Objective: Evaluate the cost-effectiveness of intravenous thrombolysis in the treatment of the ischemic stroke compared to standard medical management, in a public hospital in Bogot & aacute;, during the period from January to December 2024. Methods: Observational, cross-sectional study with retrospective data collection, using a sample of patients with ischemic stroke who received intravenous thrombolysis and those who did not, at Kennedy Hospital in Bogot & aacute;, Colombia. An economic evaluation was conducted to estimate the incremental cost-effectiveness ratio (ICER) of intravenous thrombolysis compared to standard medical management. Results: The number of patients who received thrombolysis was 82, while 156 patients received standard medical management. The average cost was $13,316,428.31 (3.269,77 USD) (SD $9,147,043/2.246 USD) for the thrombolysis group and $12,813,094 (3.146,17 USD) (SD $12,261,577/3.010 USD) for the non-thrombolysis group. The thrombolysis group showed a gain of 0.27 quality-adjusted life years (QALYs) with a higher cost of $503,334 (123,59 USD) compared to the standard medical management group, resulting in an ICER of $1,864,201 (457,74 USD) per QALY. The mean utility of 5.9 (SD 4.7) [95% confidence interval [CI]: 1.52-10.27; p = 0.16] for the thrombolyzed group, while for the non-thrombolyzed group, the mean was 5.35 (SD 4.6) [95% CI: 1.03-9.68; p = 0.23], the mean delta utility was 0.54 (SD 0.28) [95% CI: 0.28-0.80; p = 0.02] and the mean ICER per QALY was-1,473,833 (SD 1,656,379) [95% CI: -3,212,096 to 264,430; p = 0.81]. Conclusions: Thrombolytic therapy is associated with greater cost-effectiveness, better clinical outcomes, and reduced disability compared to standard medical management without thrombolytic therapy.
Objective: The aim of this study was to determine the willingness of inhabitants of Metropolitan Monterrey, Mexico, to donate their brains after death for scientific research purposes. Methods: An electronic survey with multiple-choice questions was administered online. Survey addresses willingness to donate their brains and the factors that may influence this decision. The survey was distributed through major social media platforms for 9 months. Percentages were calculated, and differences between groups were assessed with the chi 2 test. Results: A total of 350 people responded to the survey. Of these, 68.5% were female, 85.4% were between 18 and 39 years old, 76.2% were single or divorced, 71.1% practiced some religion, 72.9% had a bachelor's degree or higher, and 64.6% reported incomes <= 19,999 Mexican pesos. When asked, "How likely are you to donate your brain for scientific research after death?," 64.9% responded "highly likely" or "likely." The main reasons for donating were as follows: (1) "I like the idea that studying my brain could help save lives,"and (2) "I believe I won't need my organs after death." Conversely, the main reasons for not donating were as follows: (1) "Fear that my organs might be taken prematurely when recovery is still possible,"and (2) "I don't like thinking about it."Conclusions: A high proportion of Metropolitan Monterrey Mexicos inhabitants are willing to donate their brains after death for scientific research purposes.
Objective: The objective of this study was to describe the psychometric properties of the pilot phase of the Battery for the Assessment of Dyspraxia in a sample of 200 Mexican children, composed exclusively of neurotypical participants between 2 and 6 years of age. Methods: The test was developed based on the theoretical principles of dyspraxia proposed by Castillo-Sanchez Lara. Participants were selected through convenience sampling from public and private schools in three Mexican states. Five scales were constructed according to age groups (2, 3, 4, 5, and 6 years). Each version assessed eight key areas: somatosensory (processing of internal and external stimuli), proprioception (body position in space), body schema (global body awareness), postural control (body control in motion and at rest), orolingual-facial praxis (voluntary movements of facial and orolingual muscles), constructive praxis (visuomotor and spatial coordination), somatopraxis (precise execution of voluntary movements), and visual assessment (active visual search). Results: Statistical analyses were performed using Cronbach's alpha coefficient. The results showed acceptable reliability levels in most scales (alpha > 0.7). Conclusions: The battery for the assessment of dyspraxia demonstrated adequate psychometric properties in a preschool sample and in detecting alterations in underlying components. The findings support its application in the development and implementation of neuropsychological rehabilitation programs.
Objective: The objective of the study is to describe the clinical, epidemiological, and genetic profile of patients with Duchenne muscular dystrophy (DMD) treated at a tertiary care pediatric hospital in Mexico. Methods: This was a retrospective, observational study of 74 patients with genetically or biopsy-confirmed DMD who were evaluated by Pediatric Neurology between 2010 and 2022. Clinical, demographic, biochemical, genetic, and therapeutic data were analyzed using descriptive statistics. Results: All patients were male. The median age of symptom onset was 3 years, with a median age at diagnosis of 7 years. At the initial evaluation, 87% were in the ambulatory stage. Gastrocnemius hypertrophy (94.5%) and Gowers’ sign (87.8%) were common findings. Deletions in exons 45-55 of the DMD gene were identified in 74% of molecularly confirmed cases. Steroid therapy was administered to 81% of patients, mostly deflazacort. Neuropsychiatric (41.9%), orthopedic (44.5%), and respiratory (44.6%) comorbidities were frequently observed. Only 6.7% were candidates for gene therapy. The mean age at loss of ambulation was 10.2 years; one death due to respiratory failure was recorded. Conclusions: Despite advances in diagnostic and therapeutic strategies, patients with DMD in this setting continue to have poor outcomes, likely due to low clinical suspicion leading to delayed diagnosis and treatment. Early detection protocols, measurement of creatine kinase in children with motor delays, and multidisciplinary management are crucial to improving outcomes and survival.
This narrative review explores dementia, a multifaceted clinical syndrome of neurodegenerative or vascular origin characterized by progressive cognitive decline affecting autonomy and quality of life. Given its rising global prevalence, particularly in developing countries, and the absence of a curative treatment, understanding this condition is of paramount importance. A structured but non-systematic search was conducted in PubMed, Scopus, and ScienceDirect for studies published between 2015 and 2025, focusing on systematic reviews, meta-analyses, clinical guidelines, and original research in English or Spanish. After applying inclusion and exclusion criteria, 50 high-quality studies were included. This review addresses key aspects, including modifiable and non-modifiable risk factors such as education, physical inactivity, hypertension, and pollution, as well as associated pathologies such as type 2 diabetes and traumatic brain injury. It delves into the distinct characteristics, pathophysiology, and clinical stages of Alzheimer’s disease, vascular dementia, and frontotemporal dementia. This document also discusses diagnostic challenges and current symptomatic treatment approaches, emphasizing the critical role of prevention and early non-pharmacological interventions to improve patient outcomes and quality of life.
Objective: To compare the efficacy of immersive virtual reality therapy (VRT) versus conventional physical therapy (CPT) in patients with Parkinson's disease (PD) through a systematic review and meta-analysis. Methods: Systematic searches were conducted in PubMed, Web of Science, and Scopus (PRISMA 2020). We included randomized controlled trials (RCTs) comparing immersive VRT and CPT in PD patients. Primary outcomes included balance, measured with the Berg Balance Scale (BBS); functional mobility, measured with the timed "Up and Go" test (TUGT); motor performance, measured with the Unified PD Rating Scale (UPDRS) part III; and fall risk, measured with the dynamic gait index (DGI). Meta-analyses used random-effects models to compute mean differences (MD) and 95% confidence intervals. Heterogeneity (I2), publication bias, and trial sequential analysis (TSA) were assessed. Results: Four RCTs (n = 102) were analyzed. Immersive VRT showed favorable trends, particularly for mobility (TUGT) and balance (BBS). Balance (BBS): MD = 2.26 (-1.04, 5.55), p = 0.18, I2 = 79%; TSA showed insufficient information size (required information size = 464). TUGT: MD = 0.09 (0.00, 0.17), p = 0.04, I2 = 0%. UPDRS III: MD = -0.19 (-3.28, 2.90), p = 0.91, I2 = 94%. DGI: MD = 1.39 (-0.23, 3.02), p = 0.09, I2 = 0%. Conclusions: Immersive VRT may offer functional benefits for PD, yet current evidence is insufficient to draw firm conclusions. TSA indicates a high risk of type II error. Further high-quality RCTs with standardized protocols are needed.
To characterize the clinical presentation of optic neuritis (ON) associated with COVID-19 vaccination. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, a search was performed in PUBMED, Google Scholar, and SciELO database using the keywords “COVID-19 vaccination” AND “optic neuritis.” Only articles written in English were included. A total of 126 articles were retrieved, of which 33 corresponded to cases of ON. Because 15 (13 patients) of the 33 articles had comorbidities, these were excluded. The mean age of the included patients was 42 years, the incidence was 79% in women versus 29% in men, and 27 of the cases were unilateral versus 17 bilateral. Treatment consisted of steroids in 37 of the cases, steroids plus plasmapheresis in 7 cases. Vaccines associated with ON were vector type in 18 of the cases, genetic type in 22 cases, and inactivated type in 4 cases; no association with ON was reported for viral and protein attenuated vaccine types. As in the case reported by our group, evidence in the literature indicates that bilateral ON is rare but requires prompt plasmapheresis as an adjunct to intravenous methylprednisolone to reduce neurological sequels.
Objective: Creutzfeldt-Jakob disease (CJD) is a rare cause of rapidly progressive dementia due to the accumulation of misfolded prion proteins (PrPC) in the brain. Mortality is essentially universal within months to a few years after symptom onset. Here, we evaluated biomarkers derived from baseline complete blood counts (CBCs) in search of readily available predictors of disease progression using survival span as an outcome. Methods: We analyzed retrospective data derived from the baseline CBC from Mexican Mestizo individuals. We performed Spearman rho correlation to determine the association between survival time from disease onset with leukocyte and erythrocyte counts of people with CJD. We used Cox proportional hazard models to predict survival time, and log-rank tests to compare survival of subgroups. Results: We included 22 people with probable or definite CJD. Twelve (55%) were female. The mean age at diagnosis was 55 years (interquartile range: 25-85). Lower hemoglobin (r = -0.494, p = 0.019), hematocrit (r = -0.445, p = 0.037), and lymphocyte (r = -0.421, p = 0.050; log-rank test: chi 2 = 3.7, p = 0.05) counts and higher neutrophils (r = 0.404, p = 0.061; log-rank test: chi 2 = 5.7, p = 0.02) were associated with longer survival time. Conclusions: In the present study, we observed that common hematological values derived from a CBC were associated with survival span in people living with CJD. Those values support previous observations suggesting that the circulating availability of wild-type prion protein in blood cells is a limiting factor in the production of misfolded prion protein.
Cerebral venous thrombosis (CVT) is the involvement of the venous sinuses due to the formation of clots that occlude the cerebral veins. It is a rare cause of cerebrovascular disease, accounting for 0.5-1% of cases, with a higher frequency in women under 50 years of age. The most common symptoms are headache, papilledema, seizures, motor and sensory deficits, cranial nerve paresis, and alterations in mental status. Cases with neuropsychiatric manifestations, such as delirium, cognitive impairment, and mutism, have been reported as isolated presentations, although these are limited. Two cases of CVT are presented, both of which exhibited neuropsychiatric manifestations characterized by erratic behavior, aggression, disorientation, depressive, and catatonic symptoms. Treatment for CVT includes addressing the underlying cause, controlling symptoms, and initiating anticoagulation, which has significantly reduced mortality. CVT presenting with mental status alterations without focal neurological deficits is uncommon. In these cases, a temporal association between symptoms and vascular pathology was observed. Although neuropsychiatric manifestations are rare, CVT should be considered in atypical presentations of common diseases.
Objective: This study aims to identify executive function (EF) deficits associated with attention deficit hyperactivity disorder (ADHD) risk and their impact on academic performance (AP) among Mexican university students. Methods: The adult ADHD self-report scale v1.1 was administered to 200 university students. A total of 103 students scored within the high-risk range for ADHD. In the second phase of the study, students at high risk for ADHD were invited to undergo a neuropsychological evaluation. Forty-four students (18 men and 26 women) completed the Neuropsychological Battery of Frontal and EF to assess EF. AP was determined based on the average high school and university scores, verified through official school records. Statistical analyses included analysis of variance and correlation tests to explore relationships among the variables. Results: Over 50% of the evaluated participants met the criteria for high ADHD risk, highlighting a high prevalence of undiagnosed symptoms. EF impairments were observed, particularly in the dorsolateral prefrontal cortex. Despite achieving higher AP, women scored significantly lower on EF tasks compared to men. A positive correlation was found between orbitofrontal cortex functioning and AP. In men, higher ADHD risk was negatively associated with EF efficiency. Conclusions: These findings underscore the importance of implementing systematic ADHD screening strategies in university settings. They also suggest the potential presence of compensatory mechanisms in women at high risk for ADHD. Further research is needed to develop targeted interventions aimed at enhancing EFs and supporting academic success in this population.
Objective: To identify risk factors for phrenic nerve injury, a condition impacting respiratory function, in post-COVID-19 patients, and to understand its role in neurological complications to inform clinical strategies. Methods: A cross-sectional study with retrospective data collection analyzed medical records and electrophysiological studies of 228 post-COVID-19 patients (114 with phrenic nerve damage confirmed by nerve conduction studies and 114 controls without it) from a public rehabilitation unit (Mexican Social Security Institute, Jan-Jul 2021). Analyzed variables included demographics, pre-existing comorbidities (e.g., obesity, asthma, and type 2 diabetes), COVID-19 clinical details, and electrophysiological parameters confirming phrenic nerve status. Results: Multivariable logistic regression identified obesity (odds ratio [OR] 10.36, p < 0.001), asthma (OR 7.93, p = 0.02), male sex (OR 2.2, p = 0.01), and advanced age (OR 1.07/year, p < 0.001) as significant independent risk factors for phrenic nerve damage. Type 2 diabetes mellitus approached statistical significance (p = 0.05) but was not an independent predictor in the final model. Descriptively, in patients with phrenic nerve damage, 49.12% received corticosteroids and 68.42% had other peripheral nerve involvement; however, these were not identified as significant independent risk factors in the adjusted analysis. Conclusions: Phrenic nerve injury is an important post-COVID-19 complication. The conditions of obesity, asthma, being of male sex, and presenting an advanced age emerged as significant independent risk factors, identified through multivariable analysis, adjusting for potential confounders. These findings highlight the need for vigilant monitoring and tailored management strategies in post-COVID-19 patients with these characteristics.
Objective: The objective of the study is to report epidemiological characteristics and prognostic factors of patients with adult-type gliomas treated in the neurosurgery department of the National Medical Center of Bajio, as well as to evaluate, for the 1st time in Mexican patients, surface regularity (SR). Methods: Epidemiological and clinical features were statistically compared with international references. Survival was estimated using the Kaplan-Meier method. Kaplan-Meier curves were compared with the log-rank test. SR was obtained by segmenting magnetic resonance imaging. Results: Median age of patients with glioblastomas was less than that of patients in the United States (p = 0.021). The administration of radiotherapy (RT) and temozolomide (TMZ) prolonged survival (median gain of 35 months). Median SR was 0.6006 and was close to being statistically lower than the value reported in a large cohort (p = 0.09). Conclusions: Glioblastomas were diagnosed at younger ages and appeared to be more aggressive. The administration of RT and TMZ prolonged substantially survival.
