Encefalitis amebiana granulomatosa por Balamuthia mandrillaris en Chile confirmada con secuenciación de ADN / Granulomatous amoebic encephalitis due to Balamuthia mandrillaris in Chile confirmed with DNA sequencing

Las enfermedades causadas por amebas de vida libre son infecciones oportunistas que pueden tener un curso fatal. Pueden producir afecciones diseminadas graves con compromiso del sistema nervioso central, como la encefalitis amebiana granulomatosa. Esta infección es cada vez más frecuente en América Latina, aunque se reconocen tardíamente debido a la similitud con otras patologías o porque es inusual incluirla en el diagnóstico diferencial. Comunicamos un caso fatal de una encefalitis amebiana granulomatosa por Balamuthia mandrillaris en una niña de 10 años. Destacamos la gravedad de la afectación cerebral y la falta de esquemas antimicrobianos validados para su tratamiento. Hoy en el mundo esta infección es considerada una enfermedad emergente, influenciada por el cambio climático, lo que llama a estar atentos a su presencia.

Diseases caused by free-living amoebae are opportunistic infections that can have a fatal course. They can cause very serious disseminated conditions with involvement of the central nervous system such as granulomatous amoebic encephalitis. This infection has become more common in Latin America, although its recognition is late due to the similarity with other pathological conditions or because it is unusual to include it in the differential diagnosis. We report a fatal case of granulomatous amoebic encephalitis due to Balamuthia mandrillaris in a 10-year-old girl. We highlight the severity of the brain involvement and the lack of validated schemes for its treatment. Today in the world this infection is considered an emerging disease, influenced by climate change, which calls for being attentive to its presence.

Cortical mapping in glioma surgery: correlation of fMRI and direct electrical stimulation with Human Connectome Project parcellations.

OBJECTIVE: Noninvasive brain mapping with functional MRI (fMRI) and mapping with direct electrical stimulation (DES) are important tools in glioma surgery, but the evidence is inconclusive regarding the sensitivity and specificity of fMRI. The Human Connectome Project (HCP) proposed a new cortical parcellation that has not been thoroughly tested in a clinical setting. The main goal of this study was to evaluate the correlation of fMRI and DES mapping with HCP areas in a clinical setting, and to evaluate the performance of fMRI mapping in motor and language tasks in patients with glioma, using DES as the gold standard. METHODS: Forty patients with supratentorial gliomas were examined using preoperative fMRI and underwent awake craniotomy with DES. Functional activation maps were visualized on a 3D representation of the cortex, classified according to HCP areas, and compared with surgical mapping. RESULTS: Functional MRI was successful in identifying language and motor HCP areas in most cases, including novel areas such as 55b and the superior longitudinal fasciculus (SLF). Functional MRI had a sensitivity and specificity of 100% and 71%, respectively, for motor function in HCP area 4. Sensitivity and specificity were different according to the area and fMRI protocol; i.e., semantic protocols performed better in Brodmann area (BA) 55b/peri-sylvian language areas with 100% sensitivity and 20% specificity, and word production protocols in BAs 44 and 45 with 70% sensitivity and 80% specificity. Some compensation patterns could be observed, such as motor activation of the postcentral gyrus in precentral gliomas. CONCLUSIONS: HCP areas can be detected in clinical scenarios of glioma surgery. These areas appear relatively stable across patients, but compensation patterns seem to differ, allowing occasional resection of activating areas. Newly described areas such as 55b and SLF can act as critical areas in language networks. Surgical planning should account for these parcellations.

Caracterización de patrones alimentarios al inicio de la pandemia por covid 19 en chile / Characterization of the dietary profile of the old adults in Ibero-american during of pandemic by COVID 19

Objetivo: Caracterizar el perfil alimentario de las Personas Mayores de Iberoamérica en tiempos de pandemia por COVID 19.Material y métodos: Estudio multicéntrico en 12 países de Iberoamérica, se aplicó una encuesta en línea que incluyó preguntas sociodemográficas y un cuestionario de Ingesta de Alimentos que incluyo la frecuencia de consumo para verduras, bebidas azucaradas, legumbres, lácteos y porción de los alimentos.Resultados: La muestra quedó conformada por 624 participantes, 72,1% (n= 450) de mujeres. El 54,7% de mujeres no consume bebidas azucaradas, en cambio en hombres un 54% consume al menos un vaso al día (p=0,012). El 35,6% de hombres consumieron ≥3 por semana legumbres versus el 23% mujeres (p=0,020). El 37,3% de las mujeres consumen ≥2 porciones diarias de lácteos, en hombres solo un 28,1% (p= 0,030). Las mujeres presentan un mayor consumo de verduras (44,7%, n= 201) respecto de los hombres (28,7%), (p=0,001). El 17,4% de la muestra total aumentó el tamaño de la porción de alimentos, sin do mayor en mujeres (p=0.005).Conclusión: Las mujeres presentan hábitos alimentarios más saludables que los hombres en base a frutas, verduras, por otra parte, la variación del tamaño se observa un incremento en especial en mujeres lo que puede relacionarse con el aumento de la obesidad.(AU)

Objective: To characterize the food profile of the OlderPeople of Ibero-America in times of the COVID 19 pandemic.Material and methods: Multicenter study in 12 Ibero-American countries, an online survey was applied thatincluded sociodemographic questions and a Food Intakequestionnaire that included the frequency of consumption forvegetables, sugary drinks, legumes, dairy products andportion of food.Results: The sample was made up of 624 participants,72.1% (n= 450) of women. 54.7% of women do not consumesugary drinks, while in men 54% consume at least one glassa day (p=0.012). 35.6% of men consumed ≥3 legumes perweek versus 23% of women (p=0.020). 37.3% of womenconsume ≥2 daily servings of dairy products, in men only28.1% (p= 0.030). Women have a higher consumption ofvegetables (44.7%, n= 201) compared to men (28.7%),(p=0.001). 17.4% of the total sample increased the size ofthe food portion, being higher in women (p=0.005).Conclusion: Women have healthier eating habits thanmen based on fruits, vegetables, on the other hand, thevariation in size increases, especially in women.(AU)

Transradial access for pediatric teenage neurointervention: A single-center case series.

Transradial access is widely used in cardiological adult interventions and less in pediatrics. In recent years, this access has become more popular in the neuroradiological community in adult patients since it has fewer complications and is more comfortable for the patient after the procedure. We present a single-center case series of 52 transradial access neurointerventions (43 angiographies and 9 therapeutic procedures) in pediatric patients, with a failure of 4 cases (7.7%) in which we could not puncture the artery, crossing over to transfemoral access. Since in five cases we did angiography followed by therapeutic intervention, thus doing only one puncture access for both procedures, then our access failure rate was 10.6%. The 34 successful transradial access solely angiographies had a median radiation exposure of 887 mGy (interquartile range 628-1352), median fluoroscopy time of 9.5 min (interquartile range 7.5-15.3), and median procedure time of 28 min (interquartile range 24-33 min) Therapeutic procedure diagnosis were: one ruptured saccular aneurysm, two juvenile nasopharyngeal angiofibromas, and five arteriovenous malformations. The transradial access neurointerventions for pediatric population older than 11 years is safe and feasible, having previous experience in adults. Younger population should be considered on a case-to-case basis, depending on ultrasound measurement of the arterial diameter and the materials available.

Etapas de cambio en alimentos con etiquetado frontal de advertencia / Stages of change in foods with front warning labeling

Los datos en Chile demuestran el efecto que causa la mala alimentación y sus consecuencias. Considerando los problemas alimentarios, el 26 de junio de 2016, la Ley 20.606, entró en vigencia. Determinar el estado de cambio en la intención de compra de alimentos con sello de advertencia en la tercera etapa de la ley. Estudio descriptivo transversal en población chilena, de ambos sexos, entre 18 y 59 años de edad, en usuarios frecuentes de internet. Los datos se obtuvieron a través de una encuesta creada y validada mediante el método de Lawshe, la cual contiene un total de 45 preguntas, en las que se plantea, ¿qué nivel de confianza siente el participante para realizar un cambio? y ¿Cuán importante es para el realizar ese cambio?. Se analizaron 545 encuestas a nivel nacional, el 59,8% corresponde a mujeres, del total de personas el 52,1% es mayor de 30 años de edad. Respecto a la compra de alimentos con sello según sexo, se observa que hay diferencias significativas en la compra de galletas, papas fritas y bebidas azucaradas, en todos los casos los hombres presentan una mayor resistencia al cambio que las mujeres. Pese a que todos los alimentos se encuentran en contemplación, hay diferencias significativas en el puntaje en galletas y bebidas azucaradas y papas fritas en los hombres, respecto a la edad, hay diferencias en todos los alimentos. Al comparar por estado nutricional se observan diferencias significativas en bebidas, galletas, papas fritas y chocolates, en obesidad. Los hombres presentan una mayor resistencia al cambio, por otro lado, se observa que la intención de compra de todos los alimentos se encuentra en contemplación sin embargo hay diferencias en todos los alimentos.

Data in Chile demonstrate the effect caused by poor diet and its consequences. Considering food problems, on June 26, 2016, Law 20,606 came into force. To determine the status of change in the intention to purchase food with a warning labels in the third stage of the law. Cross-sectional descriptive study in a Chilean population, of both sexes, between 18 and 59 years of age, in frequent Internet users. The data were obtained through a survey created and validated using the Lawshe method, which contains a total of 45 questions, in which it is asked, what level of confidence does the participant feel to make a change? And how important is it for making that change?. 545 surveys were analyzed at the national level, 59.8% correspond to women, of the total number of people 52.1% are over 30 years of age. Regarding the purchase of food stamped by sex, it is observed that there are significant differences in the purchase of cookies, French fries and sugary drinks, in all cases men present a greater resistance to change than women. Although all foods are in contemplation, there are significant differences in the score in cookies and sugary drinks and French fries in men, with respect to age, there are differences in all foods. When comparing by nutritional status, significant differences are observed in beverages, cookies, French fries and chocolates, in obesity. Men present greater resistance to change, on the other hand, it is observed that the intention to purchase all foods is in contemplation, however there are differences in all foods.

Impact of b-Value Sampling Scheme on Brain IVIM Parameter Estimation in Healthy Subjects.

PURPOSE: Intravoxel incoherent motion (IVIM) analysis has attracted the interest of the clinical community due to its close relationship with microperfusion. Nevertheless, there is no clear reference protocol for its implementation; one of the questions being which b-value distribution to use. This study aimed to stress the importance of the sampling scheme and to show that an optimized b-value distribution decreases the variance associated with IVIM parameters in the brain with respect to a regular distribution in healthy volunteers. METHODS: Ten volunteers were included in this study; images were acquired on a 1.5T MR scanner. Two distributions of 16 b-values were used: one considered 'regular' due to its close association with that used in other studies, and the other considered 'optimized' according to previous studies. IVIM parameters were adjusted according to the bi-exponential model, using two-step method. Analysis was undertaken in ROI defined using in the Automated Anatomical Labeling atlas, and parameters distributions were compared in a total of 832 ROI. RESULTS: Maps with fewer speckles were obtained with the 'optimized' distribution. Coefficients of variation did not change significantly for the estimation of the diffusion coefficient D but decreased by approximately 39% for the pseudo-diffusion coefficient estimation and by 21% for the perfusion fraction. Distributions of adjusted parameters were found significantly different in 50% of the cases for the perfusion fraction, in 80% of the cases for the pseudo-diffusion coefficient and 17% of the cases for the diffusion coefficient. Observations across brain areas show that the range of average values for IVIM parameters is smaller in the 'optimized' case. CONCLUSION: Using an optimized distribution, data are sampled in a way that the IVIM signal decay is better described and less variance is obtained in the fitted parameters. The increased precision gained could help to detect small variations in IVIM parameters.

[Propofol Infusion Syndrome in a refractory epileptic status case]. / Síndrome por Infusión de Propofol en un caso de estatus epiléptico refractario.

INTRODUCTION: Propofol Infusion Syndrome (PRIS) is a rare but potentially lethal adverse reaction secondary to the continuous intravenous infusion of this drug. The diagnosis is based on the com bination of metabolic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, renal failure, hyperli pidemia, arrhythmias, and rapidly progressive heart failure. OBJECTIVE: To report a case of PRIS and literature review. CLINICAL CASE: A 6-year-old female patient with history of epilepsy secondary to large malformation of cortical development of the right hemisphere. The patient presented a refractory status epilepticus that required admission to the Intensive Care Unit for life support and treatment, which included continuous intravenous infusion of propofol at 10 mg/kg/h. She developed hemo dynamic instability, and after 24 h of treatment an increase of creatine phosphokinase (CPK) levels, metabolic acidosis and elevated lactacidemia were observed. After ruling out other causes, PRIS was diagnosed; therefore, the drug was suspended, achieving hemodynamic stabilization after 24 hours. DISCUSSION: The diagnosis of PRIS is complex and should be considered in patients who are receiving this drug and present metabolic acidosis or heart failure. The factors that most influence mortality are the cumulative dose of the drug, the presence of fever, and cranial brain injury. In the case described, the patient received a dose higher than 4 mg/kg/h, which is the maximum recommended dose, and responded favorably 12 hours after stopping the drug.

Síndrome por Infusión de propofol en un caso de estatus epiléptico refractario / Propofol infusion syndrome in a refractory epileptic status case

INTRODUCCIÓN: El síndrome por infusión de propofol (SIP) es una reacción adversa poco frecuente, pero potencialmente letal descrita por la utilización de dicho fármaco en infusión intravenosa (IV) continua. El diagnóstico se basa en la combinación de acidosis metabólica, rabdomiolisis, hiperkalemia, hepatomegalia, insuficiencia renal, hiperlipidemia, arritmias e insuficiencia cardiaca rápida mente progresiva. OBJETIVO: Presentación de un caso clínico de SIP y revisión de literatura. CASO CLÍNICO: Paciente femenino de 6 años de edad con antecedentes de epilepsia secundaria a extensa alteración del desarrollo cortical hemisférico derecho. Presentó estatus epiléptico refractario que requirió ingreso a Unidad de Cuidados Intensivos para soporte vital y tratamiento, el que incluyó como terapia de tercera línea infusión intravenosa continua de propofol en dosis progresivas hasta alcanzar una tasa 10 mg/kg/h. Cursó con compromiso hemodinámico y a las 24 h de iniciado el tratamiento se observó alza de la creatinifosfokinasa (CK), acidosis metabólica y lactacidemia elevada, y luego de descartar otras causas se planteó el diagnóstico de SIP por lo que se suspendió la droga, logrando estabilización hemodinámica a las 24 h. DISCUSIÓN: El diagnóstico de SIP es complejo, se debe considerar en pacientes que estén recibiendo el fármaco y presenten acidosis metabólica o insuficiencia cardiaca. Los factores que más influyen en la mortalidad son la dosis acumulativa de la droga, la presencia de fiebre y lesión encéfalo craneana. En el caso descrito la paciente recibió una dosis mayor a 4 mg/ kg/h que es la dosis máxima recomendada y respondió favorablemente luego de 12 h después de la suspensión del fármaco.

INTRODUCTION: Propofol Infusion Syndrome (PRIS) is a rare but potentially lethal adverse reaction secondary to the continuous intravenous infusion of this drug. The diagnosis is based on the com bination of metabolic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, renal failure, hyperli pidemia, arrhythmias, and rapidly progressive heart failure. OBJECTIVE: To report a case of PRIS and literature review. CLINICAL CASE: A 6-year-old female patient with history of epilepsy secondary to large malformation of cortical development of the right hemisphere. The patient presented a refractory status epilepticus that required admission to the Intensive Care Unit for life support and treatment, which included continuous intravenous infusion of propofol at 10 mg/kg/h. She developed hemo dynamic instability, and after 24 h of treatment an increase of creatine phosphokinase (CPK) levels, metabolic acidosis and elevated lactacidemia were observed. After ruling out other causes, PRIS was diagnosed; therefore, the drug was suspended, achieving hemodynamic stabilization after 24 hours. DISCUSSION: The diagnosis of PRIS is complex and should be considered in patients who are receiving this drug and present metabolic acidosis or heart failure. The factors that most influence mortality are the cumulative dose of the drug, the presence of fever, and cranial brain injury. In the case described, the patient received a dose higher than 4 mg/kg/h, which is the maximum recommended dose, and responded favorably 12 hours after stopping the drug.

Fronto-Subcortical Circuits for Cognition and Motivation: Dissociated Recovery in a Case of Loss of Psychic Self-Activation.

In humans and non-humans primates, extensive evidence supports the existence of subcortico-cortical circuits for cognition and behavior. Lesions studies are critical to understand the clinical significance of these functionally segregated circuits. Mapping these circuits from lesion studies is difficult given the heterogeneous etiology of the lesions, the lack of long-term and systematic testing of cognitive and behavioral disturbances, as well as the scarcity of neuroimaging data for identifying the precise location and extent of subcortical lesions. Here, we report the long-term follow-up study of a patient who developed a loss of psychic self-activation associated to a dysexecutive syndrome following resuscitation from cardiac arrest. Neuroimaging revealed extensive bilateral lesions in the putamen, with a relative spare of the caudate, and exhibiting a dorsoventral gradient that was predominantly rostrally to the anterior commissure and spared most of the ventral striatum. In comprehensive neuropsychological and neuropsychiatric assessments, we observed dissociation between the improvement of the self-activation deficits and the stability of the dysexecutive syndrome. The pattern of recovery after this lesion lends support to current models proposing the existence of two main subcortico-cortical circuits: a dorsal circuit, mostly mediating cognitive processes, and a ventral circuit, implicated in motivation.

Efectos cognitivos de la estimulación audiovisual en niños con limitaciones severa de la movilidad: la utilidad de las tecnologías de apoyo de bajo costo / The cognitive effects of audiovisual stimulation in children with severe mobility limitations: the utility of low-cost assistive technology

El desarrollo cognitivo del niño requiere de la exploración del entorno. En niños con enfermedades neuromusculares, esta exploración está limitada, dificultando su desarrollo. El objetivo de este estudio es evaluar un modelo de estimulación audiovisual de bajo costo. Se desarrollaron dos vehículos de estimulación audiovisual portátiles (VEP), usados para presentar la intervención, y que eran apropiados para la población participante. En la intervención se incluyó a 9 niños(mediana edad=42,6 meses; rango = 16-99 meses) con enfermedades neuromusculares. El programa de estimulación duró 20 días. Para evaluar la intervención, se usó un lector de movimientos oculares que registró la actividad en una tarea de rastreo visual. Además, se evaluó la frecuencia de respuesta en una tarea de causa-efecto. En la tarea de rastreo visual, tres pacientes (42,8 por ciento) disminuyeron el tiempo de ejecución, en magnitud del 61,9 por ciento (mediana: 13s; rango: 9-54,5 s). Con respecto al número de errores: 5 de 7 participantes (71,4 por ciento) disminuyeron los errores, en magnitud del 56 por ciento (mediana: 5 errores; rango: 2,3-5,8 errores). Respecto a la tarea de causa-efecto, dos de cuatro pacientes mostraron un mejor rendimiento, siendo mas responsivos a la estimulación ambiental. Los resultados muestran que los niños se beneficiaron de la intervención, incluso, los más pequeños. Estas intervenciones deben ser parte de la atención de niños con limitaciones del movimiento...

The cognitive development of children requires the exploration of the environment. In children with neuromuscular diseases this exploration is limited, compromising their development.The aim of this study is to assess a model of low-cost audiovisual stimulation. Two audiovisual stimulation portable vehicle (VEP, in Spanish), were used to apply the intervention, as they were appropriate for the patients. In the intervention, 9 children (age median=42.6 months; range= 16.99) with muscular disease were included. The program of stimulation lasted 20 days. In order to assess the intervention, an eye-tracker device was used to register the performance in a visual pursuit task. In addition, responsiveness was assessed. In the visual pursuit task, three patients (42,8 per cent) diminished the latency in 61,9 per cent (median: 13s; range: 9-54,5 s). Regarding the amount of errors: 5 out 7 participants (71,4 per cent) diminished the amount of errors in 56 per cent (median: 5 errors; range: 2,3-5,8 errors). In regards of the cause-effect task, two out of four subjects showed a better performance, being more responsive to the environmental stimulation. The results show that children are benefited from the intervention, even the younger ones. This intervention should be part of the attention of children with mobility limitations...

Middle cerebral artery occlusion with moyamoya-like vessels and aneurysms. A report of two cases.

We describe two cases of aneurysmal rupture in moyamoya-like vessels in middle cerebral artery occlusion. This phenomenon was previously described in severe steno-occlusive disease and accounts for the hemorrhagic presentation. To our knowledge, these are the second and third clinical cases published in modern neuroradiological literature.

Tecnología, acompañamiento psicológico y neuropsicología: tres vías para salir del síndrome de enclaustramiento / Technology, psychological support and neuropsychology: three ways out from Locked-in Syndrome

Los trastornos severos de la movilidad (TSM) se refieren a un conjunto amplio de patologías en las que se ve comprometida la capacidad de realizar movimientos voluntarios, involucrando no sólo la movilidad física, sino que también la comunicación y participación en la comunidad. Los avances médicos han mejorado notablemente las tasas de sobrevida de estas personas, planteando nuevos desafíos para su rehabilitación. Modelos actuales de rehabilitación en enfermedades neurológicas han destacado la importancia de intervenciones interdisciplinarias, donde no sólo se enfoque al tratamiento médico de la enfermedad, sino que también se promueva el bienestar psicosocial y la reinserción laboral. Desafortunadamente, estos modelos no se han transferido completamente a personas con TSM. En este trabajo se presenta una intervención tecnológica para favorecer la inclusión de una persona con Síndrome de Enclaustramiento producto de un traumatismo craneano. Con tal fin, se creó un sistema de comunicación aumentativa basado en un dispositivo lector de movimientos oculares. El diseño de dicho aparato fue ajustado de acuerdo a los rendimientos cognitivos del paciente. Este comunicador, permitió realizar una experiencia de acompañamiento psicológico orientada a apoyar la reinserción social y laboral de la persona. En un equipo interdisciplinario, y trabajando en conjunto con su red de trabajo, se facilitó el proceso de comunicación y re-inserción laboral a través de la estrategia de teletrabajo. Los resultados obtenidos en este caso apoyan la utilidad del uso integral de tecnología, acompañamiento psicológico y evaluación cognitiva, para promover la participación en personas con trastornos severos de movilidad...

Severe mobility disorders (SMD) refer to a broad set of difficulties, in which the ability to perform voluntary movements is compromised. Importantly, this impairment does not only have an impact on locomotion, but also generates drastic changes on social participation. Medical treatments have remarkably improved the survival rates of these patients, generating new challenges for rehabilitation teams. Current models in neuro-rehabilitation have highlighted the value of interdisciplinary interventions, particularly on those that promote psychosocial well-being and vocational rehabilitation. Nevertheless, these models have not been completely applied to people with SMD. This article describes the rehabilitation process of a patient with a Locked in Syndrome, which main goal was the use of technology to promote social inclusion and vocational rehabilitation. In order to achieve such goal, an augmentative communication system was created, based on an eye-tracker device. The design of the communicator was tailored to the particular cognitive abilities [and deficits] presented by the patient. This communicator enabled the rehabilitation team to psychologically support the patient during the process of social and vocational reinsertion. A telework-based strategy was used to enable the patient to resume productive life, as well as activating the patient’s social network. The experience obtained in this case supports the value of combining neuropsychological data, technology and psychological support in the rehabilitation process of people with SMD. Finally, general guidelines for clinical practices in rehabilitation with this population are suggested...

Estimulación audiovisual en niños con limitación grave de la motricidad: ¿mejora su calidad de vida? / Audiovisual stimulation in children with severely limited motor function: does it improve their quality of life?

Introducción. Los niños con enfermedades neurológicas que condicionan una limitación grave de la movilidad tienen una calidad de vida (CV) deficiente. Objetivo. Estudiar si la CV de dichos pacientes mejora con la aplicación de un programa de estimulación audiovisual. Pacientes y métodos. Estudio prospectivo en nueve niños, seis de ellos varones (edad media: 42,6 ± 28,6 meses), con limitación grave de la movilidad, hospitalizados de manera prolongada. Se elaboraron dos programas de estímulo audiovisual que, junto con vídeos, se aplicaron mediante una estructura especialmente diseñada. La frecuencia fue de dos veces al día, por 10 minutos, durante 20 días. Los primeros diez días se llevó a cabo de manera pasiva y los segundos diez con guía del observador. Se registraron variables biológicas, conductuales, cognitivas y se aplicó una encuesta de CV adaptada. Resultados. Se diagnosticaron tres casos de atrofia muscular espinal, dos de distrofia muscular congénita, dos de miopatía y dos con otros diagnósticos. Ocho pacientes completaron el seguimiento. Desde el punto de vista basal, presentaron CV regular (7,2 ± 1,7 puntos; mediana: 7,0; rango: 6-10), que mejoraba a buena al finalizar (9,4 ± 1,2 puntos; mediana: 9,0; rango: 8-11), con diferencia intraindividual de 2,1 ± 1,6 (mediana: 2,5; rango: –1 a 4; IC 95% = 0,83-3,42; p = 0,006). Se detectó mejoría en cognición y percepción favorable de los cuidadores. No hubo cambio en las variables biológicas ni conductuales. Conclusión. Mediante la estimulación audiovisual es posible mejorar la calidad de vida de niños con limitación grave de la movilidad (AU)

Introduction. Children with neurological diseases that impose severe limitations on their mobility have a deficient quality of life (QL). Aims. To study whether the QL of such patients improves with the application of a programme of audiovisual stimulation. Patients and methods. A prospective study was conducted on nine children, six of whom were males (mean age: 42.6 ± 28.6 months), with severely limited mobility and who had been hospitalised for long periods. Two audiovisual stimulation programmes were produced and applied, together with videos, by means of a specially designed structure. The stimulus was applied twice a day for 10 minutes over 20 days. The first ten days the stimulus was carried out in a passive manner and the second block of ten days it was performed with the guidance of the observer. Biological, behavioural and cognitive variables were recorded and an adapted QL survey was applied. Results. Three cases of spinal muscular atrophy, two of congenital muscular dystrophy, two of myopathy and two with other conditions were diagnosed. Eight patients completed the follow-up. From the baseline point of view, they presented a regular QL (7.2 ± 1.7 points; median: 7.0; range: 6-10), which improved to good on finishing the therapy (9.4 ± 1.2 points; median: 9.0; range: 8-11), with an intra-individual difference of 2.1 ± 1.6 (median: 2.5; range: –1 to 4; CI 95% = 0.83-3.42; p = 0.006). Improved cognition and a favourable perception in the caregivers were detected. No changes took place in the biological or behavioural variables. Conclusions. Audiovisual stimulation can be used to enhance the quality of life of children with severely limited mobility (AU)

[Audiovisual stimulation in children with severely limited motor function: does it improve their quality of life?]. / Estimulacion audiovisual en niños con limitacion grave de la motricidad: mejora su calidad de vida?

INTRODUCTION: Children with neurological diseases that impose severe limitations on their mobility have a deficient quality of life (QL). AIMS: To study whether the QL of such patients improves with the application of a programme of audiovisual stimulation. PATIENTS AND METHODS: A prospective study was conducted on nine children, six of whom were males (mean age: 42.6 ± 28.6 months), with severely limited mobility and who had been hospitalised for long periods. Two audiovisual stimulation programmes were produced and applied, together with videos, by means of a specially designed structure. The stimulus was applied twice a day for 10 minutes over 20 days. The first ten days the stimulus was carried out in a passive manner and the second block of ten days it was performed with the guidance of the observer. Biological, behavioural and cognitive variables were recorded and an adapted QL survey was applied. RESULTS: Three cases of spinal muscular atrophy, two of congenital muscular dystrophy, two of myopathy and two with other conditions were diagnosed. Eight patients completed the follow-up. From the baseline point of view, they presented a regular QL (7.2 ± 1.7 points; median: 7.0; range: 6-10), which improved to good on finishing the therapy (9.4 ± 1.2 points; median: 9.0; range: 8-11), with an intra-individual difference of 2.1 ± 1.6 (median: 2.5; range: -1 to 4; CI 95% = 0.83-3.42; p = 0.006). Improved cognition and a favourable perception in the caregivers were detected. No changes took place in the biological or behavioural variables. CONCLUSIONS: Audiovisual stimulation can be used to enhance the quality of life of children with severely limited mobility.

TITLE: Estimulacion audiovisual en niños con limitacion grave de la motricidad: mejora su calidad de vida?Introduccion. Los niños con enfermedades neurologicas que condicionan una limitacion grave de la movilidad tienen una calidad de vida (CV) deficiente. Objetivo. Estudiar si la CV de dichos pacientes mejora con la aplicacion de un programa de estimulacion audiovisual. Pacientes y metodos. Estudio prospectivo en nueve niños, seis de ellos varones (edad media: 42,6 ± 28,6 meses), con limitacion grave de la movilidad, hospitalizados de manera prolongada. Se elaboraron dos programas de estimulo audiovisual que, junto con videos, se aplicaron mediante una estructura especialmente diseñada. La frecuencia fue de dos veces al dia, por 10 minutos, durante 20 dias. Los primeros diez dias se llevo a cabo de manera pasiva y los segundos diez con guia del observador. Se registraron variables biologicas, conductuales, cognitivas y se aplico una encuesta de CV adaptada. Resultados. Se diagnosticaron tres casos de atrofia muscular espinal, dos de distrofia muscular congenita, dos de miopatia y dos con otros diagnosticos. Ocho pacientes completaron el seguimiento. Desde el punto de vista basal, presentaron CV regular (7,2 ± 1,7 puntos; mediana: 7,0; rango: 6-10), que mejoraba a buena al finalizar (9,4 ± 1,2 puntos; mediana: 9,0; rango: 8-11), con diferencia intraindividual de 2,1 ± 1,6 (mediana: 2,5; rango: ­1 a 4; IC 95% = 0,83-3,42; p = 0,006). Se detecto mejoria en cognicion y percepcion favorable de los cuidadores. No hubo cambio en las variables biologicas ni conductuales. Conclusion. Mediante la estimulacion audiovisual es posible mejorar la calidad de vida de niños con limitacion grave de la movilidad.

The technology - activities of daily living questionnaire: a version with a technology-related subscale.

BACKGROUND: Information and communication technology (ICT) has become an increasingly important part of daily life. The ability to use technology is becoming essential for autonomous functioning in society. Current functional scales for patients with cognitive impairment do not evaluate the use of technology. The objective of this study was to develop and validate a new version of the Activities of Daily Living Questionnaire (ADLQ) that incorporates an ICT subscale. METHOD: A new technology-based subscale was incorporated into the Spanish version of the ADLQ (SV-ADLQ), entitled the Technology version of the ADLQ (T-ADLQ). The T-ADLQ was administered to 63 caregivers of dementia patients, 21 proxies of mild cognitive impairment patients and 44 proxies of normal elderly subjects (mean age of the sample ± SD: 73.5 ± 8.30 years). We analysed the convergent validity, internal consistency, reliability cut-off point, sensitivity and specificity of the T-ADLQ. The results of the T-ADLQ were compared to the SV-ADLQ. RESULTS: The T-ADLQ showed significant correlations with the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB) as well as other measures of functional impairment and dementia severity (MMSE: r = -0.70; FAB: r = -0.65; Functional Assessment Questionnaire: r = 0.77; Instrumental Activities of Daily Living Scale: r = -0.75; Clinical Dementia Rating Scale: r = 0.72; p < 0.001). The T-ADLQ showed a good reliability with a relatively high Cronbach's α-coefficient (Cronbach's α = 0.861). When considering a functional impairment cut-off point greater than 29.25%, the sensitivity and specificity of the T-ADLQ were 82 and 90%, respectively. The area under the receiver-operating characteristic curve was 0.937 for the T-ADLQ and 0.932 for the original version of the test. CONCLUSIONS: The T-ADLQ revealed adequate indicators of validity and reliability for the functional assessment of activities of daily living in dementia patients. However, the inclusion of technology items in the T-ADLQ did not improve the performance of the scale, which may reflect the lack of widespread use of technology by elderly individuals. Thus, although it appeared reasonable to add technology use questions to the ADLQ, our experience suggested that this has to be done cautiously, since the sensitivity of these additional items could vary in different populations. The T-ADLQ needs to be validated in a different population of dementia subjects.

The relationship of clinical, cognitive and social measures in schizophrenia: a preliminary finding combining measures in probands and relatives.

This study examines performance of schizophrenia patients, unaffected relatives and controls in social cognition, cognitive and psychiatric scales looking for possible markers of vulnerability in schizophrenia. Performance of schizophrenia patients from multiplex families, first-degree relatives, and matched controls was compared and, subsequently, discriminant analysis method was used for identifying the best predictors for group membership. By using Multigroup Discriminant Analyses on the three groups, the best predictors were PANSS, Premorbid Adjustment Scale, Faux Pas test, and a face/emotion categorizing task. This model obtained 82% correct global classification, suggesting that the combination of psychiatric scales and neuropsychological/social cognition tasks are the best approach for characterizing this disease. Although preliminary, our results suggest that social cognition tasks are robust markers of schizophrenia family impairments, and that combining clinical, social and neuropsychological measures is the best approach to asses patients and relatives vulnerability.

The face and its emotion: right N170 deficits in structural processing and early emotional discrimination in schizophrenic patients and relatives.

Previous studies have reported facial emotion recognition impairments in schizophrenic patients, as well as abnormalities in the N170 component of the event-related potential. Current research on schizophrenia highlights the importance of complexly-inherited brain-based deficits. In order to examine the N170 markers of face structural and emotional processing, DSM-IV diagnosed schizophrenia probands (n=13), unaffected first-degree relatives from multiplex families (n=13), and control subjects (n=13) matched by age, gender and educational level, performed a categorization task which involved words and faces with positive and negative valence. The N170 component, while present in relatives and control subjects, was reduced in patients, not only for faces, but also for face-word differences, suggesting a deficit in structural processing of stimuli. Control subjects showed N170 modulation according to the valence of facial stimuli. However, this discrimination effect was found to be reduced both in patients and relatives. This is the first report showing N170 valence deficits in relatives. Our results suggest a generalized deficit affecting the structural encoding of faces in patients, as well as the emotion discrimination both in patients and relatives. Finally, these findings lend support to the notion that cortical markers of facial discrimination can be validly considered as vulnerability markers.

Facial and semantic emotional interference: a pilot study on the behavioral and cortical responses to the Dual Valence Association Task.

BACKGROUND: Integration of compatible or incompatible emotional valence and semantic information is an essential aspect of complex social interactions. A modified version of the Implicit Association Test (IAT) called Dual Valence Association Task (DVAT) was designed in order to measure conflict resolution processing from compatibility/incompatibly of semantic and facial valence. The DVAT involves two emotional valence evaluative tasks which elicits two forms of emotional compatible/incompatible associations (facial and semantic). METHODS: Behavioural measures and Event Related Potentials were recorded while participants performed the DVAT. RESULTS: Behavioural data showed a robust effect that distinguished compatible/incompatible tasks. The effects of valence and contextual association (between facial and semantic stimuli) showed early discrimination in N170 of faces. The LPP component was modulated by the compatibility of the DVAT. CONCLUSIONS: Results suggest that DVAT is a robust paradigm for studying the emotional interference effect in the processing of simultaneous information from semantic and facial stimuli.

Effects of donepezil on behavioral manifestations of thalamic infarction: a single-case observation.

OBJECTIVE: To examine the effect of donepezil for the treatment of cognitive and behavioral disorders associated with thalamic lesions in a 45-year-old male who suffered an infarct in the left thalamus. BACKGROUND: Recent studies suggest that donepezil may improve executive functions impairments due to subcortical ischemic lesions. METHOD: The effects of donepezil were analyzed in a single-case of thalamic infarction with cognitive and behavioral alterations in an open label study. RESULTS: Significant behavioral modifications related to improved performances in executive functions were observed with the treatment. CONCLUSION: The results suggest that donepezil may have significant effect on executive functions that can alter behavioral outcomes after thalamic infarctions.