Switching from originator recombinant growth hormone (Genotropin™) to biosimilar (CRISCY™): Results from a 6-month, multicentric, non-inferiority, extension trial.

OBJECTIVE: A previous 12-month comparative trial with Criscy™ (r-hGH Cristália), a biosimilar recombinant growth hormone, demonstrated equivalent efficacy and safety to Genotropin™. This extension trial evaluated the effects of switching patients treated with Genotropin™ to the biosimilar Criscy™ over an additional 6-month treatment period, comparing efficacy, safety, and immunogenicity parameters with patients remaining in the Criscy™ arm. DESIGN: This extension study included 11 research centers and 81 patients who participated in the CERES study (Czepielewski et al., 2019 [1]). Participants from the Genotropin™ arm (n = 39) had the drug replaced by Criscy™ and the remaining participants were kept in the Criscy™ arm (n = 42) for an additional 6-month period to evaluate immunogenicity, efficacy (growth rate, height SDS), and safety (laboratory tests, and adverse events). RESULTS: Before the switch, both Criscy™ and Genotropin groups were similar concerning demographics, and auxological measures: age, sex, height, height SDS, weight, and BMI. Height velocity (HV) after 18 months of treatment was 8.7 ± 1.56 cm/year for Criscy™ group and 8.9 ± 1.36 cm/year for Genotropin™ group in the ITT population (p = 0.43). The auxological parameters and IGF-1 and IGFBP-3 SDS were comparable between both groups of patients. No participants were excluded from the study due to adverse events. There were no clinical or statistical relevant differences between the treatment groups concerning frequency, distribution, intensity, and AEs outcome. Similarly, no new anti-r-hGH (ADA) cases among patients that switched from Genotropin™ to Criscy™ were reported. No neutralizing antibody (nAb) was detected in either group. CONCLUSIONS: This trial showed that switching from originator recombinant human growth hormone to Criscy™ had no impact on efficacy, safety, nor immunogenicity as compared to continued treatment with Criscy™. Growth rates and ADA incidence remained the same as seen before the switch.

Mental health, migration stressors and suicidal ideation among Latino immigrants in Spain and the United States.

BACKGROUND: Immigration stress appears to augment the risk for suicide behaviors for Latinos. Yet, specific risk factors that contribute to suicidal ideation (SI) among diverse Latino immigrant populations are not well established. METHODS: Data were collected in Boston, Madrid and Barcelona using a screening battery assessing mental health, substance abuse risk, trauma exposure, demographics, and sociocultural factors. Prevalence rates of lifetime and 30-day SI were compared across sites. Logistic regression modeling was used to identify sociodemographic, clinical, and sociocultural-contextual factors associated with 30-day SI. RESULTS: Five hundred and sixty-seven Latino patients from primary care, behavioral health and HIV clinics and community agencies participated. Rates of lifetime SI ranged from 29-35%; rates for 30-day SI were 21-23%. Rates of SI were not statistically different between sites. Factors associated with SI included exposure to discrimination, lower ethnic identity, elevated family conflict, and low sense of belonging (P<0.01). In the adjusted model, higher scores on depression, posttraumatic stress disorder, and trauma exposure were significantly associated with 30-day SI (OR=1.14, 1.04, and 7.76, respectively). Greater number of years living in the host country was significantly associated with increased odds of having SI (OR=2.22) while having citizenship status was associated with lower odds (OR=0.45). CONCLUSION: Latinos suffering depression, trauma exposure, and immigration stressors are more likely to experience SI. Despite differences in country of origin, education, and other demographic factors between countries, rates of SI did not differ. Recommendations for prevention and clinical practice for addressing suicidal ideation risk among Latino immigrants are discussed.

Functional characterization of a novel ß-fructofuranosidase from Bifidobacterium longum subsp. infantis ATCC 15697 on structurally diverse fructans.

AIM: In this study, we describe the isolation of a gene encoding a novel ß-fructofuranosidase from Bifidobacterium longum subsp. infantis ATCC 15697, and the characterization of the enzyme, the second one found in this strain, significantly different in primary sequence to the already reported bifidobacterial ß-fructofuranosidases. METHODS AND RESULTS: The gene, found through genome-mining was expressed in Escherichia coli C41(DE3). The recombinant enzyme (B.longum_l1) has a molecular weight of 75 kDa, with optimal activity at 50°C, pH 6·0-6·5, and a remarkable stability with a half-life of 75·5 h at 50°C. B.longum_l1 has a wide specificity for fructans, hydrolysing all substrates through an exo-type mechanism, including Oligofructose P95 (ß2-1 fructooligosaccharides (FOS), DP 2-8), Raftilose Synergy 1(ß2-1 FOS & inulin, DP 2-60), Raftiline HP (inulin, DP 2-60), bacterial inulin (3000 kDa) and levan (8·3 & 3500 kDa), Agave fructans (mixed fructans, DP 3-29) and levan-type FOS (ß2-6 FOS, DP 2-8), with the highest relative activity and turnover number found for levan-type FOS. The apparent affinity of the enzyme for levan-type FOS and Oligofructose P95 was found to be 9·2 and 4·6 mmol l(-1) (Km ) with a specific activity of 908 and 725 µmol min(-1)  mg(-1) of protein (k2 ), respectively, more than twice the activity for sucrose. CONCLUSION: B.longum_l1 is a wide substrate specificity enzyme, which may contribute to the competitiveness and persistence of this strain in the colon. SIGNIFICANCE AND IMPACT OF THE STUDY: The bifidobacterial ß-fructofuranosidase activity was evaluated with a wide variety of substrates including noncommercial fructans, such as levan-type and mixed agave fructans. Its activity on these substrates certainly strengthens their commercial prebiotic character and contributes to the understanding of bifidobacteria stimulation by structurally diverse fructans.

Crisis gelásticas como forma de presentación de un infarto del giro cingulado / Gelastic seizures as the presenting symptom of infarction of the cingulate gyrus

Introducción. Las crisis gelásticas son crisis epilépticas poco frecuentes en las que la risa inapropiada es la manifestación principal. Su etiología es diversa. No hemos encontrado en la bibliografía ningún caso de risa patológica claramente epiléptica relacionada con ictus, aunque hay múltiples descripciones de risa patológica no epiléptica como síntoma prodrómico en pacientes con ictus (fou rire prodromique). Presentamos un caso de infarto del giro cingulado que cursó con crisis gelásticas al inicio y durante la evolución del proceso clínico. Caso clínico. Mujer de 81 años, que bruscamente presentó episodios de dificultad para la expresión verbal con desconexión del medio, acompañados de accesos de risa inmotivada e incontrolable de duración inferior a cinco minutos. Tras los episodios, tenía bajo nivel de consciencia. Coincidiendo con alguno de ellos, se observaron también movimientos involuntarios de los miembros superiores. La resonancia desveló la existencia de una lesión isquémica aguda del territorio del giro cingulado izquierdo y el electroencefalograma puso de manifiesto la existencia de actividad epileptógena frontal y temporal anterior izquierda. Conclusiones. El perfil clínico, los resultados de las exploraciones complementarias y la respuesta al tratamiento antiepiléptico permiten afirmar que los episodios descritos en esta paciente corresponden a crisis gelásticas relacionadas con una lesión isquémica aguda del giro cingulado izquierdo

Introduction. Gelastic seizures are infrequent epileptic seizures in which the main manifestation is inappropriate laughter. They have a variety of causations. A search of the literature did not reveal any cases of pathological laughter that was clearly related with strokes, although there a numerous reports of non-epileptic pathological laughter as a prodromal symptom in stroke patients (fou rire prodromique). We report the case of a patient with infarcted cingulate gyrus who progressed with gelastic seizures at onset and during the course of the clinical process. Case report. An 81-year-old female who suddenly presented bouts of difficulties in verbal expression with disconnection from the milieu that were accompanied by fits of unmotivated and uncontrollable laughter that lasted less than five minutes. Following the attacks, her level of consciousness had dropped. In some of the attacks there were also involuntary movements of the upper limbs. Resonance imaging revealed the existence of an acute ischaemic lesion in the left territory of the cingulate gyrus and an electroencephalogram revealed the existence of epileptogenic activity in the left-hand anterior temporal and frontal regions. Conclusions. The clinical profile, the results of the complementary examinations and the response to the antiepileptic treatment allow us to state that in the episode reported in this patient we are dealing with gelastic seizures related to an acute ischaemic lesion in the left cingulate gyrus

[Gelastic seizures as the presenting symptom of infarction of the cingulate gyrus]. / Crisis gelasticas como forma de presentacion de un infarto del giro cingulado.

INTRODUCTION: Gelastic seizures are infrequent epileptic seizures in which the main manifestation is inappropriate laughter. They have a variety of causations. A search of the literature did not reveal any cases of pathological laughter that was clearly related with strokes, although there a numerous reports of non-epileptic pathological laughter as a prodromal symptom in stroke patients (fou rire prodromique). We report the case of a patient with infarcted cingulate gyrus who progressed with gelastic seizures at onset and during the course of the clinical process. CASE REPORT: An 81-year-old female who suddenly presented bouts of difficulties in verbal expression with disconnection from the milieu that were accompanied by fits of unmotivated and uncontrollable laughter that lasted less than five minutes. Following the attacks, her level of consciousness had dropped. In some of the attacks there were also involuntary movements of the upper limbs. Resonance imaging revealed the existence of an acute ischaemic lesion in the left territory of the cingulate gyrus and an electroencephalogram revealed the existence of epileptogenic activity in the left-hand anterior temporal and frontal regions. CONCLUSIONS: The clinical profile, the results of the complementary examinations and the response to the antiepileptic treatment allow us to state that in the episode reported in this patient we are dealing with gelastic seizures related to an acute ischaemic lesion in the left cingulate gyrus.

TITLE: Crisis gelasticas como forma de presentacion de un infarto del giro cingulado.Introduccion. Las crisis gelasticas son crisis epilepticas poco frecuentes en las que la risa inapropiada es la manifestacion principal. Su etiologia es diversa. No hemos encontrado en la bibliografia ningun caso de risa patologica claramente epileptica relacionada con ictus, aunque hay multiples descripciones de risa patologica no epileptica como sintoma prodromico en pacientes con ictus (fou rire prodromique). Presentamos un caso de infarto del giro cingulado que curso con crisis gelasticas al inicio y durante la evolucion del proceso clinico. Caso clinico. Mujer de 81 años, que bruscamente presento episodios de dificultad para la expresion verbal con desconexion del medio, acompañados de accesos de risa inmotivada e incontrolable de duracion inferior a cinco minutos. Tras los episodios, tenia bajo nivel de consciencia. Coincidiendo con alguno de ellos, se observaron tambien movimientos involuntarios de los miembros superiores. La resonancia desvelo la existencia de una lesion isquemica aguda del territorio del giro cingulado izquierdo y el electroencefalograma puso de manifiesto la existencia de actividad epileptogena frontal y temporal anterior izquierda. Conclusiones. El perfil clinico, los resultados de las exploraciones complementarias y la respuesta al tratamiento antiepileptico permiten afirmar que los episodios descritos en esta paciente corresponden a crisis gelasticas relacionadas con una lesion isquemica aguda del giro cingulado izquierdo.

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The associations between socio-economic status and major depressive disorder among Blacks, Latinos, Asians and non-Hispanic Whites: findings from the Collaborative Psychiatric Epidemiology Studies.

BACKGROUND: This study examined whether there were associations between individual measures of socio-economic status (SES) and the 12-month prevalence of major depressive disorder (MDD) in representative samples of Blacks, Latinos, Asians and Whites in the USA. METHOD: The data used were from the Collaborative Psychiatric Epidemiology Studies (CPES). RESULTS: There was an association between household income and MDD among Whites. However, the association was not statistically significant. Statistically significant associations were present between educational attainment and MDD among Whites. Among both Whites and Latinos, being out of the labor force was significantly associated with MDD. In analyses by nativity, being out of the labor force was significantly associated with MDD among US-born and foreign-born Latinos. CONCLUSIONS: Significant associations between various measures of SES and MDD were consistently observed among White and, in some cases, Latino populations. Future studies should continue to examine sociopsychological factors related to SES that increase the risk of MDD among people from racial-ethnic communities.

Early treatment of multiple sclerosis: a Latin American experts meeting.

Patients with clinically isolated syndrome (CIS) by definition do not have multiple sclerosis (MS) but are at risk of developing it. While studies show earlier immunomodulating drug use is effective, treatment must consider likely patient prognosis. In this paper we review current diagnosis, prognosis, and treatment literature for patients with CIS within Latin American clinical settings. Latin American MS experts, convened by ACINDES (The Civil Association for Research and Development in Health), reviewed current CIS (and early MS) literature and drew consensus conclusions. Three subgroups addressed separate questionnaires on CIS issues: prognosis, diagnosis, and treatment. MRI can contribute to predicting MS risk in patients with CIS; in Latin America, investigation of haplotype presence associated with CIS would be appropriate. McDonald's criteria and subsequent revisions enable earlier, more accurate MS diagnosis. Type A evidence exists supporting all leading immunomodulating MS drugs for effective treatment of CIS with a high risk of conversion to MS. In conclusion, patients with CIS are usually young, with often-limited symptomatic manifestations, and must be adequately prepared to receive preventive treatment. This consensus review should contribute to the dialogue between physicians and patients.

[Gastric plasmacytoma as an uncommon cause of upper gastrointestinal bleeding]. / Plasmocitoma gástrico como causa infrecuente de hemorragia digestiva alta.

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma.

Plasmocitoma gástrico como causa infrecuente de hemorragia digestiva alta / Gastric plasmacytoma as an uncommon cause of upper gastrointestinal bleeding

El plasmocitoma gástrico es una forma rara de presentación de las gammapatías monoclonales, y puede ser una causa de hemorragia digestiva alta si se encuentra ulcerado. Suele ser localizado, pero puede evolucionar hacia un mieloma múltiple u otras formas de gammapatía monoclonal. El diagnóstico diferencial hay que hacerlo con otras gammapatías monoclonales, basándose en criterios analíticos e histológicos, y con otros tumores gástricos, como el adenocarcinoma, los tumores de la estroma gastrointestinal, los tumores neuroendocrinos y los linfomas. Para ello, nos podemos basar en las diferentes características radiológicas y endoscópicas, aunque, sin duda, el estudio histológico y las técnicas inmunohistoquímicas establecerán el diagnóstico definitivo. En esta observación clínica se describe el caso de un paciente que presentaba una hemorragia digestiva alta y una anemia ferropénica, con diagnóstico final de mieloma múltiple asociado a plasmocitoma gástrico

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma

[The neuropsychological profile of mild cognitive impairment with involvement of multiple cognitive areas. The importance of amnesia in distinguishing two subtypes of patients]. / Perfil neuropsicológico del deterioro cognitivo leve con afectación de múltiples áreas cognitivas. Importancia de la amnesia en la distinción de dos subtipos de pacientes.

INTRODUCTION: The use of diagnostic criteria for mild cognitive impairment (MCI) that do not require the presence of amnesia enables patients to be classified into three types of MCI: pure amnestic MCI (aMCI), MCI with involvement of multiple cognitive functions and amnesia (mf-aMCI) and MCI with involvement of multiple cognitive functions without amnesia, or non-amnestic MCI (mf-nonaMCI). AIM: To determine whether patients with MCI with involvement of multiple functions (mfMCI) have a different profile of cognitive involvement depending on whether amnesia is present or not. PATIENTS AND METHODS: Out of a total sample of 175 patients with MCI, we studied 138 with mfMCI. Of these, 109 (79%) had memory disorders (mf-aMCI) and 29 (21%) did not (mf-nonaMCI). For each group of patients, we determined the percentage who scored below normal in each of the items on the abbreviated Barcelona test. RESULTS: Patients with mf-aMCI failed more frequently in temporal orientation, naming and semantic category evocation tests. Patients with mf-nonaMCI failed more often in motor praxis and abstraction tests. Differences were statistically significant. Additionally, it was noted that patients with mf-nonaMCI tended to make more mistakes in attention tests. CONCLUSIONS: The presence of amnesia allows us to identify an mf-aMCI group with a cognitive profile suggesting temporal involvement, unlike the mf-nonaMCI group, whose members have a cognitive profile that suggests subcortical compromise.

Perfil neuropsicológico del deterioro cognitivo leve con afectación de múltiples áreas cognitivas. Importancia de la amnesia en la distinción de dos subtipos de pacientes / The neuropsychological profile of mild cognitive impairment with involvement of multiple cognitive areas. The importance of amnesia in distinguishing two subtypes of patients

Introducción. El uso de criterios diagnósticos de deterioro cognitivo leve (DCL) que no exigen la presencia de amnesia, permite clasificar a los pacientes en tres tipos de DCL: DCL amnésico puro (DCLa), DCL con afectación de múltiples funciones cognitivas y amnesia (DCLmf-A) y DCL con afectación de múltiples funciones cognitivas sin amnesia o DCL no amnésico (DCLmf-noA). Objetivo. Determinar si los pacientes con DCL con afectación de múltiples funciones (DCLmf) tienen un perfil de afectación cognitiva distinto en función de la presencia o no de amnesia. Pacientes y métodos. De un total de 175 pacientes con DCL, estudiamos a 138 con DCLmf. De ellos, 109 (79%) tenían afectación de la memoria (DCLmf-A) y 29 (21%) no la presentaban (DCLmf-noA). Para cada grupo determinamos el porcentaje de pacientes que tenían una puntuación inferior a la normal en cada uno de los elementos del test Barcelona abreviado. Resultados. Los pacientes con DCLmf-A fallaban con más frecuencia en los tests de orientación temporal, denominación y evocación categorial semántica. Los pacientes con DCLmf-noA fallaban más en las pruebas de praxis motora y abstracción. Las diferencias eran estadísticamente significativas. Además, se apreciaba una tendencia mayor a cometer errores en las pruebas de atención por parte de los pacientes con DCLmf-noA. Conclusiones. La presencia de amnesia permite identificar a un grupo de DCLmf-A con un perfil cognitivo sugestivo de afectación temporal, diferente del grupo de DCLmf-noA con perfil cognitivo, que sugiere afectación subcortical

Introduction. The use of diagnostic criteria for mild cognitive impairment (MCI) that do not require the presence of amnesia enables patients to be classified into three types of MCI: pure amnestic MCI (aMCI), MCI with involvement of multiple cognitive functions and amnesia (mf-aMCI) and MCI with involvement of multiple cognitive functions without amnesia, or non-amnestic MCI (mf-nonaMCI). Aim. To determine whether patients with MCI with involvement of multiple functions (mfMCI) have a different profile of cognitive involvement depending on whether amnesia is present or not. Patients and methods. Out of a total sample of 175 patients with MCI, we studied 138 with mfMCI. Of these, 109 (79%) had memory disorders (mf-aMCI) and 29 (21%) did not (mf-nonaMCI). For each group of patients, we determined the percentage who scored below normal in each of the items on the abbreviated Barcelona test. Results. Patients with mf-aMCI failed more frequently in temporal orientation, naming and semantic category evocation tests. Patients with mf-nonaMCI failed more often in motor praxis and abstraction tests. Differences were statistically significant. Additionally, it was noted that patients with mf-nonaMCI tended to make more mistakes in attention tests. Conclusions. The presence of amnesia allows us to identify an mf-aMCI group with a cognitive profile suggesting temporal involvement, unlike the mf-nonaMCI group, whose members have a cognitive profile that suggests subcortical compromise

[An update on the diagnosis of vascular dementia]. / Actualización en el diagnóstico de la demencia vascular.

INTRODUCTION: Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer's disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance. CONCLUSIONS: Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies.

Actualización en el diagnóstico de la demencia vascular / An update on the diagnosis of vascular dementia

Introduction. Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer’s disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance. Conclusions. Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies (AU)

Introducción. La demencia vascular (DV) es la segunda causa de demencia tras la enfermedad de Alzheimer en la sociedad occidental. Incluye un grupo heterogéneo de trastornos en los que se piensa que los factores vasculares desempeñan un papel esencial en el desarrollo del deterioro cognitivo. Objetivo y desarrollo. Nuestro objetivo es analizar con qué instrumentos y con qué fiabilidad somos capaces de diagnosticar la DV. Para ello, revisamos los criterios diagnósticos existentes hasta la actualidad, el papel de la neuropsicología, del estudio neuroecográfico y el creciente desarrollo de las técnicas de neuroimagen, en especial la resonancia magnética. Conclusión. Los criterios diagnósticos actuales para la DV seleccionan a un grupo clínica y etiológicamente muy heterogéneo, y es necesario modificarlos hacia unos nuevos criterios basados en evidencias, derivados del análisis de estudios poblacionales que se centren en la enfermedad en sus estadios iniciales, y que diferencien adecuadamente a los pacientes con demencia mixta. El subtipo de deterioro cognitivo vascular subcortical (DCVS) representa una forma de deterioro vascular más homogéneo y que selecciona a pacientes más representativos, con un cuadro clínico, evolución, respuesta al tratamiento y pronóstico más predecibles. Estas características hacen del DCVS un grupo ideal para la comparabilidad de estudios y ensayos clínicos (AU)

[Prevalence of neurosonographic disturbances in chronic instability]. / Prevalencia de alteraciones neurosonológicas en la inestabilidad crónica.

INTRODUCTION: Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. AIM. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique. PATIENTS AND METHODS: A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler. RESULTS: Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%). CONCLUSIONS: The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability.

Prevalencia de alteraciones neurosonológicas en la inestabilidad crónica / Prevalence of neurosonographic disturbances in chronic instability

Introducción. El mareo es un síntoma muy frecuente en las consultas de atención primaria. Su origen es generalmente multifactorial y tiene un curso benigno. Existe, sin embargo, una tendencia a relacionar el mareo con una alteración vascular cerebral. Objetivo. Determinar si existen alteraciones cerebrovasculares en los pacientes con mareo crónico utilizando una técnica no invasiva. Pacientes y métodos. Se realizó un estudio prospectivo que incluía a 404 pacientes sin restricción de edad. Se evaluó a los pacientes en la consulta de neurología, con el objetivo de seleccionar los que tenían inestabilidad crónica. A los pacientes incluidos se les realizó un estudio neurosonológico con ecografía Doppler con color de las arterias cervicales y Doppler transcraneal. Resultados. En el 54 % de los pacientes, el estudio neurosonológico carotídeo fue rigurosamente normal. En el resto de los pacientes, el hallazgo más prevalente fue la ateromatosis carotídea no estenosante. En el sistema vertebrobasilar, el estudio de las arterias vertebrales fue completamente normal en el 81,7%, seguido de la presencia de microangiopatía en un 12,1%. El estudio de la arteria basilar fue también normal en una alta proporción de pacientes (78%), seguido de la presencia de microangiopatía en un 17,1%. Conclusiones. Las alteraciones vasculares vertebrobasilares son un hallazgo excepcional en pacientes con inestabilidad crónica

Introduction. Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. Aim. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique. Patients and methods. A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler. Results. Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%). Conclusions. The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability