Predictors of Mechanical Ventilation in Guillain-Barré Syndrome with Axonal Subtypes.

BACKGROUND: The early clinical predictors of respiratory failure in Latin Americans with Guillain-Barré syndrome (GBS) have scarcely been studied. This is of particular importance since Latin America has a high frequency of axonal GBS variants that may imply a worse prognosis. METHODS: We studied 86 Mexican patients with GBS admitted to the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a referral center of Mexico City, to describe predictors of invasive mechanical ventilation (IMV). RESULTS: The median age was 40 years (interquartile range: 26-53.5), with 60.5% men (male-to-female ratio: 1.53). Most patients (65%) had an infectious antecedent (40.6% gastrointestinal). At admission, 38% of patients had a Medical Research Council (MRC) sum score <30. Axonal subtypes predominated (60.5%), with acute motor axonal neuropathy being the most prevalent (34.9%), followed by acute inflammatory demyelinating polyneuropathy (32.6%), acute motor sensory axonal neuropathy (AMSAN) (25.6%), and Fisher syndrome (7%). Notably, 15.1% had onset in upper limbs, 75.6% dysautonomia, and 73.3% pain. In all, 86% received either IVIg (9.3%) or plasma exchange (74.4%). IMV was required in 39.5% patients (72.7% in AMSAN). A multivariate model without including published prognostic scores yielded the time since onset to admission <15 days, axonal variants, MRC sum score <30, and bulbar weakness as independent predictors of IMV. The model including grading scales yielded lower limbs onset, Erasmus GBS respiratory insufficiency score (EGRIS) >4, and dysautonomia as predictors. CONCLUSION: These results suggest that EGRIS is a good prognosticator of IMV in GBS patients with a predominance of axonal electrophysiological subtypes, but other early clinical data should also be considered.

Levosulpiride Relieved Persistent Hiccups in a Patient With COVID-19 and Vascular Cognitive Impairment.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is a systemic illness that implies neurological features and complications. Persistent (>48 hours) hiccups (ie, singultus or hiccoughs) have been recently described as a rare presentation of COVID-19. Even when considered benign, the frequency and duration of hiccup spells can be burdensome and sometimes difficult to treat. CASE PRESENTATION: We report the case of a 62-year-old man known by the treating physicians for vascular cognitive impairment, who consulted for progressive persistent hiccups that commenced 5 days earlier, about 24 hours after testing positive for the severe acute respiratory syndrome coronavirus 2 by real-time reverse transcription polymerase chain reaction. The patient could barely sleep because the hiccups reached the highest rate of 47 per minute in a spell lasting almost 72 hours. The patient initially received levomepromazine 25 mg by mouth, but sedation and delirium impeded the continuation of treatment, which only reduced the frequency of the hiccup spells by about 25%. Afterward, the patient was offered levosulpiride 25 mg thrice a day by mouth, resulting in a steady reduction in the hiccups rate, as well as the duration and daily frequency of spells, which disappeared after 3 days of levosulpiride treatment. COVID-19 pneumonia was moderate by chest computed tomography scan imaging and biomarkers, meriting continuous oxygen therapy, dexamethasone 6 mg once a day by mouth for 10 days, and enoxaparin 40 mg once a day, subcutaneously, for 7 days (due to elevated D-dimer serum concentration). Oxygen therapy was gradually withdrawn after 12 days. CONCLUSIONS: Oral levosulpiride is a suitable option in persistent hiccups that occur in patients with COVID-19 pneumonia. To our knowledge, this is the fourth published case of persistent hiccups as a clinical feature of COVID-19.

Mitochondrial calcium uniporter is essential for hearing and hair cell preservation in congenic FVB/NJ mice.

Mitochondrial Ca2+ regulates a wide range of cell processes, including morphogenesis, metabolism, excitotoxicity, and survival. In cochlear hair cells, the activation of mechano-electrical transduction and voltage-gated Ca2+ channels result in a large influx of Ca2+. The intracellular rise in Ca2+ is partly balanced by the mitochondria which rapidly uptakes Ca2+ via a highly selective channel comprised of the main pore-forming subunit, the mitochondrial Ca2+ uniporter (MCU), and associated regulatory proteins. MCU thus contributes to Ca2+ buffering, ensuring cytosolic homeostasis, and is posited to have a critical role in hair cell function and hearing. To test this hypothesis, Ca2+ homeostasis in hair cells and cochlear function were investigated in FVB/NJ mice carrying the knockout allele of Mcu (Mcu+/- or Mcu-/-). The Mcu knockout allele, which originated in C57BL/6 strain cosegregated along with Cdh23ahl allele to the FVB/NJ strain, due to the close proximity of these genes. Neither Mcu+/- nor Mcu-/- genotypes affected cochlear development, morphology, or Ca2+ homeostasis of auditory hair cells in the first two postnatal weeks. However, Mcu-/- mice displayed high-frequency hearing impairment as early as 3 weeks postnatal, which then progressed to profound hearing loss at all frequencies in about 6 months. In Mcu+/- mice, significantly elevated ABR thresholds were observed at 6 months and 9 months of age only at 32 kHz frequency. In three-month-old Mcu-/- mice, up to 18% of the outer hair cells and occasionally some inner hair cells were missing in the mid-cochlear region. In conclusion, mitochondrial Ca2+ uniporter is not required for the development of cochlea in mice, but is essential for hearing and hair cell preservation in congenic FVB/NJ mice.

Clinical and neurophysiological description of patients with POEMS syndrome.

INTRODUCTION: POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) is a monoclonal gammopathy with polyneuropathy as a mandatory criterion. OBJECTIVE: To describe potential associations between clinical expression and electrodiagnostic patterns in POEMS syndrome. METHOD: Observational, retrospective, cross-sectional study of cases cared for in a referral center, diagnosed with POEMS syndrome from 2009 to 2019. RESULTS: Eleven patients (8 men) were analyzed. Median age at diagnosis was 40 years (range: 31-51; mean: 37.19 ± 15.67 years). Mean latency at diagnosis was 9.7 ± 8.37 months. In all subjects, initial clinical manifestation was polyneuropathy. Most patients had an axonal pattern (n = 5), followed by demyelinating (n = 4) and mixed patterns (n = 2). Monoclonal gammopathy was observed in all (6 l and 5 k cases; immunoglobulin [Ig] G: 72 %; IgA: 18 %; IgM: 9 %). Medical Research Council sum score was lower in the axonal pattern (median: 37.00 vs. 45.5; p = 0.024). There were no differences in systemic involvement between electrophysiological patterns. CONCLUSION: Electrophysiological patterns are unlikely to have a clear extra-neurological clinical correspondence; however, this will have to be definitively proven with a larger sample size.

INTRODUCCIÓN: El síndrome POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) es una gammapatía monoclonal con polineuropatía como criterio obligatorio. OBJETIVO: Describir las potenciales asociaciones entre la expresión clínica y los patrones de electrodiagnóstico en el síndrome POEMS. MÉTODO: Estudio observacional, retrospectivo y transversal de los casos atendidos en un centro de referencia con diagnóstico de síndrome de POEMS de 2009 a 2019. RESULTADOS: Se analizó a 11 pacientes (8 hombres). La mediana de la edad al diagnóstico fue de 40 años (rango: 31-51, media: 37.19 ± 15.67 años). La latencia media al diagnóstico fue de 9.7 ± 8.37 meses. En todos la manifestación clínica inicial fue la polineuropatía. La mayoría de los pacientes presentaron un patrón axonal (n = 5), seguido del desmielinizante (n = 4) y mixto (n = 2). La gammapatía monoclonal se observó en todos (6 casos l y 5 k, inmunoglobulina [Ig] G: 72%, IgA: 18%, IgM: 9%). El Medical Research Council sum score fue menor en el patrón axonal (medianas: 37.00 vs. 45.5, p = 0.024). No se presentaron diferencias en la afección sistémica entre patrones electrofisiológicos. CONCLUSIÓN: Es poco probable que los patrones electrofisiológicos tengan una correspondencia clínica extraneurológica clara, sin embargo, esto deberá probarse de forma definitiva con un mayor tamaño de muestra.

Prediction of acute neurovascular syndromes with prehospital clinical features witnessed by bystanders.

BACKGROUND: The prompt recognition of an acute neurovascular syndrome by the patient or a bystander witnessing the event can directly influence outcome. We aimed to study the predictive value of the medical history and clinical features recognized by the patients' bystanders to preclassify acute stroke syndromes in prehospital settings. METHODS: We analyzed 369 patients: 209 (56.6%) with acute ischemic stroke (AIS), 107 (29.0%) with intracerebral hemorrhage (ICH), and 53 (14.4%) with subarachnoid hemorrhage (SAH). All patients had neuroimaging as diagnostic gold standard. We constructed clinical prediction rules (CPRs) with features recognized by the bystanders witnessing the stroke onset to classify the acute neurovascular syndromes before final arrival to the emergency room (ER). RESULTS: In all, 83.2% cases were referred from other centers, and only 16.8% (17.2% in AIS, 15% in ICH, and 18.9% in SAH) had direct ER arrival. The time to first assessment in ≤ 3 h occurred in 72.4% (73.7%, 73.8%, and 64.2%, respectively), and final ER arrival in ≤ 3 h occurred in 26.8% (32.1%, 15.9%, and 28.3%, respectively). Clinical features referred by witnesses had low positive predictive values (PPVs) for stroke type prediction. Language or speech disorder + focal motor deficit showed 63.3% PPV, and 77.0% negative predictive value (NPV) for predicting AIS. Focal motor deficit + history of hypertension had 35.9% PPV and 78.8% NPV for ICH. Headache alone had 27.9% PPV and 95.3% NPV for SAH. In multivariate analyses, seizures, focal motor deficit, and hypertension increased the probability of a time to first assessment in ≤ 3 h, while obesity was inversely associated. Final ER arrival was determined by age and a direct ER arrival without previous referrals. CONCLUSION: CPRs constructed with the witnesses' narrative had only adequate NPVs in the prehospital classification of acute neurovascular syndromes, before neuroimaging confirmation.

Abbreviated Screening Breast MRI in Women at Higher-than-Average Risk for Breast Cancer with Prior Normal Full Protocol MRI.

OBJECTIVE: To compare the performance of abbreviated screening breast MRI (ABMR) versus full protocol MRI (FPMR) in women at higher-than-average risk for breast cancer with a prior normal FPMR. METHODS: ABMR was performed on higher-than-average-risk women who had a prior normal FPMR. ABMR protocol consisted of short inversion time inversion recovery imaging, precontrast, and two early postcontrast sequences acquired in under 10 minutes. Retrospective review of ABMR examinations performed from July 2016 to July 2018 was compared with a control group who underwent routine screening with FPMR who had a prior normal FPMR performed from July 2014 to June 2016. Screening outcome metrics were calculated and compared, adjusting for differences in patient demographics. RESULTS: The study cohort included 481 ABMR examinations, while the control group included 440 FPMR studies. There was no significant difference in the abnormal interpretation rate (AIR) or cancer detection rate (CDR) for the ABMR versus the FPMR group (AIR 6.0% vs 6.8% respectively, odds ratio (OR) 0.91, 95% confidence interval (CI): 0.53-1.5, P = 0.73; CDR 8.3 vs 11 cancers detected per 1000 examinations respectively, OR 0.73, 95% CI: 0.20-2.7, P = 0.64). The PPV2 and PPV3 for the ABMR group was 19% and 21% versus 16% and 16% for the FPMR group, with no statistical difference. Sensitivity was 100% in each group with no interval cancers. There was no difference in specificity between the ABMR and FPMR groups, 93% versus 94%, respectively (P = 0.73). CONCLUSION: ABMR may be used to screen higher-than-average-risk women with a prior normal FPMR as outcome metrics are equivalent to FPMR.

Bioprospecting of Lacmellea standleyi fruits (lechemiel) / Bioprospección de frutos de Lacmellea standleyi (lechemiel)

Introduction: the idea to explore at least some of the regions diversity such as the Colombian Orinoco through bioprospecting study of Lacmellea standleyi (Woodson) Monach. arises as a consequence of ignorance of much of the floristic richness in Colombia and the potential relevance of much of this in the nutrition, health and industry. Objective: to evaluate the antioxidant potential, nutritional and phenolic content, antimicrobial activity, and safety degree of aqueous, ethanol, and ethyl acetate extracts of Lacmellea standleyi fruits in three different ripening stages. Methods: the nutritional value was evaluated using standardized methods to full fruit in its three ripening stages. Each of the extracts was chemically characterized by spectrophotometric assays. Antimicrobial activity was measured by the size of inhibition against strains of Staphylococcus aureus, Escherichia coli, and Candida parpsilosis; the acute toxicity of the fruits was measured through in vitro tests using Artemia salina as experimental model. Results: the results show that green fruits are suppliers of antioxidant compounds. Higher levels of nutrients are found in the intermediate state and mature fruit has attractive organoleptic properties and a relatively high nutrient content. Conclusions: the antioxidant capacity of Lacmellea standleyi fruits was evident in the three ripening stages, giving the plant a promising future in the pharmaceutical industry, standing out in this field the fruits in the green stage. Furthermore, the results suggest the application of the intermediate and mature fruits in the finished products development. The safety observed in the plant material warrants its use in human consumption.

Introducción: del desconocimiento de gran parte de la riqueza florística en Colombia y de la importancia que podría tener gran parte de esta en la nutrición, salud e industria, nace la idea de explorar, al menos en parte, la diversidad de regiones como la Orinoquía colombiana a través del estudio de bioprospección de los frutos de Lacmellea standleyi (Woodson) Monach. Objetivo: evaluar el potencial antioxidante, el contenido fenólico y nutricional, la actividad antimicrobiana y el grado de inocuidad de los extractos acuoso, etanólico y de acetato de etilo, de los frutos de Lacmellea standleyi en 3 estadios diferentes de maduración. Métodos: el valor nutricional se evaluó a través de métodos estandarizados, al fruto completo en sus 3 estadios de maduración; cada uno de los extractos se caracterizó químicamente a través de ensayos espectrofotométricos. La actividad antimicrobiana se midió mediante el tamaño del halo de inhibición frente a cepas de Staphylococcus aureus, Escherichia coli y Candida parpsilosis; la toxicidad aguda de los frutos se calculó mediante pruebas in vitro, usando como modelo experimental nauplios de Artemia salina. Resultados: se pudo evidenciar que los frutos verdes aportan compuestos antioxidantes. En el estado intermedio se encuentran los niveles más altos de nutrientes y el fruto maduro ostenta atractivas propiedades organolépticas y un contenido relativamente alto de nutrientes. Conclusiones: la capacidad antioxidante de los frutos de Lacmellea standleyi resultó evidente en los 3 estadios de maduración. Esto otorga al vegetal un futuro promisorio en la industria farmacológica, sobresaliendo en este campo los frutos en el estadio verde. Además, los resultados permiten sugerir la aplicación de los frutos en estado intermedio y maduro en la elaboración de productos alimenticios terminados. La inocuidad observada en el material vegetal garantizaría su uso en el consumo humano.

Quantification, chemical and biological characterization of the saponosides material from Sida cordifolia L. (escobilla) / Cuantificación, caracterización química y biológica del contenido saponósido de Sida cordifolia L. (escobilla)

Introduction: Sida cordifolia L. (Malvaceae) is a weed about which not much is known in Colombia. This plant is used in folk medicine to treat oral mucosa, blennorrhea, asthma and bronchitis.In Brazil it finds application as an anti-inflammatory,while in Colombia its "baba" is used for treating hair loss, constipation and internal fever, among other ailments. Objectives: to quantify the saponoside content and evaluate its antioxidant and antifungal functionality. Methods: we prepared organic, aqueous and hydroalcoholic extracts from the aerial section of the plant. The saponoside material was quantified by the DNS and p-anisaldehyde methods. The most concentrated extracts were selected for antioxidant and antifungal assays. Results: it was found that Sida cordifolia, collected in Ibague-Colombia, is a good source of saponins with diverse chemical structures, mainly of steroidal nature, some of which may be hecogenin, diosgenin or a homologue. Conclusions: these factors may contribute, at least in part, to the antioxidant and antifungal functionality of Sida cordifolia L., but this capacity may be modified if these saponins act independently or together with some other metabolites of the plant such as tannins, flavonoids steroids, and alkaloids among others.

Introducción: Sida cordifolia L. (Malvaceae) es una hierba de la cual se tiene un conocimiento limitado en Colombia. Se utiliza en la medicina popular para el tratamiento de la mucosa oral, la blenorragia, el asma y la bronquitis. En Brasil encuentra aplicación como antiinflamatorio, mientras que en Colombia su "baba" se utiliza para tratar la pérdida del cabello, el estreñimiento, y la fiebre interna, entre otros padecimientos. Objetivos: cuantificar el contenido saponósido y evaluar sus propiedades antioxidantes y funcionalidad antifúngica. Métodos: se prepararon extractos orgánicos, acuosos e hidroalcohólicos de la parte aérea de la planta. El material de saponósidos se cuantificó por los métodos del DNS (dinitrosalicylic acid reagent) y de p-anisaldehído. Los extractos más concentrados se seleccionaron para los ensayos antioxidante y antifúngico. Resultados: estos mostraron que Sida cordifolia, colectada en Ibague-Colombia, es una buena fuente de saponinas con diversas estructuras químicas, principalmente de naturaleza esteroidal, algunas de las cuales pueden ser hecogenina, diosgenina o un homólogo. Conclusiones: estos factores pueden contribuir, al menos en parte, en la funcionalidad antioxidante y antifúngica de Sida cordifolia L., pero su capacidad se puede modificar si esas saponinas actúan de forma independiente o en conjunto con otros metabolitos de la planta, como taninos, esteroides flavonoides, alcaloides, entre otros.

Valoración del potencial antioxidante de Mollinedia racemosa (romadizo) / Assessment of antioxidant potential of Mollinedia racemosa (romadizo)

Introducción: Mollinedia racemosa (Schltdl.) Tul. (romadizo), es una especie usada por grupos indígenas y comunidades campesinas de la cuenca del Orinoco colombiano, empleada para tratar fiebres, dolores de cabeza y problemas de estómago, especialmente en el tratamiento del resfriado y como analgésico. Objetivo: evaluar el potencial antioxidante de las hojas de M. racemosa (romadizo). Métodos: se preparó un macerado etanólico de hojas (relación 1:15, vegetal/solvente), renovando el solvente cada 24 h hasta agotar la muestra. El extracto se filtró, se concentró a presión reducida y se almacenó (4 ºC). Se valoró el contenido de compuestos fenólicos, flavonoides y de flavonoles totales. Se estableció además la concentración de alcaloides que posee la planta. Asimismo, se evaluó la actividad antioxidante in vitro del vegetal midiendo la capacidad del extracto etanólico para estabilizar radicales DPPH (1,1-difenil-2-picrilhidracil) y ABTS (ácido 2,2'azinobis-[3 etilbenzotiazolina]-6-sulfónico), y la potencialidad para inhibir la peroxidación de un sistema lipídico. Resultados: el potencial antioxidante de M. racemosa mostró dependencia de la concentración aplicada, que a su vez está correlacionada con la diversidad y cantidad de constituyentes de naturaleza fenólica del vegetal. Concentraciones de 14,59 mg/mL y 17,32 mg/mL se requieren para inhibir 50 por ciento de la cantidad original utilizada de DPPH y ABTS, respectivamente. La actividad inhibitoria de la peroxidación lipídica alcanzó su máxima capacidad a las 360 h (15 d). Conclusiones: los resultados obtenidos permiten concluir que el extracto hidroalcohólico de las hojas de M. racemosa posee un efecto antioxidante y protector de un sistema lipídico.

Introduction: Mollinedia racemosa (Schltdl.) Tul. (romadizo), is one species used by indigenous and peasant communities in the Colombian Orinoco basin, to treat fever, headache and stomach problems, especially in the treatment of cold and as an analgesic. Objective: to evaluate the antioxidant potential of M. racemosa (romadizo) leaves. Methods: ethanolic macerate of leaves was prepared (ratio 1:15, plant/solvent), changing the solvent every 24 h until the sample was exhausted. The extract was filtered, concentrated under reduced pressure and stored (4°C). The content of phenolic compounds, flavonoids and total flavonols were assessed. The concentration of alkaloids of this plant was also established. Additionally, the in vitro antioxidant activity of plant was determined by measuring the ability of ethanol to stabilize radicals DPPH1 (1-diphenil-2-picrilhydracil) and ABTS (2,2'azinobis-[3 etilbenzotiazolin]-6-sulphonic acid) and the potential to inhibit lipid peroxidation. Results: the antioxidant potential of this plant depended on the applied concentration that in turn was correlated to the diversity and quantity of phenols present in the plant. Concentration rates of 14.59 and 17.32 µg/mL were required to inhibit 50 percent (IC50) of the original quantity of DPHH and ABTS respectively. The inhibitory capacity of lipidic peroxidation reached its maximum level after 360 hours (15 days). Conclusions: the results showed that the extract from M. racemosa leaves had antioxidant and protective effect in a lipidic system.

Climate influence on chemical composition and antioxidant activity of Justicia pectoralis Jacq. / Influencia del clima en la composición química y la actividad antioxidante de Justicia pectorales Jacq

In this paper, the influence of the altitude in the phenols and flavonoids contents and the antioxidant activity of the extracts of different polarities of Justicia pectoralis Jacq(Acanthaceae) was evaluated. There was found that the plants cultivated under the Ibagué-Tolima's climate and soil conditions, can be a source of antioxidant compounds, especially in water preparations. The chromatographic analysis revealed that J. pectoralis extracts have mainly flavonoids of the flavonone type, as apigenine. A greater (or The greatest) content of flavonoids was detected in the ethanolic extract of the plant samples grown at 1 265 m.a.s.l. (meters above sea level) (2 748,03 mg/L). The altitude level does not seem to have any influence on the functional properties, neither on the phytophenols content. The J. pectoralis Jacq can be considered one species with a high therapeutic potential and with good commercial opportunities.

En este trabajo se evaluó la influencia de la altitud en el contenido de fenoles y flavonoides y la actividad antioxidante de los extractos de diferentes polaridades provenientes de Justicia pectorales (Acanthaceae). Se halló que las plantas cultivadas en las condiciones del suelo y el clima de la zona Ibagué-Tolima pueden constituirse en compuestos antioxidantes, especialmente en preparados acuosos. El análisis cromatográfico reveló que los extractos de J. pectorales poseen en lo fundamental flavonoides del tipo flavona como es la apigenina. Un mayor contenido (sino el mayor) de flavonoides se detectó en el extracto etanol obtenido de las muestras de la planta cultivadas a 1 265 metros por encima del nivel del mar (2 748,03 mg/L). La altitud no parece influir en las propiedades funcionales, ni en el contenido de fitofenoles del extracto. La J. pectorales puede considerarse una especie de gran potencial terapéutico y buenas posibilidades de comercialización.