7 cases involving the musculoskeletal system, 3 cases involving the genitourinary system, and 5 (8.1%) cases showing mul?system involvement. Conclusion: Antenatal screening for congenital anomalies has been improved over the years. Even then fetal autopsy remains the gold standard for the iden?fica?on and confirma?on of congenital malforma?ons. Understanding this gives valuable informa?on that can be further helpful in the gene?c counseling of the parents.

Plasma exchange in inflammatory demyelinating disorders of the central nervous system: reasonable use in the clinical practice / Plasmaférese em doenças inflamatórias desmielinizantes do sistema nervoso central: uso coerente na prática clínica

Abstract Plasma exchange (PLEX) is a therapeutic apheresis modality in which the plasma is separated from inflammatory factors such as circulating autoreactive immunoglobulins, the complement system, and cytokines, and its therapeutic effect is based on the removal of these mediators of pathological processes. Plasma exchange is well established for various neurological disorders, and it is applied successfully in central nervous system inflammatory demyelinating diseases (CNS-IDD). It mainly modulates the humoral immune system; thus, it has a greater theoretical effect in diseases with prominent humoral mechanisms, such as neuromyelitis optica (NMO). However, it also has a proven therapeutic effect in multiple sclerosis (MS) attacks. Several studies have suggested that patients with severe attacks of CNS-IDD have poor response to steroid therapy but show clinical improvement after the PLEX treatment. Currently, PLEX is generally established only as a rescue therapy for steroid unresponsive relapses. However, there are still research gaps in the literature regarding plasma volume, number of sessions, and how early the apheresis treatment needs to started. Thus, in the present article, we summarize the clinical studies and meta-analyses, especially about MS and NMO, outlining clinical data regarding the experience with therapeutic PLEX in severe attacks of CNS-IDD, the clinical improvement rates, the prognostic factors of a favorable response, and highlighting the likely role of the early apheresis treatment. Further, we have gathered this evidence and suggested a protocol for the treatment of CNS-IDD with PLEX in the routine clinical practice.

Resumo Plasmaférese (PLEX) é um procedimento em que o plasma é separado de fatores inflamatórios como imunoglobulinas autorreativas circulantes, sistema complemento e citocinas, e seu efeito terapêutico se baseia na remoção desses mediadores de processos patológicos. A PLEX está bem estabelecida no tratamento de diversos distúrbios neurológicos, e é utilizada com sucesso em surtos de doenças desmielinizantes inflamatórias do sistema nervoso central (CNS-IDD). A PLEX modula principalmente o sistema imunológico humoral; assim, tem efeito teórico maior em doenças com mecanismos patológicos humorais proeminentes, como a neuromielite óptica (NMO). No entanto tem também efeito terapêutico comprovado em surtos de esclerose múltipla (EM). Estudos sugerem que a corticoterapia é pouco eficaz em pacientes com surtos graves de CNS-IDD, e que estes apresentam melhora clínica após o tratamento com PLEX. Atualmente, a PLEX está geralmente estabelecida apenas como terapia de resgate para surtos não responsivos a corticosteroides. No entanto, há lacunas na literatura sobre a quantidade de troca de volume plasmático, o número de sessões, e o tempo de início da aférese terapêutica. Dessa forma, resumimos neste artigo estudos clínicos e metanálises, especialmente sobre EM e NMO, e delineamos os dados clínicos sobre a experiência com o uso de PLEX em surtos graves de CNS-IDD, as taxas de melhora clínica, os fatores prognósticos para uma resposta favorável, e destacamos o provável papel do tratamento precoce nestes casos. Em um segundo momento, reunimos essas evidências em uma sugestão de protocolo de tratamento de CNS-IDD com PLEX na prática clínica rotineira.

Complicaciones neurológicas asociadas a la COVID-19. Hospital San Vicente de Paúl, 2021

Fundamento la COVID-19 es causada por el virus del SARS-Cov-2 y presenta una amplia sintomatología, tanto en su fase aguda como en su fase crónica. Entre los sistemas que afecta se encuentra el Nervioso, debido a su mecanismo neurotrópico. Objetivo determinar el riesgo de complicaciones neurológicas asociadas a la severidad de la COVID-19 en pacientes adultos. Métodos se realizó un estudio descriptivo y transversal, que incluyó a 143 pacientes positivos a COVID-19 atendidos en el Hospital San Vicente de Paúl, de Ibarra, Ecuador, durante el año de 2021. Se analizaron las complicaciones neurológicas y la severidad de la COVID-19. Como medida de asociación para dichas variables, se utilizó Test de Fisher (p = ≤ 0,05) y se realizó un análisis bivariado. Resultados el 54 % de los pacientes presentó complicaciones neurológicas del Sistema Nervioso Central, mientras que el 46 % fue del Sistema Nervioso Periférico; y fue la severidad leve-moderada la de mayor frecuencia (41 %), y la alteración auditiva la que mayor probabilidad estadística tuvo de presentarse (OR= 74,968; IC: 95 %). La tasa de letalidad en estos pacientes fue de 7,1 %; y en aquellos con complicaciones neurológicas, de 8,4 %. Conclusión las secuelas neurológicas con mayor probabilidad de presentarse fueron la alteración auditiva y la alteración del gusto, en pacientes con severidad leve y severidad grave, respectivamente; además de polineuropatía en pacientes con severidad crítica, la cual también se presentó en pacientes fallecidos.

Background COVID-19 is caused by the SARS-Cov-2 virus and presents a wide range of symptoms, both in its acute phase and in its chronic phase. Among the systems that it affects is the Nervous, due to its neurotropic mechanism. Objective to determine the risk of neurological complications associated with the COVID-19 severity in adult patients. Methods a descriptive and cross-sectional study was carried out, which included 143 positive patients for COVID-19 treated at the San Vicente de Paúl Hospital, in Ibarra, Ecuador, during 2021. Neurological complications and the severity of the COVID-19 disease were analyzed. As a measure of association for these variables, the Fisher Test was used (p = ≤ 0.05) and a bivariate analysis was performed. Results 54% of the patients presented neurological complications of the Central Nervous System, while 46% were of the Peripheral Nervous System; and mild-moderate severity was the most frequent (41%), and hearing impairment had the highest statistical probability of occurring (OR= 74.968; CI: 95%). The case fatality rate in these patients was 7.1%; and in those with neurological complications, 8.4%. Conclusion the neurological sequelae most likely to occur were hearing impairment and taste impairment, in patients with mild severity and serious severity, respectively; in addition to polyneuropathy in patients with critical severity, which also occurred in deceased patients.

Enfermedad de Rosai-Dorfman intracraneal: un infrecuente diagnóstico diferencial del meningioma. Reporte de un caso ilustrativo

La Enfermedad de Rosai-Dorfman es un trastorno infrecuente y de etiología desconocida. La presentación intracraneal es aún más rara y suele imitar la apariencia de un meningioma en las imágenes del encéfalo. Se presenta el caso de un paciente varón de 38 años que ingresa por una tumoración intracraneal, extra-axial y supratentorial asociada a déficit neurológico leve; con diagnóstico presuntivo de meningioma de la convexidad. Después de la intervención quirúrgica, el diagnóstico histológico definitivo fue de Enfermedad de Rosai-Dorfman intracraneal. Se debe considerar la Enfermedad de Rosai-Dorfman intracraneal dentro del diagnóstico diferencial de una lesión intracraneal extra-axial sugestiva de un meningioma debido a la similitud en las neuroimágenes y la presentación clínica entre ambas patologías.

Rosai-Dorfman disease is an infrequent condition with no known etiology. The intracranial presentation is even rarer, and it resembles the appearance of a meningioma in image studies. We present the case of a 38-year-old male patient who was admitted because of an extra-axial supratentorial cranial tumor, associated to mild neurological deficit. The presumptive diagnosis was convexity meningioma. After surgery, the definitive histologic diagnosis was intracranial Rosai-Dorfman disease. This condition should be considered in the differential diagnosis of an extra-axial intracranial lesion suggesting meningioma, because of similar neuroimaging results and the similar clinical picture.

Seis casos consecutivos de sarcoma intracraneal primario en niños en dos instituciones privadas de Lima durante la pandemia del COVID-19

Objetivo: El presente artículo describe las características clínicas e imagenológicas de seis pacientes en edad pediátrica con diagnóstico de tumor cerebral atendidos en dos instituciones privadas de Lima durante la pandemia del COVID-19. Material y métodos: Estudio descriptivo de casos de tumor cerebral en pacientes menores de 18 años, atendidos en dos clínicas privadas de Lima, desde marzo 2020 a diciembre 2021. Resultados: Seis casos consecutivos de tumores intracraneales fueron detectados durante la mayor parte del primer año de la pandemia COVID-19 (periodo de octubre del 2020 a marzo del 2021), todos ellos con el diagnóstico de sarcoma intracraneal primario. Antes de la pandemia, el último sarcoma intracraneal primario en niños operado en las instituciones mencionadas ocurrió en junio del 2018 y fue el único caso de este tipo de tumor en el año. Conclusiones: Durante la pandemia de COVID-19, se encontró una inusual frecuencia de sarcoma intracraneal primario en niños en dos instituciones privadas de Lima.

SUMMARY Objective: The article describes the clinical and neuroimaging characteristics of six children with the diagnosis of brain tumor attended in two private institutions from Lima, during the COVID-19 pandemic. Material and methods: Descriptive study of cases of brain tumor in patients aged 18 and younger, followed at two private institutions in in Lima, from March 2020 to December 2021. Results: Six consecutive cases of intracranial tumors were detected during a large part of the COVID-19 pandemic's first year (October 2020 to March 2021), all of them with diagnosis of primary intracranial sarcoma. Before the pandemic, the last primary intracranial sarcoma in children, operated in the mentioned institutions, occurred in June 2018 and was the only case that year. Conclusions: During the COVID-19 pandemic, an unusual frequency of primary intracranial sarcoma in children was found in two private institutions from Lima.

Application of cellular metabolomics in central nervous system diseases / 药学实践杂志

Cell metabolomics is an important branch of metabolomics, which could dynamically monitor cell response and metabolic changes after drugs acting on cells, and look for potential biomarkers. Cell metabolomics has been widely used in illustration of disease mechanism, evaluation of drug efficacy and development of new drug through elucidating the pathophysiological mechanism of the disease and the effect of drug treatment intervention. The researches process of cellular metabolomics and its application in central nervous system diseases were reviewed in order to provide theoretical basis for in-depth study of the pathogenesis and prevention and treatment of central nervous system diseases.

Association Between Ferroptosis and Central Nervous System Diseases and A Review of Traditional Chinese Medicine Intervention / 中国实验方剂学杂志

Central nervous system （CNS） is a sophisticated system subject to complex regulation， which dominates the high-level neural activities of the human body. Due to its complex physiological structure and refined regulatory mechanism covering a variety of diseases， CNS is the place where many chronic， refractory and rare diseases occur. Nerve cell is the basic unit of CNS， and its dysfunction and death is the root cause of CNS diseases. Ferroptosis is a new form of programmed cell death proposed in recent years， and has been proved to be closely related to the production and development of multiple CNS diseases. Traditional Chinese medicine （TCM）， including Chinese herbs， acupuncture and moxibustion， and massage， has shown unique advantages in the treatment of CNS diseases for a long time. A large number of studies have demonstrated that TCM participates in the regulation of CNS diseases via regulating ferroptosis and shows a good research prospect. This paper summarized the characteristics of ferroptosis and discussed the association between ferroptosis and CNS diseases in pathological mechanism. We also reviewed the regulation of various CNS diseases by different TCM interventions through ferroptosis， providing references for TCM to participate in the treatment of CNS diseases properly in the future.

Replication of Rocio virus in primary cultures of mouse neural cells

ABSTRACT Objective This study verified the replication efficiency of the Rocio virus in a primary culture of mouse neural cells. Methods Mixed primary cultures (neurons/glia) obtained from the brains of newborn isogenic BALB/c mice were inoculated with Rocio virus on the 7 th day of culture, and the development of cytopathogenic effects was monitored. The infection was confirmed via immunocytochemistry (anti-ROCV), while viral replication was quantified in infected primary cultures. The titration method used depended on the infection period. Results Rocio virus efficiently infected primary cultured neural cells, with the highest viral titer causing cytopathic changes was observed at 2 days post infection. The virus-infected primary culture survived for up to 7 days post infection, and viral load quantitation showed viral replication kinetics compatible with the cell death kinetics of cultures. Conclusion The findings of this study suggest that mouse neural cell primary cultures support Rocio virus replication and could be used as an alternative system for studying Flavivirus infection in the central nervous system.

Efeitos da cafeína no organismo humano / Effects of caffeine on the human body / Efectos de la cafeina en el cuerpo humano

A cafeína é uma substância presente em diversas bebidas e suplementos, que sua forma mais comum de ingestão é através do café. Devido a ampla procura pela substância e sua larga distribuição mundial, este trabalho apresenta uma revisão de literatura sobre a cafeína e seus efeitos no organismo humano. Ao longo do tempo, a cafeína teve seu consumo aumentado em diversas faixas etárias, além de estar presente em diferentes produtos. A ingestão da cafeína pode estimular a concentração e melhorar o desempenho físico, devido ao seu efeito estimulante do sistema nervoso central. O uso em suplementos está envolvido nos seus efeitos termogênicos, auxiliando no processo de lipólise e melhorando o rendimento nas atividades físicas. O consumo da cafeína é associado ainda com a redução do LDL-colesterol, porém, os efeitos sobre o colesterol plasmático ainda são controversos. Todavia, o uso excessivo da cafeína pode trazer malefícios ao sistema cardiovascular como a diminuição da frequência e pressão cardíaca, dilatação de vasos e redução da temperatura corporal. A sua ingestão quando associada a bebidas alcoólicas pode ocultar a sensação depressiva do álcool, podendo elevar as chances de intoxicação. Na gestação aconselha-se o uso limitado, pois não há estudos conclusivos sobre os efeitos da cafeína para o feto. A relação risco e benefício deve sempre ser avaliada de acordo com cada indivíduo, sendo o aconselhamento e acompanhamento do consumo da cafeína realizado por um profissional de saúde habilitado, como o farmacêutico, para assim se reduzir possíveis prejuízos que a cafeína pode trazer à saúde.

Caffeine is a substance present in several drinks and supplements, which its most common form of intake is through coffee. Due to the broad demand for the substance and its wide distribution worldwide, this work presents a literature review on caffeine and its effects on the human organism. Over time, caffeine has increased its consumption in several age groups, in addition to being present in different products. The intake of caffeine can stimulate concentration and improve physical performance, due to its central nervous system stimulating effect. The use in supplements is involved in its thermogenic effects, assisting in the process of lipolysis and improving the performance in physical activities. The consumption of caffeine is also associated with the reduction of LDL-cholesterol, but the effects on plasma cholesterol are still controversial. However, excessive use of caffeine can cause harm to the cardiovascular system, such as decreased heart rate and pressure, vessel dilation, and reduced body temperature. Ingestion of alcohol in association with alcohol may mask the depressive sensation of alcohol and may increase the chances of intoxication. In pregnancy, limited use is advised, as there are no conclusive studies on the effects of caffeine on the fetus. The risk-benefit ratio should always be evaluated according to each individual, and the advice and follow-up of caffeine consumption is carried out by a qualified health care professional, such as the pharmacist, in order to reduce possible damage that caffeine can bring to health.

la cafeína es una sustancia presente en varias bebidas y suplementos, que es la forma más común de ingestión a través del café. Debido a la amplia demanda de la sustancia y su amplia distribución a nivel mundial, este estudio presenta una revisión de la literatura sobre cafeína y sus efectos en el organismo humano. Con el tiempo, la cafeína aumentó su consumo en varios grupos de edad, además de estar presente en diferentes productos. La ingesta de cafeína puede estimular la concentración y mejorar el rendimiento físico debido a su efecto estimulante sobre el sistema nervioso central. El uso en suplementos participa en sus efectos termogénicos, ayudando al proceso de lipolisis y mejorando el rendimiento en actividades físicas. El consumo de cafeína también está asociado con la reducción del colesterol LDL, pero los efectos sobre el colesterol plasmático siguen siendo polémicos. Sin embargo, el uso excesivo de cafeína puede dañar el sistema cardiovascular, como una reducción de la frecuencia y la presión cardiaca, la dilatación de los vasos y una reducción de la temperatura corporal. La deglución combinada con alcohol puede enmascarar la sensación deprimida de alcohol y puede aumentar la posibilidad de intoxicación. En el embarazo se aconseja un uso limitado, ya que no hay estudios concluyentes sobre los efectos de la cafeína sobre el feto. La relación riesgo-beneficio debe evaluarse siempre de acuerdo con cada individuo, con el asesoramiento y el control del consumo de cafeína por parte de un profesional sanitario autorizado, como el farmacéutico, a fin de reducir el posible daño que la cafeína puede causar a la salud.

Can high pain intensity and catastrophizing interfere with the cognitive performance of women with chronic pain related TMD? A cross-sectional study

Abstract Interventions based on pain education and self-management are dependent on factors such as attention, memory, concentration, and executive function. Objective To explore the relationship between cognitive performance and the variables pain intensity, central sensitization, catastrophizing, and hypervigilance in women diagnosed with chronic pain-related TMD. Methodology This is a cross-sectional study. A total of 33 women (mean age: 38±4.6 years; range: 18 to 66 years) with chronic pain-related TMD (myalgia and/or arthralgia) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Specific questionnaires were used to evaluate cognitive performance, overall pain intensity, central sensitization, hypervigilance, and pain catastrophizing. The data were analyzed using Pearson's correlation coefficient and backward stepwise multiple linear regression (statistical significance at 5% alpha). Results Approximately 53% of the study sample showed decreased cognitive performance. High central sensitization, hypervigilance, and pain catastrophizing were observed. A significant negative correlation was observed between cognitive performance and hypervigilance (p=.003, r=−.49), cognitive performance and catastrophizing (p<.001, r=−.58), and cognitive performance and pain intensity (p<.001, r=−.58). Regarding the partial regression coefficients, only catastrophizing and pain intensity showed statistical significance (t=−2.12, p=.043; t=−2.64, p=.014, respectively), indicating a significant role in explaining cognitive performance at the sample. Conclusion High pain intensity and the presence of catastrophic thoughts regarding pain can predict impaired cognitive performance in women with chronic pain-related TMD. Management strategies addressing psychosocial dimensions such as reducing catastrophizing and ensuring complete understanding of the condition are important.

Comparative analysis between cytomorphology and flow cytometry methods in central nervous system infiltration assessment in oncohematological patients

ABSTRACT Introduction Oncohematological patients require the evaluation for possible infiltration of the central nervous system (CNS) by neoplastic cells at diagnosis and/or during the monitoring of the chemotherapeutic treatment. Morphological analysis using conventional microscopy is considered the method of choice to evaluate the cerebrospinal fluid (CSF) samples, despite technical limitations. Objective This study aimed to compare the performance of the cytomorphology and flow cytometric immunophenotyping (FC) in the detection of CNS infiltration. Method We evaluated 520 CSF samples collected from 287 oncohematological patients for whom the detection of neoplastic cells was simultaneously requested by cytomorphology and FC. Results Laboratory analyses revealed 435/520 (83.7%) conclusive results by the two methods evaluated, among which 385 (88.5%) were concordant. Discordance between the methods was observed in 50/435 (11.5%) samples, 45 (90%) being positive by FC. Furthermore, the FC defined the results in 69/72 (95.8%) inconclusive samples by cytomorphology. The positivity of FC was particularly higher among hypocellular samples. Among 431 samples with a cell count of < 5/μL, the FC identified neoplastic cells in 75 (17.4%), while the cytomorphology reported positive results in 26 (6%). Among the samples that presented adequate cell recovery for evaluation by both methods (506/520), the comparative analysis between FC and cytomorphology revealed a Kappa coefficient of 0.45 (CI: 0.37-0.52), interpreted as a moderate agreement. Conclusion The data showed that the CSF analysis by FC helps in the definition of CNS infiltration by neoplastic cells, particularly in the cases with dubious morphological analysis or in the evaluation of samples with low cellularity.

Síndrome de Dandy-Walker. Presentación de un caso y revisión de la literatura

El síndrome de Dandy-Walker se asocia con dilatación quística del cuarto ventrículo, diversos grados de alteración del vérnix cerebeloso e hidrocefalia supratentorial. Se basa principalmente en un desarrollo anormal de las vías de comunicación del líquido cefalorraquídeo. Se ha sugerido predisposición genética asociada a malformaciones y alteraciones cromosómicas. El diagnóstico se puede llevar a cabo durante la etapa prenatal o posnatal, de forma clínica y estudios de diagnóstico por imagen. Se presenta el caso de una recién nacida que ingresó en la Unidad de Cuidados Intensivos Neonatales por presentar hipotonía, protrusión de la lengua con trastornos de la succión. Se le realizó ultrasonido transfontanelar, con dilatación de ventrículos laterales. Se apreció además de la dilatación de los ventrículos laterales, quiste en el plexo coroideo y signos de atrofia cerebral. Fue diagnosticada con el síndrome de Dandy-Walker, sin criterio quirúrgico, por no presentar signos de hidrocefalia. Se presenta el caso porque es una malformación poco frecuente del sistema nervioso central.

Dandy-Walker syndrome is associated with cystic dilatation of the fourth ventricle, varying degrees of abnormality of the cerebellar vermix, and supratentorial hydrocephalus. It is mainly based on an abnormal development of the cerebrospinal fluid communication pathways. Genetic predisposition associated with malformations and chromosomal alterations has been suggested. The diagnosis can be carried out during the prenatal or postnatal stage, clinically and diagnostic imaging studies. We present the case of a newborn who was admitted to the Neonatal Intensive Care Unit due to hypotonic, tongue protrusion with sucking disorders. A transfontanellar ultrasound was performed, with dilation of the lateral ventricles. In addition to the dilation of the lateral ventricles, a cyst in the choroid plexus and signs of brain atrophy were observed. She was diagnosed with Dandy-Walker syndrome, without surgical criteria because she did not present signs of hydrocephalus. The case is presented because it is a rare malformation of the central nervous system.

Síndrome de Baller-Gerold. A propósito de un caso clínico y revisión de la literatura

El síndrome de Baller-Gerold es secundario a mutaciones en el gen RECQL4 (8q24.3). Este gen pertenece a la familia de las RecQhelicasas y está implicado en otras enfermedades de predisposición al cáncer. El diagnóstico se basa en criterios clínicos y debido al elevado número de diagnósticos diferenciales, encontrar una mutación en el gen puede ayudar a precisar el espectro diagnóstico, el consejo genético y su tratamiento. Se han descrito en la literatura alrededor de 30 casos, aunque se sabe que se ha presentado en menos de 200 000 personas en el mundo, por lo que se considera, una condición clínica rara. Se presenta el caso de una paciente que desde su nacimiento se constataron múltiples malformaciones músculo-esqueléticas: aplasia radial, pulgares aplásicos, malformaciones de la parrilla costal, clinodactilia de todos los dedos de miembros superiores, antebrazos hipoplásicos, clinodactilia del miembro inferior izquierdo. Se le realizó alimentación parenteral por varios días, fue imposible establecer vía oral adecuada por ausencia y/o incoordinación de los reflejos de succión-deglución como expresión de sus malformaciones a nivel de sistema nervioso central. Se presenta el caso por su baja incidencia y prevalencia por lo que es considerada una enfermedad rara.

Baller-Gerold syndrome is secondary to mutations in the RECQL4 gene (8q24.3). This gene belongs to the RecQhelicase family and is implicated in other diseases predisposing to cancer. Diagnosis is based on clinical criteria and due to the high number of differential diagnoses, finding a mutation in the gene can help to specify the diagnostic spectrum, genetic counseling and treatment. Around 30 cases have been described in the literature, although it is known that it has occurred in less than 200,000 people in the world, being considered a rare clinical condition. We present the case of a newborn, who at birth was found to have multiple musculoskeletal malformations: radial aplasia, aplastic thumbs, malformations of the rib cage, clinodactyly of all the fingers of the upper limbs, hypoplastic forearms, clinodactyly of the left lower limb. She was given parenteral feeding for several days, it was impossible to establish an adequate oral route due to the absence and/or incoordination of the sucking-swallowing reflexes as an expression of her malformations at the central nervous system level. The case is presented due to its low incidence and prevalence, which is why it is considered a rare disease.

Apuntes actualizados sobre la neurocisticercosis

Introducción: La neurocisticercosis es una infección parasitaria prevenible, producida por los quistes larvarios de la Taenia solium (solitaria), que pueden infectar cualquier parte del cuerpo, en este caso, el cerebro, siendo la forma más grave de la enfermedad y en ocasiones puede ocasionar convulsiones e incluso llegar a ser mortal. Objetivo: Sistematizar la información acerca de esta patología. Método: Se realizó una búsqueda bibliográfica actualizada en bases de datos como PubMed, Google Scholar, Medline, Web of Science, Cochrane Library y ClinicalKey, así como en revistas de alto impacto en SciELO, Scopus, complementada la información con revisiones sistemáticas, estudios clínicos aleatorizados y enfoques de metaanálisis, en los cuales se indagaron palabras claves para facilitar la búsqueda como: "Neurocisticercosis", "Fisiopatología", "etiología", "manifestaciones clínicas", "prevalencia", "morbimortalidad", "diagnostico", "tratamiento". Desarrollo: La investigación permitió reconocer el arduo trabajo que se precisa en el diagnóstico de esta enfermedad, debido a la dificultad que requiere su tipificación Se destacó la importancia de los estudios de neuroimagen como herramientas para calificar la gravedad de la neurocisticercosis y, de esta manera, escoger el tratamiento adecuado. Se desarrollaron acápites de: epidemiología, etiopatogenia, ciclo de vida, manifestaciones clínicas, clasificación, estadio evolutivo de las lesiones, diagnóstico, criterios diagnósticos, y tratamiento. Conclusiones: Ecuador es considerado como un país endémico para la Taenia solium. Implementar la prevención debe ser un pilar fundamental del ministerio de salud debido a la persistencia de los factores de riesgo para la infección de este parásito y el conjunto de aspectos asociados a la precaria calidad de vida en muchos sitios del país.

Introduction: Neurocysticercosis is a preventable parasitic infection caused by larval cysts of Taenia solium (tapeworm), which can infect any part of the body, including the brain and is the most severe form of the disease, sometimes lead to seizures and even be fatal. Objective: To synthesize information concerning this pathology. Method: An updated bibliographic search was carried out in databases such as PubMed, Google Scholar, Medline, Web of Science, Cochrane Library and ClinicalKey, as well as in high impact journals like SciELO, and Scopus. The information gathered was complemented with the use of systematic reviews, randomized clinical studies and meta-analysis approaches, in which to facilitate the search process various key words were used: "neurocysticercosis", "pathophysiology", "etiology", "clinical manifestations", "prevalence", "morbimortality", "diagnosis", and "treatment". Development: The research allowed the researchers to recognize the arduous work required for the diagnosis of this disease, assuming as well how difficult is to typify it. The importance of neuroimaging studies as tools to qualify the severity of neurocysticercosis and, thus, to choose the appropriate treatment was highlighted. The following sections were developed: epidemiology, etiopathogenesis, life cycle, clinical manifestations, classification, and evolution of lesions, diagnosis, diagnostic criteria, and treatment. Conclusions: Ecuador is considered an endemic country for Taeniasolium. The implementation of preventive actions should be regarded as a fundamental task of the Ministry of Health due to the permanent surrounding risk factors, which have an influence for getting infection and the set of aspects associated with the precarious quality of life in many parts of the country.

Introdução: A neurocisticercose é uma infecção parasitária evitável, produzida pelos cistos larvais da Taenia solium (tênia solium), que pode infectar qualquer parte do corpo, neste caso, o cérebro, sendo a forma mais grave da doença, podendo por vezes causar convulsões e podem até ser fatais. Objetivo: Sistematizar as informações sobre esta patologia. Método: Foi realizada busca bibliográfica atualizada em bases de dados como PubMed, Google Scholar, Medline, Web of Science, Cochrane Library e ClinicalKey, bem como em revistas de alto impacto no SciELO, Scopus, complementando as informações com revisões sistemáticas, análises clínicas estudos randomizados e abordagens de meta-análise, em que foram investigadas palavras-chave para facilitar a busca como: "Neurocisticercose", "Fisiopatologia", "etiologia", "manifestações clínicas", "prevalência", "morbidade e mortalidade", "diagnóstico" , "tratamento". Desenvolvimento: A pesquisa permitiu reconhecer o árduo trabalho que é exigido no diagnóstico desta doença, pela dificuldade que a sua tipificação exige, destacou-se a importância dos estudos de neuroimagem como ferramentas para qualificar a gravidade da neurocisticercose e, neste maneira, escolher o tratamento adequado. Foram desenvolvidas seções sobre: epidemiologia, etiopatogenia, ciclo de vida, manifestações clínicas, classificação, estágio evolutivo das lesões, diagnóstico, critérios diagnósticos e tratamento. Conclusões: O Equador é considerado um país endêmico para Taenia solium. A implementação da prevenção deve ser um pilar fundamental do Ministério da Saúde devido à persistência de fatores de risco para infecção por este parasita e ao conjunto de aspectos associados à precária qualidade de vida em muitas partes do país.