Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Baclofen is a structural analog of gamma-aminobutyric acid, primarily used as a skeletal muscle relaxant for treatment of spasticity and dystonia. The clinical picture of baclofen intoxication includes reduction or loss of consciousness and manifestations such as sleepness, coma or even death. Electroencephalograms performed in these cases have consistently shown the so-called burst-suppression pattern. The case of a female patient who suddenly presented difficulty to still-standing and mutism and later evolved into coma, is presented. A detailed study was performed in the emergency department, including an electroencephalogram compatible with a continuous burst-suppression pattern. The patient was treated with dialysis in the face of a possible baclofen intoxication and, in a period of five days, the clinical symptoms reverted and the electroencephalographic activity was normalized.

Objective: To determine the incidence of neonatal microcephaly in the Hospital Cayetano Heredia, throughout a well-defined period. Material and Methods: Microcephaly was determined by a cephalic perimeter lower than the third percentile for age and sex. Reported records of the Hospital’s Perinatal Computer System between January 1st, 2016 and December 31st, 2017, were used. Fenton growth chart’s parameters were used to determine the limits of normality. Results: A total of 416 cases of neonatal microcephaly were registered, a general rate of 53.4 per 1,000 live births, up to 185 per 1000 live births in preterm infants (<37 weeks), with higher figures among males. Conclusions: A high incidence rate of microcephaly was found, probably higher in preterm infants and due to multiple causes. Observational biases cannot be discarded.

Objective: To determine the incidence of neonatal macrocephaly in a third level hospital from Lima, Peru. Methods: Macrocephaly was defined on the basis of a cephalic perimeter higher than the 97th percentile for age and sex. The report records of the Perinatal Computer System of Cayetano Heredia Hospital between January 1st., 2016 and December 31st, 2017 were used, as well as the Fenton growth chart to determine the limits of normality. Results: A total of 210 cases of neonatal macrocephaly was registered, a general rate of 26 per 1,000 live births. Neonatal macrocephaly incidence were inversely proportional to gestational age. Conclusions: Macrocephaly was higher in preterm neonates, with a risk factor five times higher in this population group.

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Multiple Sclerosis (MS) is a chronic disease of the central nervous system, for which there is still no definitive cure; but there is a diverse variety of therapies with the objective of modifying the course of the disease, which promotes the constant inclusion of new therapeutic strategies. Objective: The Peruvian Society of Neurology, as requested by the Peruvian Health Ministry, convened a committee of experts with the purpose of elaborating a clinical practice guideline for the diagnosis and treatment of MS. Method: Clinical practice guidelines were searched and evaluated according to the AGREE II methodology, choosing the Catalan Clinical Practice Guide as a model. The clinical questions not related to treatment were solved through a systematic review. The clinical treatment questions were assessed under the PICO format and were solved with a meta-analysis of clinical trials available until August 2017, considering the therapies approved by DIGEMID until January 2017. The final recommendations were elaborated using the modified Delphi method with a consensus of at least 80% of the members of its committee. Finally, an external revision of the manuscript was made by international experts in MS. Results: Eighteen clinical questions and twenty-one recommendations for management were developed, including therapeutic algorithms.

Variants of the genes ABCB1 and ABCC2 have been associated with an increased risk of drug-resistant epilepsy; this phenomenon, however, has been scarcely tested by means of comparisons between populations: In Latin America there have only been 3 studies. Objective: To evaluate the association between the variants C3435T of the gene ABCB1, and --24C> T of the gene ABCC2 with drug-resistant epilepsy in Peruvian patients treated at the Epilepsy Unit of a Peruvian Hospital. Material and Methods: Blood samples from 22 patients with drug-resistant epilepsy and eight patients with pharmaco-responsive epilepsy were analyzed between May 2016 and June 2017. The identification of the C3435T variant of the ABCB1 gene was performed by polymerase chain reaction (PCR) and subsequent enzymatic digestion; the -24C>T variant of the ABCC2 gene was obtained by sequencing. Results: An allelic frequency of 0.717 was obtained for C in the C3435T variant of the gene ABCB1, and 0.967 for C in the -24C> T variant of the gene ABCC2. When genetic and allelic frequencies were compared between drug-resistant and drug-responsive patients no significant difference was observed, from which a lack of association between drug-resistant epilepsy and the C3435T variant of the gene ABCB1 and the -24C> T variant of the gene ABCC2 (p> 0.05) was inferred. Conclusions: In a sample of Peruvian patients with epilepsy, no association was found between drug-resistant epilepsy and the C3435T and -24C>T polymorphisms of the genes ABCB1 and ABCC2, respectively.

A link is traced between the basic concepts on health and mental illness in the Hippocratic Treaties and the current elements of thermodynamics and cybernetics, through the contributions of authors such as Maturana and Valera (autopoiesis and teleonomy) or Bergson (regularities vs. indeterminism). Anankastic and stochastic phenomena are defined and characterized, highlighting their complementary connection. Following a thermodynamic approach, a mental illness is defined as a structure that imposes itself on the rest of the mental activities and consumes the energy that regulates the remnants of the affected person’s metabolism. Clinical evidences of the benefits of this perspective are given, presenting, for instance, anxiety as “entropic crisis” and depression as an “interference of teleonomy”, while obsessive-compulsive disorders are described from the cybernetic perspective. Throughout the text, the greatest relevance is conferred to the notion of mental illness as a “hegemonic pathos” that absorbs energy resources and diminishes the affected individuals’ possibilities of adaptation to their external environment, and of successfully coping with their own tensions.

Objectives: Although the term dysthymia was coined by Kahlbaum, its current clinical meaning originated in the 1980s, when it appears in the American Psychiatric Association Diagnostic and Statistical Manual (DSM) designating a chronic mild depression distinguishable from Major Depression Disorder. In this article, the cases of two female patients with this disorder (according to the CIE-10) are presented and the "subjective components" that sustain the depressive symptoms, not usually mentioned in the publications, are examined. Material and methods: The Approach to Subjectivity Method (MAS) was used; it consists of non-directive interviews writing down the patient’s exact verbal expressions, and avoiding any allusion to theories, particular beliefs, values, judgments, etc. Results: We concluded that these two women have a sentimental distancing from their love object, even though they are unable to separate from or leave him while depressive symptoms appear in an insidious way. This drives them to fall off the romantic ideal they were looking for as a guide for their lives and an anchor of their personality, and it can also explain why their symptoms do not improve. This point of view questions to some extent the classic notions about "mourning". Conclusions: To improve symptomatically, the dysthymic patients need to talk about and realize what is really happening to them. What is found here shows the subjective coordinates that are necessary in order to conduct an adequate psychotherapeutic intervention.

The study of the human genome, when performed only through the DNA sequence information, does not completely explain the high level of inter-individual variation usually observed. It is the control of gene expression by the epigenetics what allows to explain those variations of gene expression, as a reversible and hereditary process in the short term under the influence of the environment during various stages of development and adulthood, without modifying the genetic sequence. Epigenetic alterations are already being studied as valuable candidates in the eventual identification of biomarkers. Furthermore, their reversible nature makes them promising factors in the amelioration of disease symptoms through the use of therapeutic approaches. This article explains the epigenetic mechanisms and its relationship with the environment, diet, and its influence on evolution, the occurrence of diseases, human behavior and mental health.

Cerebral palsy is a disorder of movements and postures, accompanied by other dysfunctions that limit the development of daily life activities; in children, this condition demands special care and upbringing to be provided by the parents. As a result, the latter experience a series of changes and needs in their personal, family, work and social spheres, from the moment they receive the clinical diagnosis and throughout the child’s whole developmental process. As a result, parents frequently present symptoms of anxiety, stress, depression, sleep disturbances and musculoskeletal disorders, generating a low quality of life level. Several studies show that psychosocial changes, health and quality of life of parents are affected by the child’s characteristics, the parents’ personal traits and / or the family’s environmental and contextual factors. It is suggested that the health systems must also assist the parents in parallel with the treatment of children with cerebral palsy, and according to the context in which they occur.