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Mexico City, Mexico

Sandercock P.,The 3 Co ordinating Center | Lindley R.,University of Sydney | Wardlaw J.,The 3 Co ordinating Center | Dennis M.,The 3 Co ordinating Center | And 25 more authors.
Trials | Year: 2011

Background: Intravenous recombinant tissue plasminogen activator (rtPA) is approved in Europe for use in patients with acute ischaemic stroke who meet strictly defined criteria. IST-3 sought to improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety) of rtPA in acute ischaemic stroke, and to determine whether a wider range of patients might benefit.Design: International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE) trial of intravenous rtPA in acute ischaemic stroke. Suitable patients had to be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracranial haemorrhage and stroke mimics.Results: The initial pilot phase was double blind and then, on 01/08/2003, changed to an open design. Recruitment began on 05/05/2000 and closed on 31/07/2011, by which time 3035 patients had been included, only 61 (2%) of whom met the criteria for the 2003 European approval for thrombolysis. 1617 patients were aged over 80 years at trial entry. The analysis plan will be finalised, without reference to the unblinded data, and published before the trial data are unblinded in early 2012. The main trial results will be presented at the European Stroke Conference in Lisbon in May 2012 with the aim to publish simultaneously in a peer-reviewed journal. The trial result will be presented in the context of an updated Cochrane systematic review. We also intend to include the trial data in an individual patient data meta-analysis of all the relevant randomised trials.Conclusion: The data from the trial will: improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety) of iv rtPA in acute ischaemic stroke; provide: new evidence on the balance of risk and benefit of intravenous rtPA among types of patients who do not clearly meet the terms of the current EU approval; and, provide the first large-scale randomised evidence on effects in patients over 80, an age group which had largely been excluded from previous acute stroke trials.Trial registration: ISRCTN25765518. © 2011 Sandercock et al; licensee BioMed Central Ltd.

Banos-Gonzalez M.,Hospital General Ticoman | Cantu-Brito C.,Instituto Nacional Of Ciencias Medicas | Chiquete E.,Instituto Nacional Of Ciencias Medicas | Arauz A.,Instituto Nacional Of Neurologia | And 4 more authors.
Archivos de Cardiologia de Mexico | Year: 2011

Objective: To analyze the association between the admission systolic blood pressure (SBP) and 30-day outcome in patients with acute cerebrovascular disease. Methods: The REgistro NAcional Mexicano de Enfermedad VAScular Cerebral (RENAMEVASC) is a hospital-based multicenter registry performed between November 2002 and October 2004. A total of 2000 patients with clinical syndromes of acute cerebrovascular disease confirmed by neuroimaging were registered. The modified Rankin scale was used for outcome stratification. Results: We analyzed 1721 patients who had registered their SBP: 78 (4.5%) had transient ischemic attack, 894 (51.9%) brain infarction, 534 (30.9%) intracerebral hemorrhage, 165 (9.6%) subarachnoid hemorrhage and 50 (2.9%) cerebral venous thrombosis. Among 1036 (60.2%) patients with the antecedent of hypertension, only 32.4% had regular treatment. The 30-day case fatality rate presented a J pattern with respect to SBP, so that the risk of death was highest in <100 mmHg (37.5%), decreased between 100 and 139, and reached gradually a new zenith in >220 mmHg (35.3%). The best functional outcome corresponded to patients who had SBP between 100 mmHg and 159 mmHg. In a Cox proportional hazards model, SBP <100 mmHg or >220 mmHg was an independent risk factor for 30-day mortality (RR: 1.52, IC 95%: 1.07 - 2.15), as well as the antecedent of hypertension (RR: 1.33, IC 95%: 1.06 - 1.65) and age >65 years (RR: 2.16, IC 95%: 1.74 - 2.67). Conclusion: Both hypotension and significant arterial hypertension at hospital admission are associated with an adverse outcome after acute cerebrovascular disease. Nevertheless, a good functional outcome can be attained in a wide range of SBP. © 2011 Instituto Nacional de Cardiología Ignacio Chávez.

Duran-Salgado M.B.,Servicio de Medicina Interna | Fernandez-Valverde F.,Instituto Nacional Of Neurologia | Vargas-Canas E.S.,Instituto Nacional Of Neurologia Y Neurocirugia | Medina-Luna P.,Instituto Nacional Of Neurologia Y Neurocirugia
Medicina Interna de Mexico | Year: 2013

The muscular atrophy bulbous hawthorn is a recessive neuronopatic, linked to the X chromosome of adulthood. It is a disorder polyglutaminic caused by the expansion of the track of the polyglutamine repeat disorders in the androgen receptor. The outstanding characteristic of the muscle atrophy espino-bulbar is the loss of motoneurons in the Asta anterior of the spinal cord and brain stem. The clinical manifestations are diverse and the laboratory studies range from asymptomatic hyperkalemia until severe muscle disease, with bulbar symptoms that may require mechanical ventilatory support. The diagnosis is based on the medical history, neurological examination, biochemical studies, studies of nerve conduction velocity, electromyography and genetic analysis. Currently, there is no specific treatment. The treatment is symptomatic and often indicate drugs antioxidants such as vitamin E and co-enzyme Q10. It is reported the case of a patient with typical picture of the disease of Kennedy, without a family history of the mutation.

Rodriguez-Zepeda J.M.,Centro Medico ABC | Monzon-Falconi J.F.,Instituto Nacional Of Neurologia | Ham-Mancilla O.,Centro Medico ABC | Moreno-Jimenez S.,Centro Medico ABC | And 2 more authors.
Revista Mexicana de Anestesiologia | Year: 2015

Background: The Arnold-Chiari malformation (ACM) is a group of congenital abnormalities of the hindbrain and the spinal cord and is characterized by herniation of the cerebellum, kinking of the medulla oblongata and hydrocephalus; the anesthetic management is complicated due to the anatomic and physiologic alterations. Case description: A 23 years old woman with Arnold-Chiari type II malformation, and perforated appendicitis. Conclusions: The present case demonstrates that patients with partially corrected ACM type II, restrictive lung disease due to scoliosis and perforated appendicitis delivery require an interdisciplinary team approach, diligent preparation, and skilled physicians. © 2015, Colegio Mexicano de Anestesiologia A.C. All Rights Reserved.

Flores-Dorantes T.,National Autonomous University of Mexico | Arellano-Campos O.,INCMNSZ | Posadas-Sanchez R.,Instituto Nacional Of Cardiologia Ignacio Chavez Incich | Villarreal-Molina T.,National Autonomous University of Mexico | And 13 more authors.
Clinica Chimica Acta | Year: 2010

Background: The effect of ABCA1 genetic variation on HDL-C levels has been widely documented, although studies in children are scarce. We recently found a frequent non-synonymous ABCA1 variant (R230C) exclusive to populations with Native American ancestry, associated with low HDL-C levels and other metabolic traits in adults. Methods: We genotyped R230C variant in 1253 healthy unrelated Mexican school-aged children aged 6-15. years (595 boys and 658 girls) to seek associations with HDL-C levels and other metabolic traits. HDL subclass distribution was analyzed in a subgroup of 81 age, gender and BMI-matched children. Results: Individuals carrying the C230 allele showed a significantly lower HDL-C levels (P=2.9×10-8), and higher TC/HDL-C ratio, BMI, BMI z-score and percent fat mass (P=0.001, 0.049, 0.032 and 0.039, respectively). HDL size was smaller in R230C heterozygotes as compared to R230R homozygotes (P<0.05). Moreover, the proportion of HDL2b was lower, while the proportion of HDL3a and HDL3b particles was higher in R230C heterozygous and/or C230C homozygous individuals as compared to R230R homozygotes (P<0.05). Conclusions: Our data suggest that the R230C ABCA1 gene variant plays an important role in HDL-C level regulation and HDL subclass distribution in healthy Mexican school-aged children. © 2010 Elsevier B.V.

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