Alternative medicine therapies in neurological disorders: Prevalence, reasons and associated factors. A systematic review.

OBJECTIVE: This systematic review aimed to identify the prevalence of CAM use in patients with neurological disorders, and also to know most frequent types of CAM used. METHODS: Five databases: PubMed, Science Direct, EBSCO, Latindex and Scielo (in English and Spanish) were searched from January 2010 to May 2021. Only original cross-sectional, retrospective and cohort studies were included, whose primary objective was to describe the frequency of CAM use in neurological disorders and/or the related factors to its use in adults. Based on the data, a descriptive analysis was performed, covering the characteristics of studies, measuring methods, prevalence, types and related factors. To control the risk of bias, a quality assessment of each study was performed using STROBE checklist. RESULTS: For the final analysis, 40 studies were included. Most common pathologies observed in the studies were multiple sclerosis, headache, stroke, Parkinson and epilepsy. The STROBE score of studies ranged from 13 to 22 points, with an average of 18.2. Prevalence of CAM use was highly variable from one study to another (16% in stroke patients, to 100% in amyotrophic lateral sclerosis or spinal cord injury patients). Biological therapies (dietary supplements and herbal medicine) were the most commonly CAM types used. The associated factors identified were female sex, an age between 40 and 50 years, and higher socioeconomic level. Not all studies investigated about the results of CAMs but these ranged from 35% to more than 80% of reporting positive effects. CONCLUSIONS: The prevalence of CAM use in neurological diseases is highly variable (16%-100%); the most used type of CAM was biological therapies and the associated factors were female sex, age between 40 and 50 years old and high socioeconomic level.

Intoxicación por metanol por consumo de bebidas alcohólicas adulteradas. Efectos en el sistema nervioso. Reporte de un caso / Methanol Poisoning by Consumption of Adulterated Alcoholic Beverages. Effects on the Nervous System. A Case Report

Resumen La intoxicación por metanol puede ocurrir de forma inadvertida por la ingesta de bebidas alcohólicas adulteradas. Se trata una entidad poco frecuente, sin embargo, se ha reportado un aumento en la incidencia durante la pandemia de COVID-19. La intoxicación con metanol representa una urgencia médica, ya que puede provocar daño severo en el sistema nervioso central y periférico, además de acidosis metabólica, daño renal agudo e incluso la muerte. En este artículo se presenta el caso de un paciente que cursó con intoxicación por metanol de manera inadvertida al consumir bebidas alcohólicas presumiblemente adulteradas. En el encéfalo se demostró necrosis hemorrágica de ambos núcleos putamen, además de cursar con neuritis óptica bilateral y polineuropatía periférica. Fue manejado con pulsos de esteroides intravenosos, con lo cual, mejoró significativamente su función visual, sensitiva y motora. En el presente caso no existieron complicaciones fatales y presentó una buena respuesta al tratamiento, sin embargo, el caso pone de relieve la necesidad de una mejor regulación en la producción y comercialización de bebidas alcohólicas en nuestro país, y, por otro lado, permite hacer a un llamado a los consumidores a tomar más precauciones en el consumo de bebidas alcohólicas de dudosa calidad o procedencia.

Abstract Methanol poisoning can occur unnoticed, by the ingestion of adulterated alcoholic beverages. In general, it is a rare entity, however, an increase in incidence has been reported during the SARS-CoV-2 pandemic. Methanol poisoning represents a medical emergency as it can cause severe damage to the central and peripheral nervous systems, as well as metabolic acidosis, acute kidney injury, and even death. This article presents the case of a patient who inadvertently developed methanol intoxication after consuming presumably adulterated alcoholic beverages. In the brain, hemorrhagic necrosis of both putamen nuclei was demonstrated, in addition to presenting with bilateral optic neuritis and peripheral polyneuropathy. He was managed with intravenous steroid pulses, which significantly improved his visual, sensory, and motor function. In the present case there were no fatal complications and presented a good response to treatment, however, the case highlights the need for better regulation in the production and marketing of alcoholic beverages in our country, and on the other hand, to invite consumers to take more precautions in the consumption of alcoholic beverages of dubious quality or origin.

Alternative and complementary medicine in neurological disorders and neurological disability patients: Prevalence, factors, opinions and reasons.

OBJECTIVES: This cross-sectional study is aimed to investigate the prevalence of the use of complementary and alternative medicine (CAM), types of CAMs used, as well as reasons and factors found in patients with neurological diseases or neurological disability. METHODS: An anonymous, self-administered survey was designed to collect information about demographics, personal medical history, CAM usage habits, and different opinions about CAM vs. conventional medicine (CM). The survey was applied by non-medical personnel in a rehabilitation hospital to patients older than 18 years, with a confirmed diagnosis of neurological disorder or neurological disability. RESULTS: 453 patients were included, 59.7 % were female. Mean age: 49 years (SD: 18.2). 200 patients (44.2 %) had a history of chronic diseases. Depression was found in 139 patients (30.7 %). Neurological disorders were: peripheral neuropathy: 97 (21.4 %), headache or migraine: 78 (17.2 %), neurodegenerative diseases: 69 (15.2 %) and stroke: 58 (12.8 %). 60.2 % (n = 273) had some degree of disability. Prevalence of CAM use was 36 % (n = 163). Most common CAMs were: Biological therapies: 133 (71.1 %), energy-based therapies: 63 (33.7 %) and body manipulation therapies: 51 (27.3 %). Reasons to use CAM were: "to complement the pharmacological treatment" (45 = 27.6 %), and "treatment failure with CM" (43 = 26.4 %). Finally, older age (p = 0.0280) and having a chronic disease (p = 0.0229) or depression (p < 0.001) were the factors associated with the current use of CAM. CONCLUSION: One third of patients with neurological pathologies use CAM, the most popular type of CAM is biologic therapies. As in other pathologies, CAM use was associated with older age, history of depression, and chronic diseases. Therefore, it is suggested that physicians routinely ask patients about the use of CAM, if they need more information about CAM, and even verify the possibility of drug interactions or adverse effects.

Cambios fisiológicos durante el embarazo normal / Physiological Changes During a Normal Pregnancy

Resumen: El organismo de la mujer experimenta una serie de cambios fisiológicos, a todos niveles, que tienen la finalidad de adaptarse y dar respuesta a la gran demanda que representan las 40 semanas de gestación que durará la formación un nuevo ser humano en su interior. Dichos cambios ocurren de manera gradual, pero continua, a lo largo de todo el embarazo y van desde cambios cardiovasculares, digestivos, pulmonares, hematológicos y endocrinos, los cuales al final también terminan por revertirse de manera paulatina durante el puerperio. Los cambios fisiológicos se relacionan con el desarrollo de distintos síntomas, signos y alteraciones en la mujer embarazada, así como cambios en los parámetros de los estudios paraclínicos, lo cual hace que resulte especialmente relevante que el médico general o de primer contacto esté familiarizado con estos cambios y el momento en el que ocurren en el embarazo, para que pueda realizar una oportuna identificación de las alteraciones que pueden representar estados patológicos que resulten una amenaza para el bienestar materno y fetal. Por todo lo anterior, el objetivo de la presente revisión temática fue recopilar y describir los principales cambios fisiológicos que ocurren en la mujer durante el embarazo normal, así como los cambios que se presentan en los estudios paraclínicos más comunes.

Abstract: The woman's body undergoes a series of physiological changes at all levels that hace the purpose of adapting and responding to the the 40 weeks of gestation. These changes occur gradually, but in a continuously, throughout the pregnancy and range from cardiovascular, digestive, pulmonary, hematological and endocrine changes, which at the end also end up gradually reversing during the puerperium. The physiological changes are related to the development of different symptoms, signs and alterations in the pregnant woman, as well as changes in the parameters of the paraclinical studies, which makes it especially relevant for the general practitioner or first contact doctor to recognize these changes and the moment in which they occur in pregnancy so that they can make a timely identification of the alterations that can represent pathological states that are a threat to maternal and fetal well-being. For all of the above, the objective of this thematic review was to collect and describe the main physiological changes that occur in women during a normal pregnancy, as well as the changes that occur in the most common paraclinical studies.