We review post-infectious and post-vaccination neurological syndromes involving peripheral and central nervous system (CNS) and report an illustrative case of simultaneous occurrence of Guillain-Barré syndrome (GBS), confirmed by nerve conduction velocities, plus MRI-demonstrated transverse myelitis (TM) and acute encephalitis [acute disseminated encephalomyelitis] (ADEM+GBS) affecting a 24-year-old woman from Cúcuta, Colombia, who developed acute Zika virus (ZIKV) infection confirmed by serum reverse transcriptase-polymerase chain reaction (RT-PCR) and convalescent ZIKV IgG antibodies. With intensive care treatment, respiratory support, steroids, and intravenous immunoglobulin (IVIg), patient survived with residual flaccid paraparesis. She had preexisting immunity against Chikungunya virus (CHIKV) and Dengue virus (DENV) acquired before the arrival of ZIKV in Colombia. From reports in the Caribbean, Central and South America we review 19 cases of ZIKV-associated TM, encephalitis and ADEM occurring after a mean latent period of 10.5 days (range 1-96) post-infection. Although GBS and ADEM are usually considered post-infectious and associated with development of antibodies against peripheral nerve and CNS epitopes, we postulate that our case of ADEM+GBS is para-infectious, induced by acute ZIKV neurotropism boosted by active immunity against other arboviruses. Animal models of ZIKV demonstrated strong viral neurotropism enhanced by passive immunity with antibodies against arboviruses such as West Nile virus, CHIKV, or DENV. These considerations are relevant to prevent potential ZIKV vaccine-induced reactions involving central and peripheral nervous system.cycle where transmission to humans occurs mainly by female Aedes mosquitoes-also carriers of DENV and Chikungunya (CHIKV), an alphavirus of the family Togaviridae. In addition, sexual transmission of ZIKV has been demonstrated with virus isolations from urine, semen, blood, maternal milk and tears. Zika infection is manifested by fever, maculopapular rash, conjunctivitis and rare uveitis, arthralgias, muscle pain and headache, but about 80% of infections are asymptomatic [2]. Nonetheless, ZIKV is neuroinvasive and capable of causing numerous neurological manifestations [2].According to the World Health Organization (WHO) [3], a major

Introduction: Late-onset Alzheimer disease (LOAD) is the most common dementia worldwide. APOE-ɛ4 and BIN1 (Bridging Integrator 1) have been implicated in the pathogenesis of this disease, but, although DNA methylation of dinucleotide CpGs in the BIN1 gene influences alterations, it has not been studied in Hispanics. Objective: The objective of this study was to evaluate the BIN1 3′ intergenic region DNA methylation patterns in a Colombian sample of LOAD patients. Methods: A case-control study was conducted in 50 individuals with LOAD and 50 age-sex matched controls to determine associations of LOAD with DNA methylation. DNA was isolated from peripheral blood, and methylation levels of 8 CpGs were estimated by bisulfite conversion followed by Sanger sequencing with direct PCR analysis. Logistic regression models adjusted by age, sex, and APOE were used to calculate risk associations between methylation levels and LOAD. Results: Overall, participants with LOAD had significantly lower methylation levels on CpG26 (0.86±0.11 vs. 0.95±0.05; P>0.001), CpG44 (0.84±0.09 vs. 0.94±0.06; P=0.001), and CpG87 (0.64±0.12 vs. 0.82±0.10; P>0.001). Adjusted regression models showed that decreased methylation levels of these CpGs remained as risk factors for LOAD (P<0.05). Conclusions: Hypomethylation of CpGs in BIN1 might play an important role in the expression of BIN1 and may be a biomarker for identifying individuals at high risk of developing LOAD.

Background: Biomarkers are essential for identification of individuals at high risk of mild cognitive impairment (MCI) for potential prevention of dementia. We investigated DNA methylation in the APOE gene and apolipoprotein E (ApoE) plasma levels as MCI biomarkers in Colombian subjects with MCI and controls. Methods: In total, 100 participants were included (71% women; average age, 70 years; range, 43–91 years). MCI was diagnosed by neuropsychological testing, medical and social history, activities of daily living, cognitive symptoms and neuroimaging. Using multivariate logistic regression models adjusted by age and gender, we examined the risk association of MCI with plasma ApoE and APOE methylation. Results: MCI was diagnosed in 41 subjects (average age, 66.5 ± 9.6 years) and compared with 59 controls. Elevated plasma ApoE and APOE methylation of CpGs 165, 190, and 198 were risk factors for MCI (p < 0.05). Higher CpG-227 methylation correlated with lower risk for MCI (p = 0.002). Only CpG-227 was significantly correlated with plasma ApoE levels (correlation coefficient = −0.665; p = 0.008). Conclusion: Differential APOE methylation and increased plasma ApoE levels were correlated with MCI. These epigenetic patterns require confirmation in larger samples but could potentially be used as biomarkers to identify early stages of MCI.

Con el objeto de mejorar la calidad, eficacia, equidad, seguridad y sostenibilidad económica en la atención de pacientes con ataque cerebrovascular, se desarrolló una Guía de práctica clínica con recomendaciones sustentadas en la mejor evidencia disponible. Sin embargo, la formulación de dichas recomendaciones no garantiza el cambio esperado. Nace entonces el reto de generar estrategias de aceptación, implementación, seguimiento y ajuste de las recomendaciones en la práctica asistencial diaria, con la aplicación de facilitadores de implementación que sobrepasen las barreras y permitan lograr el efecto deseado. La Guía de práctica clínica para el diagnóstico, tratamiento y rehabilitación del episodio agudo de ataque cerebrovascular isquémico en población mayor de 18 años se desarrolla bajo un modelo de gestión que identifica las recomendaciones claves en escenarios específicos e incluye procesos de participación, revisión y socialización como facilitadores de la implementación.

We review post-infectious and post-vaccination neurological syndromes involving peripheral and central nervous system (CNS) and report an illustrative case of simultaneous occurrence of Guillain-Barré syndrome (GBS), confirmed by nerve conduction velocities, plus MRI-demonstrated transverse myelitis (TM) and acute encephalitis [acute disseminated encephalomyelitis] (ADEM+GBS) affecting a 24-year-old woman from Cúcuta, Colombia, who developed acute Zika virus (ZIKV) infection confirmed by serum reverse transcriptase-polymerase chain reaction (RT-PCR) and convalescent ZIKV IgG antibodies. With intensive care treatment, respiratory support, steroids, and intravenous immunoglobulin (IVIg), patient survived with residual flaccid paraparesis. She had preexisting immunity against Chikungunya virus (CHIKV) and Dengue virus (DENV) acquired before the arrival of ZIKV in Colombia. From reports in the Caribbean, Central and South America we review 19 cases of ZIKV-associated TM, encephalitis and ADEM occurring after a mean latent period of 10.5 days (range 1-96) post-infection. Although GBS and ADEM are usually considered post-infectious and associated with development of antibodies against peripheral nerve and CNS epitopes, we postulate that our case of ADEM+GBS is para-infectious, induced by acute ZIKV neurotropism boosted by active immunity against other arboviruses. Animal models of ZIKV demonstrated strong viral neurotropism enhanced by passive immunity with antibodies against arboviruses such as West Nile virus, CHIKV, or DENV. These considerations are relevant to prevent potential ZIKV vaccine-induced reactions involving central and peripheral nervous system.cycle where transmission to humans occurs mainly by female Aedes mosquitoes-also carriers of DENV and Chikungunya (CHIKV), an alphavirus of the family Togaviridae. In addition, sexual transmission of ZIKV has been demonstrated with virus isolations from urine, semen, blood, maternal milk and tears. Zika infection is manifested by fever, maculopapular rash, conjunctivitis and rare uveitis, arthralgias, muscle pain and headache, but about 80% of infections are asymptomatic [2]. Nonetheless, ZIKV is neuroinvasive and capable of causing numerous neurological manifestations [2].According to the World Health Organization (WHO) [3], a major

El 2 de junio de 2021, el Ministerio de Salud y Protección Social de Colombia expidió la Resolución 777, mediante la cual se determinan las condiciones para el reinicio de todas las actividades económicas y sociales restringidas y se define el Índice de resiliencia epidemiológica municipal (IREM) como la herramienta para apoyar las decisiones relacionadas con esta reactivación económica, en medio del tercer pico epidémico de la COVID-19 en el país. El objetivo de este artículo es hacer un análisis crítico de los aspectos técnicos del IREM y explorar la conveniencia de su implementación como soporte del reinicio de las actividades económicas y sociales propuesto en la resolución. Dentro de este análisis crítico se destaca la falta de una clara definición de resiliencia epidemiológica que se ajuste a la literatura científica. Además, se cuestiona tanto la validez de apariencia, contenido y de constructo del índice global, como la validez del constructo de sus dimensiones y, por tanto, la pertinencia de usarlo como herramienta para definir dicho reinicio.

La enfermedad de Alzheimer (EA) es la más común de las demencias; es un problema de salud pública en el Mundo, pero en Colombia no hace parte de las prioridades del Estado. El presente ensayo aborda cómo el sistema de salud colombiano reconoce, identifica y provee servicios a los pacientes con EA, desde una óptica de la Justicia Social. En primera medida se evalúa la información generada por la academia, su correlato con la normativa vigente y su articulación. Se explora la lógica utilitarista del sistema de salud colombiano y el incentivo a la maximización de ganancias de los aseguradores y cómo esto ha llevado a los pacientes a exigir la restitución de derechos a través de la acción de tutela. Se explora el sistema de codificación y diagnostico usado para la generación de información y como esta es imprecisa en los canales de información consolidada. Por otra parte, se valora como el rol de la familia se hace parte fundamental del proceso, y cómo esta termina siendo víctima del mismo.  Finalmente, se plantea reflexiones de cómo pueden abordarse las dificultades identificadas desde una perspectiva de la Justicia Social.

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