[Core data set for real world data in multiple sclerosis: customization for latin america from a global task force recommendation]

INTRODUCTION

The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region.

MATERIAL AND METHODS

A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables.

RESULTS

A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region.

CONCLUSION

The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.

Harvesting visible light for enhanced catalytic degradation of wastewater using TiO2@Fe3O4 embedded on two dimensional reduced graphene oxide nanosheets

Carbon-integrated binary metal oxide semiconductors have gained prominence in the last decade as a better material for photocatalytic wastewater treatment technology. In this regard, this research describes the investigation of the binary metal oxide TiO2@Fe3O4 embedded on reduced graphene oxide (rGO) nanosheets synthesized through a combination of sol-gel, chemical precipitation, and Hummer's processes. Besides, the catalyst is applied for the photocatalytic degradation of organic chlorophenol pollutants. The characterized diffraction results showed the peak broadening of the rGO-TiO2@Fe3O4 composite formed with tetragonal and cubic structures having small crystallite sizes. The TEM observation shows an enormous miniature of TiO2@Fe3O4 nanospheres spread on the folded 2D-rGO nanosheets with a large BET surface area. The XPS result holds the mixed phases of Fe3O4 and Fe2O3. Finally, the catalyst demonstrated a low band gap with extended light absorption towards visible light irradiation. The synergistic interactions between Fe3+ and Fe2+ improved the visible light activity due to the incorporation of rGO, and also possessed good recycling capacity. The increased mobility of electrons at the interfaces of TiO2 and Fe3O4 due to the mixing of rGO results in the separation of charge carriers by elevating the photocatalytic degradation efficiency of chlorophenol.

Mesoporous NiO/Ni2O3 nanoflowers for favorable visible light photocatalytic degradation of 4-chlorophenol

The present study highlights the treatment of industrial effluent, which is one of the most life-threatening factors. Herein, for the first time, two types of NiO (green and black) photocatalysts were prepared by facile chemical precipitation and thermal decomposition methods separately. The synthesized NiO materials were demonstrated with various instrumental techniques for finding their characteristics. The X-ray diffraction studies (XRD) and X-ray photoelectron spectroscopy (XPS) revealed the presence of Ni2O3 in black NiO material. The transmission electron microscopic (TEM) images engrained the nanospherical shaped green NiO and nanoflower shaped black NiO/Ni2O3 materials. Further, the band gap of black NiO nanoflower was 2.9 eV compared to green NiO having 3.8 eV obtained from UV-vis spectroscopy. Meanwhile, both NiO catalysts were employed for visible light degradation, which yields a 60.3% efficiency of black NiO comparable to a 4.3% efficiency of green NiO within 180 min of exposure. The higher degrading efficiency of black NiO was due to the presence of Ni2O3 and the development of pores, which was evident from the Barrett-Joyner-Halenda (BJH) method. Type IV hysteresis was observed in black NiO nanoflowers with high surface area and pore size measurements. This black NiO/Ni2O3 synthesized from the thermal decomposition method has promoted better photocatalytic degradation of 4-chlorophenol upon exposure to visible light and is applicable for other industrial pollutants.

A mechanothermal approach for the synthesis of Fe3O4 nanoparticles as dopant on mesoporous TiO2 for electrochemical determination of catechol

The subject of water contamination and how it gets defiled to the society and humans is confabulating from the past decades. Phenolic compounds widely exist in the water sources and it is emergent to determine the toxicity in natural and drinking water, because it is hazardous to the humans. Among these compounds, catechol has sought a strong concern because of its rapid occurrence in nature and its potential toxicity to humans. The present work aims to develop an effective electrochemical sensing of catechol using mesoporous structure of Fe₃O₄-TiO₂ decorated on glassy carbon (GC) electrode. The creation of pure TiO₂ using the sol-gel technique was the first step in the synthesis protocol for binary nanocomposite, which was then followed by the loading of Fe₃O₄ nanoparticles on the surface of TiO₂ using the thermal decomposition method. The resultant Fe₃O₄-TiO₂ based nanocomposite exhibited mesoporous structure and the cavities were occupied with highly active magnetite nanoparticles (Fe₃O₄) with high specific surface area (90.63 m²/g). When compared to pure TiO₂, catechol showed a more prominent electrochemical response for Fe₃O₄-TiO₂, with a significant increase in anodic peak current at a lower oxidation potential (0.387 V) with a detection limit of 45 μM. Therefore, the prepared magnetite binary nanocomposite can serve as an efficient electroactive material for sensing of catechol, which could also act as a promising electrocatalyst for various electrocatalytic applications.

Mesoporogen free synthesis of CuO/TiO2 heterojunction for ultra-trace detection of catechol in water samples

Creating mesoporous architecture on the surface of metal oxides without using pore creating agent is significant interest in electrochemical sensors because these materials act as an efficient electron transfer process between the electrode interface and the analytes. Recent advances in mesoporous titanium dioxide (TiO₂)-based materials have acquired extraordinary opportunities because of their interconnected porous structure could act as a host for doping with various transition metals or heteroatoms to form a new type of heterojunction. Herein, a simple method is developed to synthesize mesoporous copper oxide (CuO) decorated on TiO₂ nanostructures in which homogenous shaped CuO nanocrystals act as dopants decorated on the mesoporous structure of TiO₂, resulting in p-n heterojunction nanocomposite. The TiO₂ particles exhibit a mesoporous structure with a pore volume of about 0.117 cm³/g is capable to load CuO nanocrystals on the surface. As a result, large pore volume 0.304 cm³/g is obtained for CuO-TiO₂ heterojunction nanocomposite with the loading of uniform-shaped CuO nanocrystals on the mesoporous TiO₂. The resulting CuO-TiO₂ nanocomposite on modified glassy carbon (GC) electrode exhibits good electrochemical performance for oxidation of catechol with the observation of strong enhancement in the anodic peak potential at +0.36 V. The decrease in the overpotential for the oxidation of catechol when compared to TiO₂/GC is attributed to the presence of CuO nanocrystals providing a large surface area, resulting in wide linear range 10 nM to 0.57 μM. Moreover, the resultant modified electrode exhibited good sensitivity, selectivity and reproducibility and the sensor could able to determine the presence of catechol in real samples such as lake and river water. Therefore, the obtained CuO-TiO₂ nanocomposite on the modified GC delivered good electrochemical sensing performance and which could be able to perform a promising strategy for designing various metal oxide doped nanocomposites for various photochemical and electrocatalytic applications.

Improving the sensitivity for hydrogen peroxide determination with active V2O5 nanocubes incorporated on mesoporous TiO2

The capacity to generate a constant signal response from an enzyme on an electrode surface has been a fascinating topic of research from the past three decades. To nourish the enzymatic activity during electrochemical reactions, the immobilization of dual enzymes on the electrode surface could prevent the enzymatic loss without denaturation and thus long-term stability can be achieved. For effective immobilization of dual enzymes, mesoporous materials are the ideal choice because of its numerous advantages such as 1. The presence of porous structure facilitates high loading of enzymes 2. The formation of protective environment can withstand the enzymatic activity even at acidic or basic pH values and even at elevated temperatures. Herein, we develop bienzymatic immobilization of horseradish peroxidase (HRP) and cholesterol oxidase (ChOx) on mesoporous V₂O₅-TiO₂ based binary nanocomposite for effective sensing of hydrogen peroxide (H₂O₂) in presence of redox mediator hydroquinone (HQ). The utilization of redox mediator in second-generation biosensing of H₂O₂ can eliminate the interference species and reduces the operating potential with higher current density for electrochemical reduction reaction. Using this mediator transfer process approach at HRP/ChOx/V₂O₅-TiO₂ modified GC, the H₂O₂ can be determined at operating potential (-0.2 V) with good linear range (0.05-3.5 mM) higher sensitivity (1040 μAμM^-1 cm^-2) and lower detection limit of about 20 μM can be attained, which is due to higher mediation of electrons were transferred to the enzyme cofactors. These interesting characteristics could be due to mesoporous structure of V₂O₅-TiO₂ can induce large immobilization and facilitate higher interaction with enzymes for wide range of biosensing applications.

Orange peel extract influenced partial transformation of SnO2 to SnO in green 3D-ZnO/SnO2 system for chlorophenol degradation

In recent times, visible light enhancement has become much more considered due to the enlightening properties of nanocomposite systems. This has potential applications for wastewater treatment due to the blemish of toxic organic chemicals from industrial sectors. Therefore, this work is focused on novel 3D ZnO/SnO₂ nanocomposites synthesized by the green method (orange peel extracts supported combined chemical processes) utilized for the removal of chlorophenol effluent. The orange peel extract has been incorporated as one of the major components to synthesize an effective nanocomposite. Also, the pure materials were synthesized along with these nanocomposites and tested under various instrumental techniques. The characterized results showed that the composites prepared with orange peel extract exhibited hexagonal 3D ZnO nanospheres with 3D tetragonal structured SnO₂ nanocubes. Elemental analysis showed that the partial amount of SnO₂ has transformed to SnO due to the reducing ability of orange peel extract. Also, the existing different (Zn²⁺, Sn⁴⁺, and Sn²⁺) states helped in delaying the transfer of electron-hole recombination to obtain photocatalytic chlorophenol degradation. Further, the prevailing line dislocation can compromise more vacancy and interact with more electrons. The high surface area, least crystallite size, and lower bandgap inspired to enhance the visible light activity. Simultaneously, the pure form of nanomaterial has poor light absorption under visible light. This study achieves the photocatalytic degradation of 77.5% against chlorophenol using a green 3D composite system.

Visible light driven exotic p (CuO) - n (TiO2) heterojunction for the photodegradation of 4-chlorophenol and antibacterial activity

The treatment of industrial waste and harmful bacteria is an important topic due to the release of toxins from the industrial pollutants that damage the water resources. These harmful sources frighten the life of every organism which was later developed as the carcinogenic and mutagenic agents. Therefore, the current study focuses on the breakdown or degradation of 4-chlorophenol and the antibacterial activity against Escherichia coli (E. coli). As a well-known catalyst, pure titanium-di-oxide (TiO₂) had not shown the photocatalytic activity in the visible light region. Hence, band position of TiO₂ need to be shifted to bring out the absorption in the visible light region. For this purpose, the n-type TiO₂ nanocrystalline material's band gap got varied by adding different ratios of p-type CuO. The result had appeared in the formation of p (CuO) - n (TiO₂) junction synthesized from sol-gel followed by chemical precipitation methods. The optical band gap value was determined by Kubelka-Munk (K-M) plot through UV-Vis diffusive reflectance spectroscopy (DRS). Further, the comprehensive mechanism and the results of photocatalytic and antibacterial activities were discussed in detail. These investigations are made for tuning the TiO₂ catalyst towards improving or eliminating the existing various environmental damages.

Photocatalytic degradation of 2,4-dichlorophenol using bio-green assisted TiO2-CeO2 nanocomposite system

In recent times, cost effective synthesis of semiconductor materials has been a subject of concern for the day to today applications. In this work, novelty has been made on the facile synthesis of metal oxides (TiO₂ and CeO₂) and nanocomposites (TiO₂-CeO₂) through sol-gel and precipitation methods of imparting lemon extract. The synthesized materials behave as the functional catalysts which has been further carried out for the photocatalytic degradation against 2,4-Dichlorophenol (2,4-DCP). The materials are then valued for the structural and optical properties. The lemon extract used in synthesis has played a premier role in upgrading the charge carrier separation, bandgap, and size reduction of the composite system. Further, the CeO₂ supported TiO₂ sample acts as the better visible light catalyst, due to the prevention of aggregation and existence of line dislocation that supported to access the additional electron trap sites.

Crystallinity and lowering band gap induced visible light photocatalytic activity of TiO2/CS (Chitosan) nanocomposites

The inhibition of electrons-holes recombination and enhancement of visible light photocatalytic activity were accomplished by the synthesized TiO₂/CS nanocomposites system. In this present work, the different weight ratio of TiO₂ and chitosan (75:25, 50:50 and 25:75) nanocomposites were synthesized via two-step method. After that, the existing functional groups, size and structure of the nanocomposites system were characterized via FT-IR, TEM and XRD measurements. The band gap of the prepared materials and its excitation and emission spectra were elevated through UV-vis and PL analyses. Moreover, the MO and MB degradation capability of the synthesized TiO₂/CS nanocomposites was optimized, and the outcomes are described in detail.

Ce(3+)-ion-induced visible-light photocatalytic degradation and electrochemical activity of ZnO/CeO2 nanocomposite

In this study, pure ZnO, CeO2 and ZnO/CeO2 nanocomposites were synthesized using a thermal decomposition method and subsequently characterized using different standard techniques. High-resolution X-ray photoelectron spectroscopy measurements confirmed the oxidation states and presence of Zn(2+), Ce(4+), Ce(3+) and different bonded oxygen species in the nanocomposites. The prepared pure ZnO and CeO2 as well as the ZnO/CeO2 nanocomposites with various proportions of ZnO and CeO2 were tested for photocatalytic degradation of methyl orange, methylene blue and phenol under visible-light irradiation. The optimized and highly efficient ZnO/CeO2 (90:10) nanocomposite exhibited enhanced photocatalytic degradation performance for the degradation of methyl orange, methylene blue, and phenol as well as industrial textile effluent compared to ZnO, CeO2 and the other investigated nanocomposites. Moreover, the recycling results demonstrate that the ZnO/CeO2 (90:10) nanocomposite exhibited good stability and long-term durability. Furthermore, the prepared ZnO/CeO2 nanocomposites were used for the electrochemical detection of uric acid and ascorbic acid. The ZnO/CeO2 (90:10) nanocomposite also demonstrated the best detection, sensitivity and performance among the investigated materials in this application. These findings suggest that the synthesized ZnO/CeO2 (90:10) nanocomposite could be effectively used in various applications.

The ultrasound-assisted synthesis of effective monodisperse nickel nanoparticles: magnetic characterization and its catalytic activity in CO2 methanation

High performance nickel–zirconia nanocatalysts based on monodisperse nickel nanoparticles have been developed via a simple and continuous two-step ultrasonic method.

ZnO/Ag/Mn2O3 nanocomposite for visible light-induced industrial textile effluent degradation, uric acid and ascorbic acid sensing and antimicrobial activity

Ternary ZnO/Ag/Mn₂O₃ nanocomposite as photocatalyst, sensing and antimicrobial material.

The epidemiology of multiple sclerosis in Latin America and the Caribbean: a systematic review

The incidence and prevalence of multiple sclerosis (MS) varies geographically as shown through extensive epidemiological studies performed mainly in developed countries. Nonetheless, scant data is available in Latin America and the Caribbean (LAC). The objective of this review is to assess epidemiological data of MS in LAC. We conducted a systematic review of published articles and gray literature from January 1995 to May 2011. Twenty-two studies met the inclusion criteria after full-text review. Incidence data were found in only three studies and ranged from 0.3 to 1.9 annual cases per 100,000 person-years. Prevalence was reported in 10 studies and ranged from 0.83 to 21.5 cases per 100,000 inhabitants. The most prevalent subtype of MS was the relapsing–remitting form (48% to 91% of the series). No data about mortality were found. This study showed low frequency for MS in LAC compared with North American and European countries. The role of environmental and genetic factors should be well studied, providing new insights about its etiology.

Towards establishing MS prevalence in Latin America and the Caribbean

A very high prevalence of multiple sclerosis (MS) has been reported in some Western European and North American countries. The few surveys of MS epidemiology in South America reveal lower prevalence rates, implying that susceptibility varies between distinct ethnic groups, thus forming an important determinant of the geographic distribution of the disease. The objective of this study is to review MS prevalence estimates in different Latin American and Caribbean countries. We reviewed surveys of regional MS prevalence from 1991 to 2011. Sources included an online database, authors' reports and proceedings or specific lectures from regional conferences. We obtained a total of 30 prevalence surveys from 15 countries, showing low/medium MS prevalence rates. Both the number and the quality of prevalence surveys have greatly improved in this region over recent decades. This is the first collaborative study to map the regional frequency of MS. Establishment of standardized methods and joint epidemiological studies will advance future MS research in Latin America and the Caribbean.

[The relation between carotid ultrasound changes and seropositivity to Chlamydia pneumoniae in patients with acute stroke]

INTRODUCTION

Several infectious agents have been found to be involved in atherogenesis over the past decade. Chlamydia pneumoniae is one of the commonest associated agents. In this study we have analysed the possible relationship between a high level of antibodies to Chlamydia, and the presence of carotid ultrasound changes in patients who have had strokes.

PATIENTS AND METHODS

We studied 230 patients admitted consecutively to the Stroke Unit in our hospital, with the diagnosis of stroke. All the patients in the group had carotid duplex ultrasound studies to assess the degree of stenosis. All these patients also had serological studies using micro-immunofluorescence to detect antibodies to Chlamydia pneumoniae.

RESULTS

Only 35 patients were found to have positive Chlamydia pneumoniae serology. The degree of atheromatosis was similar in the patients with high levels of IgG for Chlamydia pneumoniae and in those with normal serology. There was no statistically significant relation between the degree of stenosis and being seropositive for Chlamydiae.

CONCLUSIONS

Our findings suggest that in an unselected population of stroke patients there is no relations between carotid atheromatosis and positive serology findings to Chlamydia pneumoniae. If there is any relationship between Chlamydia pneumoniae and carotid atheromatosis, serology does not seem to be a technique which is suitable for its assessment.

Hantavirus pulmonary syndrome in Panama: identification of novel hantaviruses and their likely reservoirs

Hantavirus pulmonary syndrome (HPS), a severe respiratory disease with high mortality caused by rodent-borne hantaviruses, has previously been identified in the United States and Canada as well as central and southern South America. In late 1999 and early 2000, an outbreak of acute illness compatible with HPS was reported in Los Santos, Panama, with the death of 3 of the 12 (25%) suspected cases. Hantavirus-specific antibodies were detected in patient sera, and virus RNA was detected by reverse transcriptase-polymerase chain reaction. Sequence analysis of virus genome N-, G1-, and G2-encoding fragments showed this to be a novel hantavirus, Choclo virus. Serologic and virus genetic analyses of rodents trapped in the area showed Oligoryzomys fulvescens to be the likely reservoir for the HPS-associated Choclo virus. In addition, Zygodontomys brevicauda rodents were shown to harbor another genetically unique hantavirus, Calabazo virus.

Asymmetrical bilateral traumatic hip dislocation with ipsilateral acetabular fracture

We report a case of simultaneous asymmetrical bilateral traumatic hip dislocation, with one hip dislocated anteriorly and the other posteriorly, with ipsilateral acetabular fracture, suffered in a traffic accident by a 36-year-old man. Closed reduction of both hips was performed, followed by delayed internal fixation of the acetabular fracture.

Asymmetrical bilateral traumatic hip dislocation with ipsilateral acetabular fracture

We report a case of simultaneous asymmetrical bilateral traumatic hip dislocation, with one hip dislocated anteriorly and the other posteriorly, with ipsilateral acetabular fracture, suffered in a traffic accident by a 36-year-old man. Closed reduction of both hips was performed, followed by delayed internal fixation of the acetabular fracture.

Spinocerebellar syndrome in patients infected with human T-lymphotropic virus types I and II (HTLV-I/HTLV-II): report of 3 cases from Panama

Cerebellar symptoms at onset are unusual in HTLV-I/II-associated tropical spastic paraparesis (TSP). A prospective study of neurological disorders in Panama (1985-1990) revealed 13 patients with TSP and 3 with HTLV-I/II-associated spinocerebellar syndrome (HSCS) presenting at onset loss of balance, wide-based stance and gait, truncal instability, and mild leg ataxia (vermian cerebellar syndrome), with absent upper limb dysmetria but with postural tremor, downbeat nystagmus, and dysarthria. In 4-5 years, spinal cord manifestations of TSP developed, including spastic paraparesis, pyramidal signs, bladder and sphincter disturbances. Two patients were infected with HTLV-I and another one, a Guaymi Amerindian woman, with HTLV-II. Magnetic resonance imaging (MRI) demonstrated cerebellar atrophy involving predominantly the superior vermis. Mild axonal peripheral neuropathy in the lower limbs, dorsal column involvement and inflammatory myopathy were found by neurophysiology studies. There are 14 similar cases reported in Japan and Canada, but to our knowledge these are the first documented cases of HSCS in the tropics. A cerebellar syndrome constitutes another form of presentation of HTLV-I/II infection of the nervous system.

Risk factors for human T cell lymphotropic virus type II infection among the Guaymi Indians of Panama

To examine risk factors for human T cell lymphotropic virus type II (HTLV-II) infection, a case-control study was conducted among the Guaymi Indians of Panama. In females, HTLV-II seropositivity was associated with early sexual intercourse (</=13 vs. >15 years; odds ratio [OR], 2.50; 95% confidence interval [CI], 1.11-6.14) and number of lifetime sex partners. One partner increased risk of seropositivity by 30% (OR, 1.30; CI, 1.05-1.64), and risk increased with number of partners. Similar risk was associated with number of long-term sexual relationships. Among males, intercourse with prostitutes was associated with HTLV-II seropositivity (OR, 1.68; CI, 1.04-2.72). These data support a role for sexual transmission in HTLV-II infection. Association of seropositivity with primary residence in a traditional village (OR, 3.75; CI, 1.02-15.38) and lack of formal education (0 vs. >6 years [OR, 3.89; CI, 1.67-9.82]) observed in males may reflect differences in sexual practices associated with acculturation.

[Neurological clinical findings as the initial manifestation of a peripheral lymphoma]

INTRODUCTION

Lymphomas of the central nervous system include primary and secondary lymphomas of Hodgkin and non-Hodgkin types. For a long time central nervous system involvement during the course of systemic non-Hodgkin lymphoma has been considered unusual, to occur late on in the disease process and usually to be located in the meninges.

CLINICAL CASE

We describe the case of a 27 year old man initially diagnosed as having a primary cerebral lymphoma after having had repeated convulsive crises. Two months later he was found to have a retroperitoneal mass. On anatomopathological study of the mass, a peripheral T lymphoma was confirmed.

CONCLUSIONS

Dissemination of systemic lymphomas to the central nervous system is usually seen in persons with advanced systemic disease. It is atypical to find a peripheral T lymphoma with initial clinical findings that were neurological, and even less frequent that these neurological findings were due to an intraparenchymatous lesion. In this article we describe a patient with these characteristics, and conclude that it is necessary to study patients with a diagnosis of primary cerebral lymphoma very fully to establish where the primary focus is.

[Myasthenia gravis in Santo Tomás Hospital 1990-1997]

Myasthenia Gravis is an infrequent disease. Diagnosis and treatment must be done early to avoid high morbidity that can compromise patients lives. Nine cases were identified during the eight year 1990-1997 at the Santo Tomas Hospital of Panama city but one had to be excluded because he refused treatment. Most of the patients (7/8) had symptoms for more than 3 months. The diagnosis of Myasthenia Gravis requires a high index of suspicion and the clinical impressión must be confirmed by various diagnostic studies that include the edrophonium test, the repetitive stimulation test, the therapeutic test with pyridostigmine, the determination of acetylcholine anti-receptor antibodies and a CT Scan of the thorax. Medical treatment consists mainly of anticholinesterase agents and surgical treatment consists of thymectomy by means of an extended transternal ablation. Operative results were excellent, seven out of eight improved.

[T-cell lymphoma/leukemia secondary to HTLV-1 in adults. Report of a case]

The Human T-Cell lymphotropic virus type I (HTLV-I) is endemic in the Caribbean basin, Japan, Central Africa and South Pacific. It as been associated to Lymphoma-Leukemia of Adult T-Cells (ATLL) and a progressive spastic paraparesis (TSP/HAM). The nationwide seroprevalence of Panama is of 1-2%. We report a case of a 73 year old male, albino, single, patient, Panamanian descendent from Jamaican immigrants who presented a skin disorder which started 1 year ago, characterized by the appearance of infiltrative, intensely pruritic papules, nodules and a non exfoliative erythroderna involving face, neck, trunk and extremities. He also had painless enlarged cervical lymph nodes, non tender hepatomegaly. Laboratory studies revealed a keukocyte count of 128,000/ml wit 67% atypical lymphocytes, serum calcium was 12.5 mg/dl, DL in 583 UNI, "flower cells" and atypical lymphocytes with hyperlobulated nuclear contour was observed in the peripheral blood smear, seropositivity to TLV-I detected by enzyme-linked immunosorbent assay (Elisa) and confirmed by Western blot assay. The skin biopsy shows a bandlike dermal infiltrates of atypical lymphoid cells with epidermotropism and Pautrier's microabscesses. Once the treatment was initiated with prednisone, cyclophosphamide, and systemic antibiotics for a bronchopneumonic process most of the cutaneous lesions cleared up although the clinical condition of our patient became progressively worse and died after a acute renal failure and a lower gastrointestinal bleeding. In 1986, the tree first cases of ATLL were identified in Panama, there has not been apparently new cases reported until now.

[Treatment of focal dystonia with botulinic toxin]

Dystonia is a neurologic disease characterized by involuntary repetitive muscular contractions which frequently causes torsion, spasmodic movements or abnormal postures. Pharmacologic and surgical treatment had been unsatisfactory in the majority of the cases. Intramuscular botulinic toxin application in focal dystonia disorders, achieve relief in approximately 90% of the cases by quimiodenervation. We included 35 patients with focal dystonia treated between November 1994 through June 1996: 14 facial hemispasm, nine blepharospasm, five cervical dystonia, two writer's cramps, one oromandibular dystonia and four patients with mixed focal dystonia. Improvement between 50-90% was observed in 32/34 (94%) of the patients; one case (2.8%) with therapeutic failure and one case (2.8%) never returned to quantify the response. Actually, botulinic toxin is the first choice treatment of focal dystonia and other diseases related to involuntary muscle spasm.

[Validation of Allen's scale for the diagnosis of stroke]

INTRODUCTION

The importance of cerebrovascular pathology demands the most exact and complete diagnosis possible, by general physical and neurological examination and complementary techniques including computerized tomography (CT). Without CT, diagnosis may be delayed, for which reason such authors as Allen have put forward scales which by means of diagnostic scoring distinguish between stroke types.

AIM

To validate the Allen scale as opposed to CT scan in a series of patients suffering from haemorrhagic and ischaemic stroke.

MATERIALS AND METHOD

Sixty-two consecutive hospitalized patients suffering from stroke were studied, who all underwent CT scan within fifteen days of admission.

RESULTS

The group consisted of 62 patients, 33 males (53%) and 29 females (47%) having an average of 70.2 +/- 11.2 years. The most frequent type of stroke was ischaemic (63%) as opposed to haemorrhagic (37%). Globally for all strokes we obtained the following results: Sensitivity (S) = 61%, Specificity (Sp) = 40%, positive predictive value ( + PV) = 84% and negative predictive value (-PV) = 17%. For ischaemic stroke the results were as follows: S = 76%, Sp = 66%; +PV = 67% and -PV = 76%. Finally for haemorrhagic stroke the results were S = 43%; Sp = 100%; +PV = 100% and -PV = 75%.

CONCLUSIONS

The Allen scale has not proved to be a valid instrument in stroke diagnosis due to its low sensitivity and specificity especially in cases of haemorrhagic stroke.

Relation between human T-lymphotropic virus type I and neurologic diseases in Panama: 1985-1990

Human T-cell lymphotropic virus type I (HTLV-I) is endemic in the Caribbean basin and in Japan. HTLV-II, a closely related virus, is endemic in several groups of native Americans, including Panamanian Guaymi. In Panama, a nationwide HTLV-I/II seroprevalence of 1-2% has been reported. We evaluated the frequency of HTLV-I/II infection in patients with neurologic diseases admitted to state tertiary hospitals in Panama City between 1985 and 1990. Nineteen of 322 patients with eligible diagnoses had antibodies to HTLV-I/II, 17 with HTLV-I and 2 with HTLV-II. HTLV-I was associated with spastic paraparesis (13 of 23, 56.5% versus 4 of 299, 1.3%, p < 0.001) and with cerebellar syndrome (2 of 13, 15.4%) and multiple sclerosis (2 of 54, 3.7%) (p < 0.05 for both diseases compared with subject with none of these diagnoses). The two HTLV-I infected patients with cerebellar syndrome later developed spastic paraparesis. HTLV-II infection was noted in one patient with cerebellar syndrome and one with amyotrophic lateral sclerosis. All patients with other diagnoses were seronegative. Among patients with spastic paraparesis, HTLV-I-infected patients were clinically indistinguishable from seronegative subjects. There is apparently an overlapping clinical spectrum of neurologic diseases associated with HTLV-I and HTLV-II infection.