RESUMO
INTRODUCTION: Multiple sclerosis (MS) is a chronic neurological autoimmune condition and the leading non-traumatic cause of neurological disability worldwide. Disease-modifying therapies (DMT) directly impact on the long-term prognosis of patients with MS preventing relapses and the associated disability progression. Here, we analyzed the impact of socioeconomic status (SES) on DMT access in Mexican patients. METHODS: We evaluated the association between SES and DMT access using the MS registry from the National Institute of Neurology and Neurosurgery in Mexico City. We included 974 patients with MS (McDonald 2010 criteria). We categorized SES according to the 2018 Mexican Association of Market Research Agencies (AMAI) SES classification. We analyzed DMT type, MS phenotype, educational level, symptomatic onset to diagnosis, EDSS at arrival, as well as the progression index. Chi-squared and Wilcoxon tests were used, and multivariable analysis performed for DMT access. RESULTS: When comparing the lower versus higher levels of SES, a significant association was found on the percentage of patients with higher levels of disability (EDSS >6) at arrival, the proportion of patients not receiving any DMT and a higher proportion of secondary progressive MS (p=0.006, p<0.001and p=0.004, respectively). We also found that lower educational levels had a significance and inverse association with EDSS on first visit (p=0.019), symptomatic onset to diagnosis (p<0.001) and a higher disability status at arrival (EDSS >6, p=0.010). CONCLUSIONS: Our study suggests that SES is an important factor determining not only prompt but overall access to highly effective DMT. Lower SES are associated with greater levels of disability at the first clinic visit and a higher proportion of patients not receiving DMT up to 12 months of follow-up.
Assuntos
Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla , Humanos , México , Recidiva , Classe SocialRESUMO
Long-term exposure to air pollution has been linked with the development of neurodegenerative diseases. The proposed mechanisms include neuroinflammation and brain oxidative stress. Multiple sclerosis (MS) is a neurodegenerative disease with an auto-immune physiopathology and some studies have associated it with long-term exposure to airborne particulate matter. In this opinion we discuss the current body of knowledge regarding air pollution and the risk of MS as well as MS relapses. Also, its relevance in the case of Mexico City is discussed.
Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Esclerose Múltipla/induzido quimicamente , Doenças Neurodegenerativas/induzido quimicamente , Material Particulado/toxicidade , Poluentes Atmosféricos/análise , Encéfalo/patologia , Exposição Ambiental , Humanos , México/epidemiologia , Esclerose Múltipla/epidemiologia , Material Particulado/análise , RecidivaRESUMO
OBJECTIVE: To explore the clinical prognostic factors for adults affected with astrocytoma. PATIENTS AND METHODS: Using a historic cohort, we selected 155 clinical files from patients with astrocytoma using simple randomization. The main outcome variable was overall survival time. To identify clinical prognostic factors, we used bivariate analysis, Kaplan Meier, the log rank test and the Cox regression models. The number of lost years lived with disability (DALY) based on prevalence, was calculated. RESULTS: The mean age at diagnosis was 45.7 years. Analysis according to tumour stage, including grades II, III and IV, also showed a younger age of presentation. Kaplan-Meier survival estimates showed that tumour grade, Karnofsky status (KPS) ≥70, resection type, chemotherapy, radiotherapy, alcohol consumption, familial history of cancer and clinical presentation were significantly associated with survival time. Using a proportional hazard model, age, grade IV, resection, chemotherapy+radiotherapy and KPS were identified as prognostic factors.The amount of life lost due to premature death in this population was 28 years. CONCLUSION: In our study, astrocytoma was diagnosed in young adults. The overall survival was 15 months, 9% (n=14) of patients presented a survival of 2 years, and 3% of patients survived 3 years. On average the number of years lost due to premature death and disability was 28.53 years.
Assuntos
Astrocitoma/epidemiologia , Neoplasias Encefálicas/epidemiologia , Adulto , Idoso , Astrocitoma/mortalidade , Neoplasias Encefálicas/mortalidade , Estudos de Coortes , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Psychosis associated with Parkinson's disease is a major neuropsychiatric complication; it has been reported that 60% of patients will develop psychosis during the disease evolution. Its pathophysiology is multifactorial and clinically psychotic phenomena include minor hallucinations and confusional states. MATERIAL AND METHODS: We performed a cross-sectional study in patients with Parkinson's disease from a tertiary hospital using a thoughtful neurological and neuropsychiatric evaluation along with specific scales for non-motor symptoms, depression, cognition, and presence and severity of psychotic symptoms and hallucinations. RESULTS: We included a total of 236 patients with Parkinson's disease, of which 33 (13.9%) patients met the criteria for psychosis at the time of the evaluation. Visual hallucinations were the most common symptom. Age (p = 0.004), age at onset of the disease (p = 0.007) and its duration (p = 0.004), use of levodopa (p = 0.02), and use of amantadine (p = 0.004) were the main factors associated with the presence of psychosis. CONCLUSION: Psychosis in Parkinson's disease is a relatively common manifestation and is mainly associated with clinical and demographic factors. Early recognition will optimize management and improve the quality of life of patients and their caregivers.
Assuntos
Doença de Parkinson/complicações , Transtornos Psicóticos/etiologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologia , PrevalênciaRESUMO
The life of Vincent van Gogh (1853-1890) has been studied thoroughly by humanists and scientists alike. His biography is an archetype of the relationship between creativity and disease. In 1956, Henri Gastaut defined his diagnosis as temporal lobe epilepsy. The artist was known for an eccentric personality and unpredictable mood, with recurrent psychotic bouts through the last two years of his life. Several authors have considered the possibility that van Gogh also suffered from bipolar affective disorder. We conducted a biographical and epistolary review with the objective of analyzing the complexity of his disease and the effects it had on his art, which ultimately placed him as one of the greatest geniuses in art.
Assuntos
Criatividade , Neuropsiquiatria , Pinturas , História do Século XIX , Países BaixosRESUMO
The participation of women in higher education in Mexico took place in the late 19th and early 20th century. The rise of women's enrollment in universities known as the "feminization of enrollment" occurred in the last thirty years. In this review we analyze how the new conditions that facilitated better access to higher education are reflected in the inclusion of women in science. We include an overview of the issues associated with a change in the demographics of enrollment, segregation of academic areas between men and women and participation in post graduate degrees. We also review the proportion of women in science. While in higher education the ratio between male and women is almost 50-50 and in some areas the presence of women is even higher, in the field of scientific research women account for barely 30% of professionals. This is largely due to structural conditions that limit the access of women to higher positions of power that have been predominantly taken by men.