[Neurological disease surveillance and mandatory reporting: a trend and outcome of the national neurological institute of health in mexico city from 2005 to 2011]. / Enfermedades neurológicas de vigilancia y notificación obligatoria: tendencia y desenlace en un Instituto Neurológico del Sistema Nacional de Salud de la Ciudad de México, de 2005 a 2011.

INTRODUCTION: There is regulated study and mandatory reporting of epidemiological surveillance of diseases worldwide. However, it is difficult to observe the behavior of conditions especially over time, and especially when it comes to diseases that are addressed by their severity in tertiary care units. OBJECTIVE: Describe and analyze the behavior of the major communicable neurological diseases subject to epidemiological surveillance for a period of seven years in the main National Institution of Health that takes in neurological, neurosurgical and psychiatric disorders in Mexico. The main conditions that are handled and reported were acute inflammatory polyneuropathy (Guillain Barre Syndrome) and viral encephalitis, 19.7 and 18.5%, respectively. The condition showing a tendency to decrease was neurocysticercosis, and conditions most strongly associated with mortality were diseases associated to the human immunodeficiency virus and unspecified viral encephalitis. The conditions were more frequent especially in men in the age group 25 to 44 years old. It is necessary to stress the importance of timely reporting of diseases under epidemiological surveillance in Mexico, since knowledge of the behavior of action allows decisions at all levels of care.

Epidemiology and trend of neurological diseases associated to HIV/AIDS. Experience of Mexican patients 1995-2009.

OBJECTIVE: The aim of this study was to identify the main neurological conditions associated with HIV/AIDS in Mexican patients treated at the National Institute of Neurology and Neurosurgery (NINN) in Mexico city, the main referral center for patients with disorders of the central and peripheral nervous system. METHODS: An observational, transversal and descriptive analysis was performed. We reviewed the databases from the Department of Epidemiology and the medical records of patients with AIDS seen during the period from January 1st, 1995 to December 31, 2009. RESULTS: 320 patients were detected, the main conditions related to HIV/AIDS were brain toxoplasmosis (42%), cerebral criptoccocosis (28%), tuberculous meningitis (8.7%), linfoma no Hodking (3.75%), acute HIV infection (3.4%) and AIDS dementia complex (3%). No specific trend on morbility and mortality were detected during the period of study. CONCLUSIONS: In Mexico the most common neurological complications of HIV/AIDS are opportunistic infections.

Nocardia abscess during treatment of brain toxoplasmosis in a patient with aids, utility of proton MR spectroscopy and diffusion-weighted imaging in diagnosis.

We report the case of a 30-year-old man with known HIV-positive status who developed, 4 months prior to admission, recurrent left partial motor seizures followed by left hemiparesis. At another hospital, contrasted CT scan of the head revealed right frontal hypodense lesion with mass effect and focal contrast enhancement. A small left occipital lesion was also present. HIV-associated brain toxoplasmosis was considered and phenytoin, pyrimethamine, clindamycin and antiretrovirals were administered. Hemiparesis improved but, 3 weeks prior to admission, he developed progressive headache and bilateral visual defects. Upon admission to our center, he was found with left homonymous hemianopsia, right hemiparesis and a large hypodense left occipital lesion on a head CT scan. Proton MR spectroscopy showed lactate at 1.3ppm, amino acids at 0.9ppm, and diffusion-weighted imaging (DWI) revealed hyperintensity at the lesion, suggesting a pyogenic abscess. Aspiration yielded purulent material and Nocardia asteroides grew in culture. The patient was treated with trimethoprim-sulfametoxazole and recovered with a mild visual field residual defect.

[Nosocomial infections at a neurologic hospital, analysis of 10 years]. / Infecciones nosocomiales en un hospital de pacientes neurológicos, análisis de 10 años.

OBJECTIVE: To describe the results of 10 years of nosocomial infection (NI) surveillance at a neurological center and evaluate the impact of control measures. PATIENTS AND METHODS: A descriptive and retrospective study was performed at a reference center for adult neurologic and neurosurgical patients located in Mexico City. Between 1990 and 2000, the number, site and type of NI were registered. Chi Square test was employed for statistical analysis of numerical data. RESULTS: Mean NI rate observed was 21 episodes per 100 discharges, with a 40% reduction during the period. Predominant NI were urinary tract infections (36%), lower respiratory tract infections (31%), phlebitis (9%), primary bacteremia (7%), surgical wound infections (7%), and pneumonia (4%). Control measures with a definite impact were organization of intravenous therapy teams with reduction in bacteremia (p = 0.009). Changes in preoperative care, hair clipping instead of shaving, clorhexidine shampoo, and technique of long tunneled ventriculostomy with a 57% reduction (p = 0.00006) in infections related with neurosurgical procedures. The increase in staff and equipment renewal of the respiratory therapy service decreased respiratory infections. CONCLUSIONS: The measures that reduced our NI rate may be useful in other centers for neurologic patients.