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The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.

BACKGROUND The average accepted depth for Non-Tunneled Catheters (NTC) insertion does not guarantee its correct position, so controversy exists. The aim is to assess the effect of two NTC placement depths on the number of NTC complication episodes. METHODS We designed a triple blind, parallel-group, randomized controlled trial in a single Hemodialysis Center in Mexico (Registry: ACTRN12619000774123). We included patients in urgent need of hemodialysis via internal right jugular vein NTC. The length of the NTC tip placement depth was randomized to second intercostal space (2ICS) or fourth intercostal space (4ICS), using physical landmarks. The primary outcome is to compare the composite number of NTC dysfunction, repositioning, and relocation episodes during 48 hours post procedure. RESULTS One hundred and sixty five patients were included, 86 and 79 patients to NTC placement in the 2ICS and 4ICS, respectively. All patients underwent intention-to treat analysis. The incidence of the composite outcome was lower in the 2ICS group compared to the 4ICS group, 4 (4.6%) and 50 (63%) combined episodes, respectively (p

Background: Self-efficacy is the individual’s assessment of his or hers ability to complete a specific task successfully and has been closely related to self-management and quality of life in several diseases. Objective: To investigate self-efficacy in a population of Parkinson’s disease (PD) patients in Mexico and study the factors that are associated with this measure. Methods: We carried out a cross-sectional observational study involving patients with PD in an outpatient neurology clinic in Mexico, using the following instruments: Spanish version of the Chronic Disease Self-Efficacy Scale (CDSES), Quality of Life Questionnaire PDQ-8, Movement Disorders Society-Unified Parkinson's disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale (NMSS). Clinical and demographic variables were also recorded. Results: We included 73 patients with a mean age of 65 years and most patients were male. Patients with lower CDSES scores (

The effect of systemic lupus erythematosus (SLE) in sexual function is one of the least studied areas. There are few previous studies that investigate sexual function in SLE, and current evidence indicates a negative impact. The main objective of this study is to evaluate sexual function in Mexican women with SLE and compare if sexual dysfunction occurs in a greater proportion than in healthy women. A case–control study with 102 Mexican women between 18 and 60 years, with SLE diagnosis and a control group of healthy women (n = 156) matched by age. They were asked about their sexual life in the last month, and the Female Sexual Function Index (FSFI) self-questionnaire was applied. Variables between groups were compared with Chi-square and Mann–Whitney U test. SLE women had less sexual activity than controls (63.7% vs 77.5%, p = 0.01). Out of the total, the FSFI was applied only to those that had an active sexual life, 65 with SLE and 121 healthy women. Sexual dysfunction (

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Mutations in the glucocerebrosidase (GBA) gene represent the most common genetic risk factor for Parkinson's Disease (PD) and are associated with a more aggressive motor phenotype at late stages. However, the motor response at early stages of disease remains understudied.Retrospective study of PD patients that underwent next-generation sequencing panel tests for PD-related genes. We extracted demographic data and the MDS-UPDRS III response to an acute levodopa challenge (LDC), the best ON score, and the levodopa equivalent daily dose (LEDD) during the first six months after the LDC and initiation of DRT. We compared the response of GBA-PD patients to that of patients without pathogenic variants or rearrangements in other PD related genes (sporadic PD).13 GBA-PD and 48 sporadic PD patients were identified. Baseline MDS-UPDRS III score (24.6 ± 9.6 vs. 21.8 ± 9.3. p = 0.4), response to LDC (39.2% ± 7.9% vs. 32.7% ± 13.4%; p = 0.1), best ON score (36.9% ± 39.5% vs. 41.6% ± 20.8%; p = 0.6) and LEDD (188 mg ± 100 mg vs. 261.8 mg ± 164.8 mg; p = 0.2) during the first six months after initiation of DRT were not different between GBA-PD and sporadic PD patients.At early disease stages of GBA-PD, the motor response to acute levodopa challenge test and the initial response to DRT are similar to that of patients with sporadic PD. Although limited by small sample size, these preliminary findings should be confirmed by future prospective larger studies.

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Dear Editor, With great interest we read the article by Novis and colleagues recently published in Arquivos de Neuro-Psiquiatria. Where they present the life and work of Professor Faustino Esposel, considered the father of Brazilian neurology, who along with Antonio Austregesilo, described a substitute sign for Babinski’s phenomenon eliciting of the extensor plantar response upon squeezing of the thigh: “Le phenomene de Babinski, provoque par l’excitation de la cuisse”, now known as the Austregesilo-Esposel sign. Upon a search of the [...]

The effect of systemic lupus erythematosus (SLE) in sexual function is one of the least studied areas. There are few previous studies that investigate sexual function in SLE, and current evidence indicates a negative impact. The main objective of this study is to evaluate sexual function in Mexican women with SLE and compare if sexual dysfunction occurs in a greater proportion than in healthy women. A case-control study with 102 Mexican women between 18 and 60 years, with SLE diagnosis and a control group of healthy women (n = 156) matched by age. They were asked about their sexual life in the last month, and the Female Sexual Function Index (FSFI) self-questionnaire was applied. Variables between groups were compared with Chi-square and Mann-Whitney U test. SLE women had less sexual activity than controls (63.7% vs 77.5%, p = 0.01). Out of the total, the FSFI was applied only to those that had an active sexual life, 65 with SLE and 121 healthy women. Sexual dysfunction ( 26.5 points) was found in 28% women with SLE and in 22% of controls, with no significant differences (p = 0.4). In the SLE group, a worse performance was found in the desire and excitation domains compared to healthy women. SLE women had less active sexual life than healthy women, but no greater sexual dysfunction. However, they performed worse in the desire and excitation domains. This alteration did not show a relation with demographic nor disease-related variables.

One third of people with epilepsy (PWE) continue to have seizures despite adequate antiepileptic drug treatment. This condition, known as drug-resistant epilepsy (DRE) significantly impairs their social, family and work environment. The aims of this study were to assess the quality of life (QoL) in PWE with DRE and to investigate which factors are associated with a better QoL. This was a cross-sectional observational study of 133 Latin American PWE. QoL was assessed with the Spanish version of the Quality of Life with Epilepsy questionnaire (QOLIE-10). Independent clinical variables were analyzed with non-parametric statistics and their association with QoL was investigated with multiple linear regression. Poor quality of life was found in 25.8% of PWE. A low number of antiepileptic drugs (AEDs) was the major factor associated with better quality of life, closely followed by seizure frequency. We conclude that careful selection of AED treatment may contribute to improving both seizure control and QoL.

Neurotoxicity from intrathecally administered chemotherapeutic drugs is frequent, particularly with some agents like methotrexate, which are more prone to developing adverse effects. Myelopathy ranks among the most frequently reported neurological entities; with the diagnosis being straightforward, after ruling out infectious, metabolic, autoimmune or paraneoplastic causes. Scarcity of cases precludes evidence-based recommendations for the management of these complications. The most common therapeutic approach consists of the suspension of chemotherapy, exclusion of infectious and neoplastic causes, with prompt administration of high-dose steroids. We report a 21-year-old patient with acute lymphoblastic leukaemia, who developed acute transverse myelitis and bilateral sensorineural hearing loss, after five rounds of intrathecal methotrexate and cytarabine. Although neurotoxicity from both agents has been documented, this combination has not been previously reported.

Intradialytic hypotension is common complication in stage 5 chronic kidney disease patients on hemodialysis. Incidence ranges from 15 to 30%. These patients have levocarnitine deficiency. A randomized, placebo-controlled quadruple-blinded trial was designed to demonstrate the levocarnitine efficiency on intradialytic hypotension prevention. Patients were randomized into four groups, to receive levocarnitine or placebo. During the intervention period, levocarnitine and placebo was administered 0 and 30 min before each hemodialysis session, respectively. During the trial, 33 patients received 1188 hemodialysis sessions. We identified 239 (21.3%) intradialytic hypotension episodes. The intradialytic hypotension episodes were less frequent in the levocarnitine group (9.3%, 60 IH events) (P

A previously healthy 28-year-old woman presented 4 days after sudden onset of neck pain radiated to both arms with progressive tetraparesis and bladder dysfunction. On neurological examination, we found normal mental status and higher functions and no meningismus; on cranial nerve examination, we

The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.La obra del erudito argentino Jorge Luis Borges (1899-1986) ha cautivado a los médicos. Asiduo lector con magnífica ironía, le fueron dados “los libros y la noche”. Borges padeció una ceguera crónica e irreversible que impulsó gran parte de su obra y ha sido objeto de distintos análisis literarios y diagnósticos desde el punto de vista oftalmológico. Sin embargo, las características de su ceguera han escapado al abordaje neurológico, por lo cual revisamos su obra en busca de datos que sugieran una lesión cerebral concomitante. En su autobiografía relata cómo durante un episodio de septicemia padeció alucinaciones y pérdida del habla; además, en algunos poemas y ensayos describe datos que sugieren “cromatopsia fantasma”, lesión de origen cortical. Tras dicho accidente, Borges sobrevivió con un cambio radical en su estilo literario. Aunque un diagnóstico preciso es imposible, su obra literaria nos permite reconocer algunos elementos que sugieren involucramiento cerebral concomitante.

Background The influence of systemic lupus erythematosus (SLE) in sexual behavior has been one of the less studied areas, being a forgotten part of quality of life, and not routinely evaluated by a rheumatologist. The seeming lack of interest in sexual problems is explained by the underlying difficulty to talk about this topic, the uncertainty of the role and capability of the rheumatologist to treat any difficulties in this area. Objectives Determine the prevalence of sexual assessment in women with SLE by their rheumatologist in the daily practice, as well as their characteristics and the possible difficulties that doctors deal with during this process. Methods A cross-sectional study, where women between 18 and 60 years with SLE diagnosis (according to SLICC 2012 criteria) were evaluated consecutively at the rheumatology clinic at Hospital Universitario “Dr. Jose Eleuterio Gonzalez”. 102 women with SLE were asked two questions: “Question 1. In the last year, has your rheumatologist asked about your sexual life?”, and “Question 2. In case of having a trouble or disorder in your sexual life, would you ask your rheumatologist about it? (if not, why?)”. Demographic and disease associated variables were analyzed with Chi-square test and Mann-Whitney U test. Results Baseline characteristics according to answers to each question are shown in Table 1. Most of the patients (62.74%, n=64) denied being asked about their sexual life in the last year; in this group, the prevalence of menopause was significantly higher than in the group that had been asked about this (30% vs 11%, p=0.025). Whilst, 82% (n=89) of patients said they were willing to talk about this topic with their doctor. The patients that answered “no” to the second question had the following characteristics: older age (45.5±10.5 vs 35.0±11.2 years; p=0.002), were in their menopause (46% vs 19%; p=0.042), had fibromyalgia (39% vs 10%, p=0.015), and had children (92% vs 64%, p=0.024). When asking the reason why they wouldn’t ask, 70% (n=9) said they were ashamed to, 23% (n=3) ignored if this belonged to the rheumatologist and 7% (n=1) because of lack of time at consultation. *- p value was obtained by Chi-square test. SD – Standard deviation. Conclusion Rheumatologists rarely approach or evaluate the sexuality topic with their patients. However, in our population, patients are willing to talk about this with their doctor. Sexuality must be assessed in all patients; but special attention must be paid to women with SLE and menopause, children, fibromyalgia and/or age over 35, because they’re prone to not discuss this topic with their doctor. References [1] Perdriger A, Solano C, Gossec L. Why should rheumatologists evaluate the impact of rheumatoid arthritis on sexuality? Jt Bone Spine. 2010;77:493-495. doi:10.1016/j.jbspin.2010.07.005 [2] Tseng J-C, Lu L-Y, Hu J-C, et al. The Impact of Systemic Lupus Erythematosus on Women’s Sexual Functioning. J Sex Med. 2011. doi:10.1111/j.1743-6109.2011.02464.x Disclosure of Interests None declared

Background: Normal sexual function consists in the transition, during sexual activity, through the phases of excitement to relaxation without problems, and with a feeling of pleasure, satisfaction and fulfillment (1). The effect of systemic lupus erythematosus (SLE) in sexual function has been one of the least studied areas, but it is thought that some disease-related characteristics could have a negative effect. There are few previous studies that investigate sexual function in SLE, general results indicate a negative impact (2). Objectives: The main aim of this study is to determine if there is an altered sexual function in Mexican women with SLE and compare if it occurs in a greater proportion than in healthy women. Methods: A case-control study with 102 Mexican women between 18 and 60 years, with SLE diagnosis (according to SLICC 2012 criteria) and a control group of healthy women (n=156) matched by age. Patients were excluded if they couldn’t answer the questionnaires reliably and pregnant women. They were asked about the presence of active sexual life in the last month and the Female Sexual Function Index (FSFI) self-questionnaire was applied. Variables between groups were compared with Chi-square and Mann U Whitney test. Results: Baseline demographic characteristics between groups are shown in table 1. Women with SLE had less sexual activity, during the last month, than controls (63.7% vs 77.5%, p = 0.01). Out of the total women included, the FSFI was applied only to those that had an active sexual life, 65 with SLE and 121 healthy women. Sexual disfunction ( *-Mann U Whitney or Chi-Square test according to type of variable. SD – Standard Deviation. *-Mann U Whitney or Chi-square test according to type of variable. Conclusion: Women with SLE, in this study, have less sexual activity than healthy women, but no greater sexual disfunction. However, they have a worse performance in the desire and excitation areas. This alteration did not show a relation with demographic nor disease-related variables. The abnormality found could be explained by a psychosocial factor not evaluated in this study. References: [1] Tristano AG. The impact of rheumatic diseases on sexual function. Rheumatol Int. 2009. doi:10.1007/s00296-009-0850-6 [2] Daleboudt GMN, et al. The impact of illness perceptions on sexual functioning in patients with systemic lupus erythematosus. J Psychosom Res. 2013. Disclosure of Interests: None declared

Introduccion. Recientemente, se ha incrementado la atencion hacia causas metabolicas de la perdida de celulas dopaminergicas en la enfermedad de Parkinson (EP), dada la intolerancia a la glucosa que pueden presentar estos pacientes. Un sindrome caracterizado por resistencia a la insulina es el sindrome metabolico. Objetivo. Determinar la prevalencia y las caracteristicas clinicas del sindrome metabolico y sus componentes en pacientes con EP. Pacientes y metodos. Se analizaron variables de 99 pacientes con EP. Se registraron escalas que evaluan las funciones motora, no motora y cognitiva, los trastornos del sueno y la calidad de vida. El sindrome metabolico se diagnostico segun los criterios de la Organizacion Mundial de la Salud. Resultados. La prevalencia de sindrome metabolico se notifico en un 8%. Al subdividir a los pacientes en funcion de los criterios positivos de sindrome metabolico, no se observaron diferencias significativas en las funciones motora y cognitiva, la calidad de vida ni los trastornos del sueno entre los grupos. No obstante, pacientes con sindrome metabolico mostraron peores puntuaciones en la escala de sintomas no motores en comparacion con pacientes sin el sindrome, especialmente en cuanto a tracto gastrointestinal, estado de animo/apatia, funcion sexual, problemas perceptivos y miscelaneos. No se observaron diferencias significativas en las caracteristicas clinicas al agrupar a los pacientes sobre la base del componente unico de sindrome metabolico presente. Conclusion. El sindrome metabolico podria tener un efecto sobre la sintomatologia no motora en la EP, ya que los pacientes con este sindrome mostraron peores puntuaciones en la escala de sintomas no motores.

With great interest, we read the article by Barichella et al.1 that presents evidence of a nutritional strategy—in addition to an intensive rehabilitation program—associated with better rehabilitation outcomes in patients with parkinsonism. Previous evidence in patients with Parkinson disease linking muscle mass loss to disease progression2 and worse scores across multiple disease-domains (motor, mood, and quality of life),3 emphasize the importance of nutritional strategies accompanying an exercise program.4 Furthermore, the inclusion of patients with atypical parkinsonism represents a major strength demonstrating that nutritional strategies are fundamental in the management of patients with parkinsonism whether typical, atypical, or atypically atypical.5 We wonder whether there were any differences between Parkinson disease (PD) and non-PD parkinsonisms—regardless of the small number of patients with the latter—given the scarcity of studies on the topic. This article represents evidence for the systematic inclusion of nutritional strategies as a standard of care in patients with parkinsonism and encourages research that will allow to improve current interventions while addressing risks of malnutrition, even in patients with advanced stages of the disease.

The eight-and-a-half syndrome (EHS)—defined by the combination of a seventh cranial nerve palsy and an ipsilateral one-and-a-half syndrome—is a rare brainstem syndrome, which localises to the caudal tegmental region of the pons. We present a case of the EHS secondary to an inflammatory lesion on a previously healthy 26-year-old woman, with a literature review emphasising the relevance of aetiological assessment.

Background The vertiginous pace with which modern medicine advances, can seem overwhelming to students and young doctors. Aim of the study To reappraise an oration by William Osler delivered to medical students at the point of their graduation. Methods Narrative review. Results Osler emphasised the Art of Detachment, the Virtue of Method, the Quality of Thoroughness and the Grace of Humility, which he considers the basic pillars on which a successful medical practice is achieved, Osler's words serve as a guiding light for physicians struggling with the demands of twenty first century medicine.

The association between memory loss and Hodgkin's lymphoma has been given the eponym of Ophelia syndrome, in memory of Shakespeare's character in The Tragedy of Hamlet, Prince of Denmark. Nevertheless, there are differences between the disease and the character. Objective: To review the origins and uses of the eponym through an original article by pathologist Ian Carr, its relation to the character Ophelia, and the related autoantibodies. Methods: Historical narrative review. Results: Besides an eloquent description in the original article, Carr presaged the presence of autoantibodies, before they had been thoroughly researched. Since then, five different autoantibodies (mGluR5, Hu, NMDAR, SOX, PCA2) have been associated with Hodgkin's disease. It is interesting to note the divergent outcomes of Shakespeare's character and the patient in the original description by Carr, the latter recovering to lead a normal life, and the former deceased. Conclusions: Although there is little relationship between the fictional character and the syndrome, both imply the unintentional trigger of self-harm (suicide in one case, autoimmunity in the other), thus remaining associated. RESUMO El síndrome de Ofelia describe la asociación entre pérdida de memoria y enfermedad de Hodgkin, en memoria del personaje de La Tragedia de Hamlet, Príncipe de Dinamarca, de William Shakespeare. Sin embargo, existen diferencias entre ambos. Objetivo: Revisar los orígenes y usos del epónimo a través del artículo original, su relación con el personaje y los autoanticuerpos relacionados. Métodos: Revisión narrativa histórica. Resultados: Además de una descripción elocuente, el artículo original prefigura los autoanticuerpos, cuando no se buscaban de rutina. Desde entonces, cinco distintos (mGluR5, Hu, NMDAR, SOX, PCA2) han sido asociados. Cabe destacar, que el desenlace del personaje y del paciente fueron diametralmente opuestos, el primero falleció y el segundo se recuperó, llevando una vida normal. Conclusiones: A pesar de la poca relación entre el personaje y el síndrome, ambos implican el desencadenamiento no intencional de daño auto-inflingido (suicidio en un caso, autoinmunidad en el otro), manteniendo así la adecuacía.