Introduction. Therapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (ANDs), and its main objective is the removal of pathogenic autoantibodies. Our aim was to describe the clinical profile and the experience with the usage of TPE in patients with ANDs at our institution. Methods. This is an observational retrospective study, including medical records of patients with diagnosis of ANDs who received TPE, between 2011 and 2018. Characteristics of TPE, such as number of cycles, type of replacement solution, and adverse effects, were evaluated. The modified Rankin Scale (mRS) was applied to measure the clinical response after the therapy. Results. 187 patients were included with the following diagnoses: myasthenia gravis (MG), n = 70 (37%); Guillain–Barré syndrome (GBS), n = 53 (28.3%), neuromyelitis optica spectrum disorders (NMOSD), n = 35 (18.7%); chronic inflammatory demyelinating polyneuropathy (CIDP), n = 23 (12.2%); and autoimmune encephalitis (AE), n = 6 (3.2%). The most used types of replacement solution were albumin (n = 131, 70%) and succinylated gelatin (n = 45, 24%). All patients received a median of five cycles (IQR 5-5). Hypotension and hydroelectrolytic disorders were the main complications. After TPE, 99 patients (52.9%) showed improvement in the mRS scores and a statistical significance (p<0.05) was seen between the admission score and after TPE for every diagnosis except for CIDP. Conclusion. TPE has an adequate safety profile, and improvement in functionality in treated patients reflects its effectiveness.

Unusual clinical course Background: Retinoid-induced myositis is a rare condition encountered in clinical practice. Its occurrence implies a diagnostic challenge due to the multiple causes associated with myopathic syndromes. The most common clinical presentation is generalized affection. Focal myositis is even less frequent and easily misdiagnosed as muscular disease of other etiology. Case Report: We describe a case of 45-year-old male with a history of nephrolithiasis and rosacea diagnosed by dermatology, who was management with isotretinoin 1 mg/kg per day in 2 doses with clinical improvement. Later, he presents muscle pain in the upper limbs with marked functional limitation associated by choluria, without muscular pains in other location; he had no history of using another medication. At his physical examination, vital signs were normal, with edema and pain in the bilateral bicipital region associated with limitation for flexionextension of shoulders and elbows and high levels of creatine phosphokinase (CPK). He was transferred to the intensive care unit where he received fluid therapy because of the high risk of deterioration of renal function, very high CPK levels, and a history of obstructive uropathy. One year after this hospitalization, the cutaneous symptoms worsened and the patient voluntarily restarted isotretinoin and 5 months later he presented again with the same symptoms of the first episode. Conclusions: Drug-induced myositis should be taken into consideration in the differential diagnosis of myopathic syndromes. Retinoids have the potential to cause varying degrees of myositis and their rapid identification could prevent major complications.

OBJETIVO: Este artículo describe las características clínicas, indicaciones y desenlaces de mortalidad, eventos adversos e independencia funcional en pacientes con ataque cerebrovascular isquémico, ACVi, sometidos a trombectomía mecánica con stent Solitaire, TMSS. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo, de corte trasversal llevado a cabo entre abril de 2013 y abril de 2016. RESULTADOS: Durante el periodo de tiempo evaluado, se sometieron un total de 10 pacientes a TMSS. La edad media de los pacientes fue 62 años. Todos los pacientes tenían una buena clase funcional previa al ACVi, definida como una escala modificada de Rankin de 0 a 2. Al momento de la consulta, la escala de Rankin modificada fue 4. Los pacientes se sometieron a estrategia reperfusión combinada que consta de trombolisis intravenosa más trombectomía mecánica. Sin embargo, un 40 % de los pacientes tenía contraindicación para trombolisis. La mortalidad fue de 20 %, al igual que el sangrado cerebral que se presentó en 20 % de los pacientes y el Rankin modificado mejoró a lo largo del seguimiento en el 70 % de los pacientes, con un total de 50 % de pacientes que lograron independencia funcional significativa. CONCLUSIÓN: Parece haber impacto importante en la independencia funcional de pacientes sometidos a estrategia combinada de reperfusión cerebral con el uso de stents recuperadores, sin diferencia en la seguridad y mortalidad comparado con la estrategia estándar.

Background Delirium is a frequent event in severely ill patients; its incidence and prevalence varies depending on several factors; Covid has been associated to high incidence of delirium leading to speculation of specific mechanisms of neurotoxicity by the SARS-CoV-2. We present the analysis of risk factors for delirium incidence and the impact of delirium in the functional outcomes. Methods We included patients admitted to a referral center in Cali, Colombia between April and August 2020. Patients were evaluated for demographics, severity of disease, comorbidities, clinical outcomes, delirium and survival at discharge. We evaluated the association of patient characteristics and disease factors with delirium incidence by multivariate analysis (Hosmer and Lemeshow) and the associations of delirium with functional outcome at discharge Results Among 333 patients, 58 (17.42%. 95% CI: 13.62–21.77%) presented delirium 16 (IQR: 11 − 20) days after symptom onset. Patients with delirium were older, reported muscular weakness more often, had a higher NEWS2 score at admission, and had more comorbidities (mainly Diabetes Mellitus II). Multivariate analysis of hospitalization events and treatments found mechanical ventilation as the only significant covariate. The association between need for mechanical ventilation and delirium development was estimated at OR = 11.72, (95%CI = 4.16–34.23). Patients who developed delirium had a higher frequency of functional impairment: mRs > 2 (70.7% vs 24.7%, p < 0.001) and had a prolonged ICU stay (median 13 days, IQR 8–21 vs median 5, IQR 3–10 days, p < 0.0001) compared to patients without delirium. Conclusion Our data show that premorbid functional status, the severity of respiratory disfunction and the presence of inflammatory markers are determinant in the risk of delirium; we believe that delirium might not be specially related to SARS-CoV-2 infections, its high frequency during this pandemic could be the result of concurring factors shared between critically-ill patients and severe COVID-19 patients. Further research is granted to clarify this aspect

Background: Delirium is a frequent event in severely ill patients; its incidence and prevalence varies depending on several factors; Covid has been associated to high incidence of delirium leading to speculation of specific mechanisms of neurotoxicity by the SARS-CoV-2. We present the analysis of risk factors for delirium incidence and the impact of delirium in the functional outcomes.Methods: We included patients admitted to a referral center in Cali, Colombia between April and August 2020. Patients were evaluated for demographics, severity of disease, comorbidities, clinical outcomes, delirium and survival at discharge. We evaluated the association of patient characteristics and disease factors with delirium incidence by multivariate analysis (Hosmer and Lemeshow) and the associations of delirium with functional outcome at dischargeResults: Among 333 patients, 58 (17.42%. 95% CI: 13.62%–21.77%) presented delirium 16 (IQR: 11 –20) days after symptom onset. Patients with delirium were older, reported muscular weakness more often, had a higher NEWS2 score at admission, and had more comorbidities (mainly Diabetes Mellitus II). Multivariate analysis of hospitalization events and treatments found mechanical ventilation as the only significant covariate. The association between need for mechanical ventilation and delirium development was estimated at OR=11.72, (95%CI=4.16–34.23). Patients who developed delirium had a higher frequency of functional impairment: mRs>2 (70.7% vs 24.7%, p<0.001) and had a prolonged ICU stay (median 13 days, IQR 8–21 vs median 5, IQR 3–10 days, p<0.0001) compared to patients without delirium.Conclusion: Our data show that premorbid functional status, the severity of respiratory disfunction and the presence of inflammatory markers are determinant in the risk of delirium; we believe that delirium is not specially related to SARS-CoV-2 infections, but rather its high frequency during this pandemic is the result of concurring factors shared between critically-ill patients and severe COVID-19 patients.