Background: Neurosurgical treatment, although controversial, is considered a useful resource in the treatment of chronic psychiatric diseases such as refractory aggressiveness. Objective: To evaluate the clinical results and side effects of posteromedial hypothalamotomy associated with amygdalotomy in patients with refractory aggressiveness. Method: A clinical trial was conducted in patients with chronic aggressiveness and refractory to pharmacological treatment. A central amygdalotomy associated with posteromedial hypothalamotomy was performed using thermo-coagulation by radiofrequency. The degree of aggressiveness was quantified by the Yudofsky's global scale of aggression. Postoperative changes in aggressive behavior continued to be evaluated every 6 months for at least 36 months. Results: A statistically significant change in aggressive behavior was observed during 36 months of follow-up. The collateral effects of the association of both procedures are described, the most frequent being drowsiness and some cases of reduction in sexual behavior. Conclusion: Symmetric and simultaneous unilateral lesions of the central nucleus of the amygdala and the posteromedial hypothalamus contralateral to motor dominance give the same clinical effect in the reduction of the pathological aggression that the bilateral lesions.

Tras haber leído el manuscrito escrito por nuestro par Parra-Medina1, en su manuscrito titulado "Mente y cerebro: de los egipcios a Cajal y los neuromitos", hemos decidido realizar algunos comentarios como aporte agregado. Para comenzar, coincidimos con el autor en relación con la amplia necesidad que cubrió la psicología cognitiva tras su genesis, así como el avance que originaron las aportaciones de Santiago Ramón y Cajal (1852-1934); empero, consideramos pertinente la mención de algunos hechos de actualidad que pudiesen ayudar al entendimiento de la interacción social, la conciencia y la mente. Si bien, no existe una localización primaria bien definida para la conciencia y / o la mente humana, hoy en día, la comprensión sobre la “cognición social” mediante las preguntas: ¿qué son los estados mentales?, ¿cómo son representados?, y ¿cómo nuestro cerebro nos permite entender otras mentes? se ha convertido en un tema importante para la investigación médica y psicosocial; tal hecho podría explicar el deterioro en las funciones ejecutivas y socio-emocionales (ej. dificultad del lenguaje verbal y no verbal) asociadas a ciertas condiciones neurológicas y psiquiátricas, tales como: el autismo, la esquizofrenia, la enfermedad de Alzheimer, la enfermedad de Parkinson e, incluso, la depresión. Como consecuencia ha nacido el constructo denominado “Teoría de la mente” (ToM por sus siglas en inglés), que busca explicar la capacidad mental innata para atribuir estados cognitivos a las situaciones cotidianas tanto para uno mismo (meta-cognición & meta-representación), como para otros sujetos; es decir, representa un mecanismo teórico creado para explicar la racionalidad humana dentro de un entorno social.

Background: The incidence of postoperative spinal infection (PSI) ranges from 0% to 10%, with devastating effects on the patient prognosis because of higher morbidity while increasing costs to the health care system. PSIs are elusive and difficult to diagnose, especially in the early postoperative state, because of confusing clinical symptoms, rise in serum biomarkers, or imaging studies. Current research on diagnosis has focused on serum biomarkers; nevertheless, most series rely on retrospective cohorts where biomarkers are studied individually and at different time points. Objective: This paper presents the protocol for a systematic review that aims to determine the inflammatory biomarker behavior profile of patients following elective degenerative spine surgery and their differences compared to those coursing with PSIs. Methods: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. This protocol was registered at PROSPERO on January 19, 2022. We will include studies related to biomarkers in adult patients operated on for degenerative spinal diseases and those developing PSIs. The following information will be extracted from the papers: (1) study title; (2) study author; (3) year; (4) evidence level; (5) research type; (6) diagnosis group (elective postoperative degenerative disease or PSI); (7a) region (cervical, thoracic, lumbosacral, and coccygeal); (7b) type of infection by anatomical or radiological site; (8) surgery type (including instrumentation or not); (9) number of cases; (10) mean age or individual age; (11) individual serum biomarker values from the preoperative state up to 90 days postoperative for both groups, including (10a) interleukin-6, (10b) presepsin, (10c) erythrocyte sedimentation rate, (10d) leukocyte count, (10e) neutrophil count, (10f) C-reactive protein, (10g) serum amyloid, (10h) white cell count, (10i) albumin, (10j) prealbumin, (10k) procalcitonin, (10l) retinol-associated protein, and (10m) Dickkopf-1; (11) postoperative days at symptoms or diagnosis; (12) type of organism; (13) day of starting antibiotics; (14) duration of treatment; and (15) any biases (including comorbidities, especially those affecting immunological status). All data on biomarkers will be presented graphically over time. Results: No ethical approval will be required, as this review is based on published data and does not involve interaction with human participants. The search for this systematic review commenced in February 2021, and we expect to publish the findings in mid-2023. Conclusions: This study will provide the behavior profile of biomarkers for PSI and patients following elective surgery for degenerative spinal diseases from the preoperative period up to 90 days postoperative, providing cutoff values on the day of diagnosis. This research will provide clinicians with highly trustable cutoff reference values for PSI diagnosis. Finally, we expect to provide a basis for future research on biomarkers that help diagnose more accurately and in a timely manner in the early stages of illness, ultimately impacting the patient’s physical and mental health, and reducing the disease burden. Trial Registration: PROSPERO CRD42022304645; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304645 International Registered Report Identifier (IRRID): DERR1-10.2196/41555

Introducción: la neuralgia del trigémino (NT) es un síndrome de dolor facial unilateral de intensidad severa, que sigue el trayecto de una o más ramas del quinto par craneal. Su impacto en la calidad de vida es significativo, limita las actividades diarias y favorece el desarrollo de trastornos psiquiátricos en los pacientes afectados. Objetivos: presentar la experiencia de nuestra institución en el manejo quirúrgico de la NT, evaluando su eficacia y seguridad. Materiales y métodos: se realizó un análisis retrospectivo de los casos intervenidos quirúrgicamente en un período de un año posterior a la pandemia de COVID-19. Se efectuó un seguimiento clínico a los pacientes al mes, 3, 6 y 12 meses postoperatorios. Resultados: se incluyeron 17 pacientes. El puntaje promedio de dolor prequirúrgico fue de 9.06 (DE 1.43), mientras que en el posquirúrgico inmediato se redujo a 2.12 (DE 3.04; p < 0.0001). Se observó recurrencia del dolor en 5 pacientes (29.4%), mientras que en los 12 restantes (70.5%) se logró reducir o suspender por completo el tratamiento farmacológico. Conclusión: la NT refractaria al tratamiento médico constituye una indicación para la intervención quirúrgica. Los resultados obtenidos en nuestra institución fueron consistentes con los reportados en la literatura internacional, demostrando una alta tasa de éxito en la reducción del dolor y la optimización del manejo farmacológico.

Objective. Accidental fracture of epidural analgesia catheters has a very low incidence of 2.5 per 100,000 anesthesia. A rare image of the fracture is reported. Methods. A 42-year-old female patient was attending a cesarean section eight years earlier to her consult. In the cesarean section, she received regional epidural anesthesia, and the main complaint was low back pain, specifically between the spinous processes L2 and L3. The somatic pain had been presenting intermittently for eight years. The sagittal section of magnetic resonance imaging of the lumbar spine showed a golf club image from the midline to the laminae of L2 and L3 with the subcutaneous tissue. Results. A small right hemilaminectomy was performed to remove the complete catheter, which did not adhere, but was coiled in the S-shape. The catheter was trapped between the left facets of L2 and L3 laterally than through the midline. Several risk factors and therapeutic procedures have been proposed. Conclusion. In a systematic review, 24 articles were reported on this specific issue. No surgical procedure and follow-up were informed by 8 authors. Surgical remotion by laminectomy was used in 9 articles, surgical explanation by skin incision was reported by 4 authors, and remotion by endoscopy was reported in 1 article. Two articles not reported solution.

Introduction: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. Objective: Validation of the Comic Strip Test to evaluate empathy. Method: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. Results: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. Conclusions: The Comic Strip Test was validated with parametric psychometric parameters.