[Comparison of glycemic control in diabetic patients with and without metabolic syndrome]. / Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico.

OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6%). SM Criteria were : low HDL: 62.9%; hypertriglyceridemia: 56.3%; obesity abdominal (OA) 90.1%, hypertension (HBP): 62.5%. The prevalence of MS was 86.6% (95% CI 83% to 89%). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9% 2.3 vs 8.5% 2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95% in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.

Objetivo: Comparar el nivel glucémico en pacientes con diabetes tipo 2 (DM2) con y sin síndrome metabólico (SM). Metodología: Estudio transversal analítico. Se incluyeron aleatoriamente pacientes con DM2 corroborado en su expediente clínico. El SM se identificó en pacientes con al menos 3 de 5 criterios del ATP III (AdultTreatment Panel III). Se aplicó un cuestionario estructurado. Se determinó hemoglobina glucosilada (HbA1c), colesterol-HDL, triglicéridos, hipertensión arterial sistémica (HAS), índice de masa corporal (IMC), circunferencia de cintura (CCi) y cadera (CCa). Plan de análisis: prevalencia, prueba t de Student, correlación de Pearson y regresión logística. Resultados: Se incluyeron 283 pacientes. Edad promedio: 59.8±10.6 años. Predominó el sexo femenino (73.6%)Criterios cubiertos para SM: hipocolesterolemia-HDL: 62.9%; hipertrigliceridemia: 56.3%; obesidad abdominal (OA) 90.1%; hipertensión arterial sistémica (HAS): 62.5%. La prevalencia de SM fue 86.6% (IC95% 83% a 89%). No hubo diferencia significativa en el promedio de HbA1c en pacientes con y sin SM, HAS, OA, e hipocolesterolemia-HDL. En cambio, sujetos con hipertrigliceridemia tuvieron un promedio significativamente mayor de HbA1c que aquellos sin hipertrigliceridemia (8.9±2.3 vs 8.5±2.1, respectivamente; p=0.01). HbA1c correlacionó positivamente con trigliceridemia (r=0.24, p=0.001), y negativamente con el peso (r= -0.19, p=0.001), IMC (r= -0.172, p=0.004), CCi (r= -0.12, p=0.004) y CCa (r=-0.14, p=0.02). En el análisis multivariado ajustado, solamente la duración de la diabetes se asoció con el nivel glucémico (OR= 1.014, IC95% 1.010 a 1.016). Conclusiones: No encontramos diferencias significativas en el nivel glucémico en pacientes con y sin SM.

Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico / [Comparison of glycemic control in diabetic patients with and without metabolic syndrome].

OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6

. The prevalence of MS was 86.6

). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9

2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95

in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.

Comparación del control glucémico en pacientes diabéticos con y sin síndrome metabólico. / [Comparison of glycemic control in diabetic patients with and without metabolic syndrome].

OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6

). SM Criteria were : low HDL: 62.9

; hypertriglyceridemia: 56.3

; obesity abdominal (OA) 90.1

, hypertension (HBP): 62.5

. The prevalence of MS was 86.6

(95

CI 83

to 89

). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9

2.3 vs 8.5

2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95

in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.

47 year-old man with HIV infection and hemiplegia.

CNS aspergillosis is often missed in the setting of advanced HIV infection, especially in the absence of presumed risk factors such as neutropenia or prior steroid treatment. We describe the postmortem evaluation of the brain of a patient with AIDS that developed progressive neurologic deterioration. Sequence brain MRIs, CSF analysis, and multiple presumed treatments failed to reveal the possible causes or improve his ongoing condition. His brain autopsy showed numerous abscesses with septated hyphae consistent with CNS angioinvasive aspergillosis.

Estimates of sexual partnership dynamics: extending negative and positive gaps to status lengths.

BACKGROUND: The aims of this study are to generalise the concept of gap length between partners and to estimate the duration of four types of measures for heterosexual partnerships, called status lengths: (1) time spent as single before becoming monogamous (S-M, positive gap), (2) duration of concurrency before monogamy (C-M, negative gap), (3) duration of monogamy before concurrency (M-C) and (4) time spent in monogamy before becoming single (M-S). METHODS: Medians and CIs were obtained using the US National Survey of Family Growth Cycle 6 conducted in 2002. RESULTS: A significant gender difference was found in the monogamous to single status length (medians 38 months for women, and 19.3 months for men). Other status lengths were similar between genders (S-M: 20 women, 18 men; M-C: 16 women, 13 men; and C-M: 5 for women and men). Respondents younger than the median age at first marriage showed shorter status lengths compared to older ones. Median status lengths were comparable between heterosexuals and bisexuals. Percentage of concurrency in 1 year was 3.3% for women and 3.8% for men. CONCLUSIONS: One of the new status lengths (M-C) qualitatively indicates the transmission risk to an upcoming concurrent partner. The set of four status lengths may be useful in the context of epidemiological models with partnership dynamics.

[Analytic epidemiological information of amyotrophic lateral sclerosis]. / Epidemiología analítica de la esclerosis lateral amiotrófica.

INTRODUCTION: The analytical epidemiological information on amyotrophic lateral sclerosis (ALS) is extensive and is based on case-control studies, selective patient series and few cohort studies that analyze the risk factors for the disease. REVIEW: The studies found in the literature on analytical epidemiology have been reviewed in an attempt to analyze the methodology, compare their results and comment on the possible biases and confounding factors such as the different roles of the risk factors. CONCLUSION: In spite of the extensive information available, the analytical epidemiology of ALS has still not clarified the etiological factors of the disease. This may be due to the influence of the genetic factors, but also to the variability of the methodological designs. However, the analytical factor that has the greatest consistency is that of exhibition to heavy metals. Greater physical activity or increased frequency in special situations such as is the cases from the first Gulf War could be suggested as a more than casual precipitating factor.

[The history of myasthenia gravis. Men and ideas.] / La historia de la miastenia gravis. Los hombres y las ideas.

The first description of a patient with myasthenia gravis was done by Thomas Willis (1621-1675). He was an eminent professor of natural history at Oxford University who also described the arteries of the brain and made the first precise drawings of it. At the present time myasthenia gravis is considered one of the most well described autoimmune diseases with great advances in its diagnosis, pathophysiology and treatment. In this review we summarize the most important events and ideas in the history of this disease since the original description by Willis; mention the most important clinicians, anatomists and physiologists that were concerned with its understanding and make reference of some the most recent advances in its diagnosis and treatment and finally discuss some present controversies. Neurología 2007;22(0):0-0.

Subarachnoid hemorrhage as a complication of systemic lupus erythematosus.

BACKGROUND: Subarachnoid hemorrhage (SAH) is a rare complication of systemic lupus erythematosus (SLE). METHODS: We made a retrospective search for patients with SLE and nontraumatic SAH from 1990 to 2006. RESULTS: We found 10 patients with SLE and primary SAH of a total of 1,077 patients with SLE (0.93%); mean age of onset was 37.4 +/- 15.25 years and the mean duration of SLE at the onset of SAH was 98.3 +/- 50.32 months. SLEDAI and chronic damage scores were 3.67 +/- 5.20 (n = 9) and 2.90 +/- 1.45 (n = 10), respectively; 60% of patients had high Hunt-Hess scores and in only 50% of cases a saccular aneurysm was identified. CONCLUSIONS: SAH presents in about 1% of SLE patients. Long duration of SLE and chronic damage scores might be associated risk factors.

Personality in patients with migraine evaluated with the "Temperament and Character Inventory".

The objective of this study was to assess the personality profile of a sample of Mexican patients with migraine using the Temperament and Character Inventory (TCI). A cross-sectional study was performed including adult migraine patients identified from the outpatient neurology clinics of two large teaching hospitals in Mexico City. Patients were asked to voluntarily participate in the study. A physician conducted a standardised diagnostic interview adhering to the criteria of the International Headache Society (IHS). Patients were interviewed and administered the TCI. We used two healthy controls groups and a third group of non-migraine pain controls. One hundred and fortytwo subjects with migraine, 108 healthy blood donors, 269 young healthy controls and 30 patients with non-migraine pain (NMP) were included in the study. Patients with migraine had higher scores in the dimension harm avoidance (HA) and all its sub-dimensions (p<0.05) than healthy patients. Patients with non-migraine pain had high scores in HA and low scores in novelty seeking, self-directedness and cooperativeness. Blood donors had high scores in the following subdimensions: HA1, HA4 and C3 (Cooperativeness). Personality features consistent with migraine are avoidance, rigidity, reserve and obsessivity. Our study shows that patients with chronic pain share some of the personality features of patients with migraine but their TCI profile could be indicative of cluster C avoidant personality. Blood donors were shown to have more energy, with a tendency to help other people and be more optimistic. The results support serotoninergic involvement as explaining the physiopathology of migraine.

Associated conditions in myasthenia gravis: response to thymectomy.

To compare the response of thymectomy in patients with associated conditions (PWAC) and without associated conditions (PWOAC). Comparative, retrospective. 198 patients with the established diagnosis of myasthenia gravis who had a thymectomy between 1987 and 2000, and who were folowed up for at least 3 years. We formed two groups, one with associated conditions and the second without associated conditions. The patients were divided into four groups: (i) patients in remission, (ii) patients with improvement, (iii) patients without changes, and (iv) patients whose condition worsened. Associated conditions (AC) were found in 49 patients (26%). The main associated conditions were hyperthyroidism in 16 patients (33%) hypothyroidism in seven (14%), rheumatoid arthritis in five (10%) and hypothyroidism and Sjogren syndrome in three (6%). Concerning the response of thymectomy, 13 patients WAC showed remission (27%), vs. 54 patients WOAC (39%). Twenty patients WAC showed improvement (41%) vs. 46 WOAC (33%). Thirteen patients WAC had no changes (27%) vs. 37 WOAC (26%). Finally, in three patients WAC their condition worsened (6%) vs. three WOAC (2%). The response to thymectomy was high (69%) in both groups. We did not identify significant differences.

Prevalence and factors associated with headache in patients with systemic lupus erythematosus.

Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-beta2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache (P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and beta2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and beta2GP-I antibodies.

[Painful neuropathies: their pathophysiology and treatment]. / Neuropatías dolorosas: fisiopatología y tratamiento.

OBJECTIVES: The purpose of this study is to review the different studies published in the literature concerning the different physiological mechanisms involved in the genesis of painful neuropathy, as well as the diagnostic options and the different pharmacological treatments currently available. DEVELOPMENT: Distinct pathologies usually condition painful neuropathy, one of the main ones being diabetes mellitus. The triggering phenomenon is often some kind of damage to the tissues that contain nervous pain receptors, which later gives rise to a release of proinflammatory molecules, and triggers a cascade of phenomena that result in disorders in the central and peripheral nervous system (peripheral and central sensitisation). These disorders usually produce clinical manifestations, such as allodynia, paresthesias, among others, and these are sometimes the sole manifestation of painful neuropathy. Diagnosis of this syndrome is at times complicated due to the involvement of thin fibres, which cannot be identified by the conventional methods used in neurophysiological studies. There is also a broad range of pharmaceuticals used in the treatment of painful neuropathy that range from tricyclic antidepressants, non-steroidal anti-inflammatory drugs, opioid analgesics, antiarrhythmics and even agents for topical use. CONCLUSIONS: Diagnosis of thin fibre neuropathy is usually performed by carrying out a Quantitative Sudomotor Axon Reflex Test, quantitative sensory tests and a skin biopsy. As regards the pharmacological treatment, the new generation of anticonvulsive drugs like gabapentin seems to have advantages over the traditional pharmaceuticals, although their widespread use is still largely restricted by their cost.

Neuropatías dolorosas: fisiopatología y tratamiento / Painful neuropathies: their pathophysiology and treatment

Objetivo. El presente trabajo pretende hacer una revisión de los diversos mecanismos fisiopatológicos involucrados en la génesis de la neuropatía dolorosa, las opciones diagnósticas, así como los diversos tratamientos farmacológicos disponibles en la actualidad, comunicados en diversos estudios. Desarrollo. Diversas patologías suelen condicionar neuropatía dolorosa, y una de las principales es la diabetes mellitus. El fenómeno desencadenante suele ser un daño a tejidos que albergan receptores nerviosos del dolor, que posteriormente producen una liberación de moléculas proinflamatorias y desencadenan una cascada de fenómenos que culminarán en alteraciones del sistema nervioso central y periférico (sensibilización periférica y central). Estas alteraciones suelen dar manifestaciones clínicas, como son alodinia y parestesias, entre otras, y que en ocasiones son la única manifestación de la neuropatía dolorosa. El diagnóstico de ésta, en ocasiones, es complicado, debido a la afección de fibras delgadas, que no se pueden identificar por los métodos convencionales de estudios neurofisiológicos. También existe una amplia variedad de fármacos utilizados para el tratamiento de la neuropatía dolorosa, que incluyen antidepresivos tricíclicos, antinflamatorios no esteroideos, analgésicos opioides, antiarrítmicos e incluso agentes de uso tópico. Conclusiones. El diagnóstico de la neuropatía de fibras delgadas se suele realizar por medio de una prueba cuantitativa axonal sudomotora, pruebas sensitivas cuantitativas y una biopsia de piel. En cuanto al tratamiento farmacológico, los anticonvulsionantes de nueva generación, como la gabapentina, parecen tener ventajas sobre los fármacos tradicionales, aunque su coste todavía suponga una limitación para su uso (AU)

Aims. The purpose of this study is to review the different studies published in the literature concerning the different physiological mechanisms involved in the genesis of painful neuropathy, as well as the diagnostic options and the pharmacological treatments currently available. Development. Distinct pathologies usually condition painful neuropathy, one of the main ones being diabetes mellitus. The triggering phenomenon is often some kind of damage to the tissues that contain nervous pain receptors, which later gives rise to a release of proinflammatory molecules, and triggers a cascade of phenomena that result in disorders in the central and peripheral nervous system (peripheral and central sensitisation). These disorders usually produce clinical manifestations, such as allodynia, paresthesias, among others, and these are sometimes the sole manifestation of painful neuropathy. Diagnosis of this syndrome is at times complicated due to the involvement of thin fibres, which cannot be identified by the conventional methods used in neurophysiological studies. There is also a broad range of pharmaceuticals used in the treatment of painful neuropathy that range from tricyclic antidepressants, non-steroidal anti-inflammatory drugs, opioid analgesics, antiarrhythmics and even agents for topical use. Conclusions. Diagnosis of thin fibre neuropathy is usually performed by carrying out a quantitative sudomotor axon reflex test, quantitative sensory tests and a skin biopsy. As regards the pharmacological treatment, the new generation of anticonvulsive drugs like gabapentin seems to have advantages over the traditional pharmaceuticals, although their widespread use is still largely restricted by their cost (AU)

Prevalence of pulmonary hypertension and its association with respiratory disturbances in obese patients living at moderately high altitude.

OBJECTIVE: To determine the point prevalence of pulmonary hypertension (PH) and its relationship with respiratory disturbances in obese patients living at moderate altitude. SUBJECTS: A total of 57 obese patients comprised the final sample and consisted of 34 women and 23 men, with a mean age of 42.7+/-12.1 ys and a mean body mass index (BMI) 47.1+/-10.6 kg/m(2) (range from 30.1 to 76.1). The mean living altitude was 2248.7 m, range 2100-2400 m above sea level. MEASUREMENTS: Doppler echocardiography, pulmonary function tests, arterial blood gas analysis, and polysomnography were performed. RESULTS: Data showed that 96.5% of the studied sample had daytime PH defined as calculated systolic pulmonary artery pressure (PSAP) >30 mmHg (mean PSAP=50, s.d.=13 mmHg). The severity of diurnal PH was found to be related to the presence of alveolar hypoventilation and BMI. The main risk factor for severity of diurnal PH was hypoventilation with a significant odds ratio (OR) 7.96, 95% CI 1.35-46.84, BMI was (OR 1.12, 95% CI 1.02-1.25) and apnea/hypopnea index was not a predictor of pulmonary hypertension severity (OR 0.99, 95% CI 0.97-1.02). CONCLUSION: We concluded that prevalence of diurnal PH is high in obese patients living at moderate altitude, and that hypoventilation is the main risk factor associated with the severity of pulmonary hypertension.

Prevalence and factors associated with fibromyalgia in Mexican patients with systemic lupus erythematosus.

In total, 189 consecutive women diagnosed with SLE were evaluated using the ACR 1990 criteria for fibromyalgia. Patients were classified into three subgroups. The fibromyalgia group (FM) included patients experiencing pain on palpation in at least 11 of the 18 tender points examined, as well as having a history of widespread pain for at least three months. Patients who were noted to have pain in fewer than four quadrants with less than 11 of 18 tender points were considered to have regional pain (RP). All patients who did not meet criteria for either FM or RP were classified as having no pain (NP). Measurement of SLE disease activity, sleep complaints, depression, fatigue severity and health status were performed. Only 18 of the SLE patients (9.5%) (95% CI 5.3-14%) fulfilled the ACR criteria for the classification of FM. Of the patients, 106 (56.1%) fulfilled criteria for RP and had a number of tender points of 5.4 +/- 3.4, and the rest of the patients (34.4%) had no tenderness at specific tender point sites. Age, body mass index, educational level and disease duration were comparable between the groups. FM and RP groups had different patterns of symptoms prevalence, with dysmenorrhea being more distinctive for FM. Sleep disturbances were more severe in the FM than in the RP group. Daytime complaints such as sleepiness, fatigue and depression were similar for RP and FM groups, but patients with FM reported more disability. Fibromyalgia is not common in Mexican patients with SLE and has a different pattern of symptoms in RP and NP patients. These data add evidence that ethnicity can play an important role in FM manifestations.

HLA class II genotypes in Mexican Mestizo patients with myasthenia gravis.

Myasthenia gravis is an autoimmune, heterogeneous disorder, characterized by the presence of antibodies against acetylcholine receptors at the neuromuscular junction. There is a strong evidence that an individual's genetic composition is an important predisposing factor for the development of the disease. To correlate HLA class II genotypes with thymic pathology in Mexican Mestizo patients who had been subjected to thymectomy. HLA class II genes were analyzed in 60 patients and in 99 healthy ethnically matched controls. Thymic hyperplasia, atrophy, thymoma, and normal histology were encountered in 56, 33, 8 and 2% of patients, respectively. HLA-DR11 was significantly increased in patients with thymoma compared with healthy controls (pC = 0.001, OR = 13.35, 95% CI 3.5-51.3), compared with the subgroup of hyperplasia patients (pC = 0.005, OR = 15.5, 95% CI 2.78-95.58) and with the atrophy subgroup (pC = 0.04, OR = 10.5, 95% CI 1.75-70.95). This study provides the evidence of an association between HLA class II alleles with clinical and genetic heterogeneity in myasthenia gravis, particularly in those with thymoma (HLA-DR11).

Comparative efficacy of eletriptan vs. naratriptan in the acute treatment of migraine.

This was a randomized, double-blind study designed to evaluate the comparative efficacy and tolerability of the 40-mg dose of eletriptan and the 2.5-mg dose of naratriptan. Patients (n = 548) meeting International Headache Society (IHS) criteria for migraine were randomized to treat a single migraine attack with either eletriptan 40 mg, naratriptan 2.5 mg, or placebo. Headache response rates at 2 h and 4 h, respectively, were 56% and 80% for eletriptan, 42% and 67% for naratriptan (P < 0.01 for both time-points vs. eletriptan), and 31% and 44% for placebo (P < 0.0001 vs. both active drugs at both time-points). Eletriptan also showed a significantly greater pain-free response at 2 h (35% vs. 18%; P < 0.001) as well as lower use of rescue medication (15% vs. 27%; P < 0.01) and higher sustained headache response at 24 h (38%) compared with naratriptan (27%; P < 0.05) and placebo (19%; P < 0.01). Both eletriptan and naratriptan were well tolerated. The results confirm previous meta-analyses that have suggested the superiority of eletriptan vs. naratriptan in the acute treatment of migraine.

[Effect of the graded muscle contraction on the H reflex and long latency reflexes of the thenar and hypothenar muscles to a fixed threshold stimulus]. / Efecto de la contracción muscular graduada en el reflejo H y en los reflejos de larga latencia de los músculos tenares e hipotenares a un estímulo umbral fijo.

INTRODUCTION: To determine the percentage of appearance of the H reflex and long latency reflexes (LLRs) in the thenar and hypothenar muscles of normal subjects to a fixed threshold mixed nerve electrical stimulus and variable degrees of muscle contraction. METHODS: Fifteen subjects aged 21 to 32 years of age without any prior history of central or peripheral neurological diseases volunteered for the study. The stimulation was a constant currrent given at the wrist with the cathode positioned proximally; started at 1 mA and it was gradually increased mA by mA until the M response appeared with the subject relaxed. The intensity of the stimulation was thereafter kept constant. The contraction was an abducting movement of the thumb in the case of the thenar muscle and abduction of the digiti minimi in the case of the hypothenar muscle and was sustained throughout the study. The reflexes were elicited with a repetition rate of 3 Hz, the stimulus was a square pulse of 0.5 ms. We used a low frequency pass filter of 10 Hz and a high frequency pass filter of 10 kHz. The sweep speed was set a 10 ms per division. The responses were averaged 200 times and then smoothed. RESULTS: The mean intensity of the stimulus that evoked the H response, for all subjects, was 7.5 2.8 mA. The mean latency of the H reflex elicited with stimulation of the median nerve was 26 ms 2.03 ms (std. error 0.28, maximum 28.2, minimum 22.0). The mean latency of the H reflex elicited with stimulation of the ulnar nerve was 25.1 ms 1.64 ms (std. error 0.230, maximum 28, minimum 22.3). The difference between the percentage of responses attained under a relaxed condition and with any kind of muscle contraction was highly significant statistically using the Chi square method (p < 0.001). When we compared the percentage of the H responses obtained with slight, moderate, strong contraction, and contraction against resistance, between them, we did no find a significant difference. The LLRs appeared only in the trials with strong contraction. CONCLUSIONS: The H reflexes and the LLRs of the thenar and hypothenar muscle were not obtained with threshold stimulation when these muscles were relaxed. With any degree of muscle contraction the H reflex in these muscles could be obtained in 94 percent of the trials. Maximal contraction and contraction against resistance were the best conditions to elicit long latency responses.

Efecto de la contracción muscular graduadaen el reflejo H y en los reflejos de larga latenciade los músculos tenares e hipotenares a unestímulo umbral fijo / Effect of graded muscle contraction on the H reflex and long latency reflexes of the thenar and hypothenar muscles to a fixed threshold stimulus

Introducción: Determinar el porcentaje de aparición del reflejo H y de los reflejos de larga latencia (RLL) en los músculos tenares e hipotenares de sujetos sanos a un estímulo fijo a un nervio mixto con contracción muscular variable.Métodos: Quince sujetos con edades entre 21 y 32 años sin historia previa de enfermedad del sistema nervioso central periférico se ofrecieron voluntarios para el estudio. El estímulo fue dado en la muñeca con un estimulador de corriente constante con el cátodo posicionado proximalmente. El estímulo se inició a 1 mA y fue gradualmente incrementado mA por mA hasta que la respuesta M apareciese con el sujeto relajado. La intensidad del estímulo se mantuvo después constante a través del estudio. La contracción fue un movimiento isométrico de abducción del pulgar y del quinto dedo y fue mantenida constante durante la estimulación. Las respuestas fueron promediadas 200 veces y alisadas.Resultados: La intensidad promedio del estímulo que evocó el reflejo H en todos los sujetos fue 7,5 ñ 2,9 mA. La latencia promedio del reflejo H del nervio mediano fue 26 ñ 2,03 ms (EE 0.28, máximo 28,2, mínimo 22,0 ms). La latencia promedio del reflejo H estimulando el nervio cubital fue 25,1 ñ 1,64 ms (EE 0,230, máximo 28, mínimo 22,3 ms). Las diferencias en latencia entre estos dos nervios no fue significativa. La latencia no cambió con las diferentes intensidades de la contracción muscular. Con el músculo relajado se obtuvo el reflejo en 6 de las pruebas (6/60, 10 por ciento). En 227 de las 240 pruebas con contracción muscular de cualquier intensidad se obtuvo la respuesta (227/240, 94,5 por ciento). La diferencia fue altamente significativa (p < 0,001). Las respuestas de latencia larga sólo aparecieron con la contracción máxima o máxima contra resistencia.Conclusiones: Los reflejos H y los reflejos de larga latencia de los músculos tenares e hipotenares no fueron obtenidos con los músculos relajados. Con cualquier grado de contracción muscular estos reflejos fueron obtenidos en el 94 por ciento de las pruebas. La contracción muscular máxima y la contracción muscular contra resistencia fueron las condiciones óptimas para obtener las respuestas de larga latencia (AU)

Accidente cerebrovascular hemorrágico asociado a neurocisticercosis / Hemorrhagic stroke associated to neurocysticercosis

Una complicación bien reconocida de la neurocisticercosis es la arteritis cerebral, la cual puede manifestarse como isquemia cerebral o hemorragia. Existen reportes anecdóticos de evento vascular hemorrágico en pacientes con neurocisticercosis. En la literatura sólo hay dos reportes de esta manifestación. Uno de los casos descritos en la literatura tuvo una hemorragia intraquística en un paciente sin factores de riesgo cardiovascular. La autopsia demostró arteriopatía inflamatoria alrededor de la hemorragia intraquística. El segundo caso reportado en la literatura tuvo una hemorragia subaracnoidea secundaria a la ruptura de un aneurisma en la arteria cerebral anterior derecha. En la cirugía se encontró engrosamiento de las meninges y presencia de cisticercos con inflamación intensa alrededor del aneurisma. Nuestro primer caso se trató de una paciente de 32 años que desarrolló una hemorragia alrededor de una lesión cisticercosa. El segundo caso se trató de una mujer de 34 años que desarrolló una hemorragia intraquística. La angiografía cerebral fue normal en ambos casos y se consideró que las hemorragias se relacionaron con arteritis cisticercosa de vasos de pequeño calibre. Concluimos que la cisticercosis se asocia con diferentes tipos de hemorragia intracraneal, como los casos que mostramos en este artículo. En áreas endémicas de neurocisticercosis la arteritis cisticercosa debe ser incluida en la lista de causas de hemorragia intracraneal en pacientes jóvenes (AU)