ABSTRACT
Background: Multiple Sclerosis (MS) is a common neurological disease among white populations of European origin. Frequencies among Latin Americans continue to be studied, however, epidemiologic, and clinical characterization studies lack from Central American and Caribbean countries. Ethnicity in these countries is uniformly similar with a prevalent Mestizo population. Methods and results: Data from January 2014 to December 2019 from Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Dominican Republic, and Aruba on demographic, clinical, MRI and phenotypic traits were determined in coordinated studies: ENHANCE, a population-based, retrospective, observational study on incidence and clinical characteristics, and from the subgroup with MS national registries (Aruba, Dominican Republic, Honduras, and Panama), data on prevalence, phenotypes and demographics. Expanded Disability Status Scale (EDSS), and therapeutic schemes were included. ENHANCE data from 758 patients disclosed 79.8% of Mestizo ethnicity; 72.4% female; median age at onset 31.0 years and 33.2 at diagnosis. The highest incidence rate was from Aruba, 2.3-3.5 × 100,000 inhabitants, and the lowest, 0.07-0.15 × 100,000, from Honduras. Crude prevalence rates per 100,000 inhabitants fluctuated from 27.3 (Aruba) to 1.0 (Honduras). Relapsing MS accounted for 87.4% of cases; EDSS <3.0 determined in 66.6% (mean disease duration: 9.1 years, SD ± 5.0); CSF oligoclonal bands 85.7%, and 87% of subjects hydroxyvitamin D deficient. Common initial therapies were interferon and fingolimod. Switching from interferon to fingolimod was the most common escalation step. The COVID-19 pandemic affected follow-up aspects of these studies. Conclusion: This is the first study providing data on frequencies and clinical characteristics from 8 countries from the Central American and Caribbean region, addressing MS as an emergent epidemiologic disorder. More studies from these areas are encouraged.
ABSTRACT
Cell-based therapy has been studied as an alternative for Parkinson's Disease (PD), with different routes of administration. The superficial fascia and facial muscles possess a rich blood supply, while venous and lymphatic access via the orbit and the cribriform plate provide a route to cerebral circulation. We here document positive clinical effects in two patients with PD treated with autologous adipose-derived stromal vascular fraction (SVF) cell preparation, implanted into the face and nasal cavity. Two patients with PD were transplanted with 60 million total nucleated cells in processed SVF into the facial muscles and nose. Serial evaluations were carried out up to 5 years (patient 1) and 1 year (patient 2), using the PDQ-39, the UPDRS, and serial videos. Video scoring was reviewed in a blinded fashion. Both patients reported qualitative improvement in motor and nonmotor symptoms following injection. Quantitatively, PDQ-39 scores decreased in all categories for both. On-medication UPDRS motor scores decreased in both (20 to 4 in patient 1, 18 to 3 in patient 2) despite taking the same or less medication (LEDD 350 to 350 in patient 1, LEDD 1175 to 400 in pt2). Both subjects had off-medication UPDRS scores similar to their pretreatment on-medication scores (20 to 14 in patient 1, 18 to 23 in patient 2). These preliminary findings describe local facial and nasal injections of SVF preparation followed by prolonged clinical benefit in two patients. Despite an unknown mechanism of action, this potential therapy warrants careful verification and investigation.
Subject(s)
Mesenchymal Stem Cell Transplantation/methods , Parkinson Disease/therapy , Aged , Face , Facial Muscles , Fascia , Female , Humans , Male , Mesenchymal Stem Cells , Middle Aged , Nasal CartilagesABSTRACT
Poco se conoce sobre las manifestaciones de afección del sistema nervioso periférico, secundarias a intoxicación aguda con arsénico. En el presente artículo se describen las manifestaciones clínicas y los hallazgos electrofisiológicos en una paciente que desarrolló signos de neuropatía periférica, tan solo tres días después de haber ingerido una dosis elevada de este metal, con fines suicidas. Se concluye que tanto los nervios periféricos como los nervios craneales pueden resultar afectados en forma clínica o subclínica por esposición aguda al arsénico
Subject(s)
Humans , Female , Acute Disease , Arsenic/poisoning , Neural Conduction , Electromyography , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/physiopathology , Peripheral Nervous System Diseases/chemically inducedABSTRACT
Estudio de epilepsia en la edad pediatrica, descriptivo, transversal y retrospectivo. Constituido por 250 expedientes clínicos de pacientes menores de 15 años con diagnóstico de epilepsia que asistieron a la consulta externa de neurología del Hospital Infantil Manuel de Jesús Rivera en el período 86-88. Se utilizó el método de lotería y las variabeles de edad, seco y región de procedencia. El examen de diagnóstico más utilizado después del electroencefalograma EEG es la radiografía de cráneo en un 28.8% y el LCR en un 8.8%. Otros exámenes que requieren mayor complejidad como neuroecefalografía, serología, electrolitos y otros. Se enviaron en un porcentaje que oscila entre 0.4% y 1.6%. El tipo de epilepsia más frecuencia fue la tónico-clónico; el 2.4% de los embarazos de los pacientes epilepticos cursaron con antecedentes de riesgo desde el punto de vista neurológico; y los que presentaron más frecuente hipoxia al nacer fué en los partos atendidos en el domicilio. La estiología de la epilepsia correspondió en un 66% a causas adquiridas, predominando la hipoxia al nacer. Los factores que precipitaron con más frecuencia la crisis son: la omisión del tratamiento y la fiebre. Se encontró en un 67.2% la epilepsia asociada con otras alteraciones neurológicas, psicológicas o del desarrollo psicomotor - la persistencia de las crisis en los pacientes no controlados obedece a la omisión del tratamiento y toma irregular o dosis insuficiente. De las regiones atendidas predominó la Región III y con respecto al sexo hay predominio en algunos tipos de epilepsia y en otros no se encontró diferencia en cuanto al sexo. Recomienda un control prenatal y detección oportuna del embarazo de riesgo y mejorar la calidad de atención del parto y de los cuidados inmediartos del recien nacido mediante la capacitación y supervisión tanto a nivel institucional como domiciliar
