Interacción del tratamiento y el control de la presión en el deterioro de la memoria incidental visuoespacial en pacientes con hipertensión arterial sistémica / Pressure control and treatment interact in the deterioration of incidental visuospatial memory in hypertensive patients

Resumen Antecedentes: La hipertensión arterial sistémica (HAS) es el principal factor de riesgo para el deterioro cognitivo; por otro lado, la memoria visuoespacial es más vulnerable al envejecimiento. Algunos fármacos antihipertensivos tienen un efecto neuroprotector, pero tal efecto puede enmascararse o bien no manifestarse por comorbilidad o por falta de control efectivo de la presión arterial. Objetivo: Evaluar las alteraciones en la memoria visuoespacial incidental de pacientes con HAS en relación con su tratamiento antihipertensivo y su control de la presión. Método: Se incluyeron 80 pacientes con HAS (46 mujeres), agrupados por su medicación en bloqueadores de los receptores de la angiotensina II (BRA) o inhibidores de la enzima convertidora de angiotensina (IECA). Se realizó un análisis de correlaciones múltiples para los puntajes obtenidos en la prueba de memoria visuoespacial incidental/intencional y un análisis de modelos mixtos (factores fijos: tratamiento, control de la presión y comorbilidad con diabetes; factores aleatorios: edad, escolaridad, meses desde el diagnóstico de HAS y coeficiente intelectual). Resultados: De los pacientes controlados, la mayoría de los que recibían BRA fueron eficientes y los que recibían IECA fueron deficientes. De los que recibían IECA, los descontrolados hipertensos fueron más eficientes que los normotensos. La memoria visuoespacial se correlacionó negativamente con la presión sistólica a pesar de no haber diferencias en MoCA y Raven. Conclusiones: La eficiencia en la memoria visuoespacial dependió de la interacción del tratamiento y el control de la presión. Ambos factores, tratamiento y control efectivo de la presión, deben considerarse en la evaluación del deterioro cognitivo asociado a la HAS.

Abstract Background: Systemic hypertension (SH) is the main risk factor to cognitive deterioration, whereas visuospatial memory is more vulnerable to ageing. Some antihypertensive agents have a neuroprotector effect, however, such effects could be masked by comorbidities and/or the lack of effective control on the arterial pressure of patients. Objective: To assess this, the evaluation of incidental visuospatial memory of SH patients and the relation to the treatment received and the effective control of pressure were made. Method: 80 patients (46 woman) were included grouped by the received medication: angiotensin 2 receptor blockers (ARB) or angiotensin converting enzyme inhibitors (ACEI). A multiple correlation analysis between visuospatial scores and clinical variables was made; also, a mixed model analysis (fixed factors: treatment, pressure control, diabetes comorbidity; aleatory factors: age, schooling, months from SH diagnoses). Results: Half of the patients had a controlled pressure, from them the higher proportion received ARB, and a minor number of patients received ACEI. The normotensive patients receiving ACEI were inefficient whereas the hypertensive patients were more efficient. The systolic pressure was negatively related with the visuospatial scores in spite of no correlations occurred with MoCA and Raven tests. Conclusions: The visuospatial incidental/intentional scores were negatively correlated with systolic pressure. The efficiency in the visuospatial ability depends on the interaction of treatment and effective control of blood pressure. The interaction between treatment and effective pressure control must be taken in count when cognitive deterioration is studied.

Mechanism of Relaxant Action of Ethyl 6-amino-5-cyano-2-methyl- 4-(pyridin-4-yl)-4H-pyran-3-carboxylate Mainly Through Calcium Channel Blockade in Isolated Rat Trachea.

This study aims to investigate the mechanism of relaxant action of Ethyl 6-amino-5-cyano-2-methyl-4-(pyridin- 4-yl)- 4H-pyran-3-carboxylate (1) in in silico study and ex vivo tracheal rat rings pre-contracted with carbachol (1 µM). Compound 1 was more active than theophylline [a phosphodiesterases (PDE’s) inhibitor] used as positive control. Moreover, pretreatment with 1 significantly shifted to the right the carbachol-induced contraction and did not allow to reach the maximum effect (p< 0.001). In addition, compound 1 (96.30 µM) produces significant (100%) relaxant effect on the contraction induced by KCl (80mM), and the CaCl2-induced contraction was completely abolished by 1 as nifedipine does (a L-type calcium channel blocker), used as positive control (p< 0.001). Meanwhile, in the presence of isoproterenol (a β-adrenergic agonist), propranolol (a β-adrenergic antagonist), and K+ channel blocker 2-AP the relaxant curve was significantly modified (p< 0.05). Compound 1 was docked on an outer cavity located on the intracellular side of the human L-type calcium channel model and interacts in the following chains and residues: chain IP (G51, W52, T53, D54), IVP (R45, E50, A51, Q53, D54) and IS6 (W4, F7). In conclusion, ex vivo and in silico approaches suggest that compound 1 induces its relaxant effect mainly by calcium channel blockade, but other mechanisms like potassium channel and cAMP accumulation could be involved.

Cisticercosis intramedular / Intramedulary cistercosis

La cisticercosis es una entidad endémica en los países en vías de desarrollo, se conoce su incidencia dentro del sistema nervioso central y también la baja frecuencia en su variante espinal. El objetivo de esta correlación clínico radiológica es elevar el índice de sospecha diagnóstica de la neurocisticercosis. Se presenta el caso de una niña de 8 años de edad con cisticercosis intramedular con imágenes de resonancia magnética y cuadro clínico atípico, se revisa la literatura por medio de medline.