[Integrated Care Protocol: Hypertension]. / Protocolo de Atención Integral: hipertensión arterial sistémica.

Background: Hypertension is the most common cardiovascular risk factor that is responsible for complications such as cerebrovascular events, heart failure, acute myocardial infarction, kidney failure, arrhythmias and blindness. About 30% of the adult population older than 20 years is a carrier. 40% of carriers are unaware of suffering from it since its onset is generally asymptomatic. Unfortunately, of those who are already known to be hypertensive, only half take drug treatment and of these, only half achieve control figures (<14/90 mmHg). For several decades it has not been possible to forcefully modify the natural history of this disease despite the advancement of therapeutic drugs. The Mexican Institute of Social Security launches the initiative of the Integrated Care Protocols (PAI) of the main diseases. This protocol shows how the three levels of medical care are concatenated, the role of each of the members of the multidisciplinary team for medical care, including: doctor, nurse, social work, psychologist, nutritionist, among others and, to patient sharing. The main changes in diagnostic criteria, in-office and out-of-office blood pressure measurement, drug therapy (monotherapy, dual therapy and triple therapy) and non-drug therapy, and follow-up are presented. The diagnostic-therapeutic approach using algorithm as well as the diagnostic approach to secondary hypertension and special forms of hypertension such as in pregnancy, hypertensive crisis, hypertension in the elderly, ischemic or nephropathy patients.

Introducción: la hipertensión arterial sistémica (HAS) es el factor de riesgo cardiovascular más común y es responsable de complicaciones como evento cerebrovascular, insuficiencia cardiaca, infarto agudo de miocardio, insuficiencia renal, arritmias y ceguera. Alrededor del 30% de la población adulta mayor de 20 años es portadora. El 40% de los portadores ignoran padecerla ya que su inicio generalmente es asintomático. Desafortunadamente de los que ya se saben hipertensos solo la mitad toma tratamiento farmacológico y de estos, tan solo la mitad logra cifras de control (< 140/90 mmHg). Durante varias décadas no se ha logrado de forma contundente modificar la historia natural de esta enfermedad pese al avance fármaco terapéutico. El Instituto Mexicano del Seguro Social, lanza la iniciativa de los Protocolos de Atención Integral (PAI) de las principales enfermedades. En el presente protocolo se muestra cómo se concatenan los tres niveles de atención médica, el papel de cada uno de los integrantes del equipo multidisciplinario para la atención médica, incluyendo: médico, enfermera, trabajo social, psicólogo, nutricionista, entre otros y, la coparticipación del paciente. Se presentan los principales cambios en criterios diagnósticos, medición de la presión arterial dentro y fuera de consultorio, terapéutica farmacológica (monoterapia, terapia dual y terapia triple), no farmacológica y seguimiento. El Abordaje diagnóstico-terapéutico usando algoritmos, así como también el abordaje diagnóstico de la hipertensión secundaria y formas especiales de hipertensión tales como en el embarazo, crisis hipertensivas, hipertensión en el adulto mayor, pacientes isquémicos o con nefropatía.

Extraparenchymal neurocysticercosis: Demographic, clinicoradiological, and inflammatory features.

BACKGROUND: Extraparenchymal neurocysticercosis (ExPNCC), an infection caused by Taenia solium cysticerci that mainly occurs in the ventricular compartment (Ve) or the basal subarachnoid space (SAb), is more severe but less frequent and much less studied than parenchymal neurocysticercosis (ParNCC). Demographic, clinical, radiological, and lumbar cerebrospinal fluid features of patients affected by ExPNCC are herein described and compared with those of ParNCC patients. METHODOLOGY AND PRINCIPAL FINDINGS: 429 patients with a confirmed diagnosis of neurocysticercosis, attending the Instituto Nacional de Neurología y Neurocirugía, a tertiary reference center in Mexico City, from 2000 through 2014, were included. Demographic information, signs and symptoms, radiological patterns, and lumbar cerebrospinal fluid (CSF) laboratory values were retrieved from medical records for all patients. Data were statistically analyzed to assess potential differences depending on cyst location and to determine the effects of age and sex on the disease presentation. In total, 238 ExPNCC and 191 ParNCC patients were included. With respect to parenchymal cysts, extraparenchymal parasites were diagnosed at an older age (P = 0.002), chiefly caused intracranial hypertension (P < 0.0001), were more frequently multiple and vesicular (P < 0.0001), and CSF from these patients showed higher protein concentration and cell count (P < 0.0001). SAb patients were diagnosed at an older age than Ve patients, and showed more frequently seizures, vesicular cysticerci, and higher CSF cellularity. Gender and age modulated some traits of the disease. CONCLUSIONS: This study evidenced clear clinical, radiological, and inflammatory differences between ExPNCC and ParNCC, and between SAb and Ve patients, and demonstrated that parasite location determines different pathological entities.