Surgical Outcomes in Chiari 1 and Chiari 1.5 Malformation Treated by Posterior Fossa Reconstruction: A Comprehensive Analysis of 110 Pediatric Cases and Literature Review.

Background/Objectives: The management of Chiari malformations (CMs) remains a clinical challenge and a topic of great controversy. Results may vary between children and adults. The purpose of the current single-center study is to critically assess the one-year surgical outcomes of a cohort of 110 children with CM-1 or CM-1.5 who were treated using "posterior fossa reconstruction" (PFR), a surgical technique described in 1994 that has since been used in both adults and children. We also review the literature and discuss the possible causes of the drawbacks and pitfalls in children in whom PFR was ineffective in controlling the disease. Methods: The present cohort was selected from a prospective registry of adults and children with CMs collected since 2006. Patients included in this study were selected from a group of children with CMs who were operated on in our Pediatric Neurosurgical Unit between 1 January 2007 and 31 November 2023. Surgical outcome was defined based on clinical and neuroradiological results as very good, good, or bad. Results: The mean age of our child cohort was 9.9 ± 4.7 years, with 54 girls (49%) and 56 boys (51%). Sixty-six children had CM-1 (60%) while forty-four had CM-1.5 (40%). Following surgery, there was no neurological worsening or death among the children. Most children (70%) had an uneventful recovery and were discharged home on average one week after surgery. However, in 33 children (30%), we recorded at least one postoperative adverse event. Aseptic meningitis syndrome was the most frequent adverse event (n = 25, 22.7%). The final surgical outcome was evaluated one year after PFR by using both clinical and neuroradiological results. The one-year surgical outcome was excellent in 101 children (91.9%), good in 5 (4.5%), and bad in 4 (3.6%). Conclusions: PFR significantly enlarges the volume of the posterior fossa and recreates a CSF environment that generates buoyancy of the cerebellum, with a high percentage of excellent and good clinical results evaluated one year post-surgery.

Understanding to humanise: Teaching nurses' experience with caring for Mapuche patients.

BACKGROUND: The Mapuche are a minority group living in small communities in southern Chile. Due to many variables, such as poverty and cultural factors, they are susceptible to inequalities in education and healthcare. PURPOSE: To describe nurse educators' experiences of caring for Mapuche people in primary care centers in Chile. METHODS: A descriptive qualitative study was performed with nine female nurse educators who supervised nursing students in clinical placement. Data were obtained through semi-structured interviews. Triangulation was achieved through consensus among the researchers. RESULTS: The analysis yielded two themes: Cultural sensitivity and Humanisation of care. Nurse educators respect Mapuche beliefs and practices about health and treatment and adapt clinical interventions accordingly. Nurse educators are committed to integrate Mapuche spiritual and cultural needs into the biomedical model, aiming to build a genuine person-centered relationship with patients and to promote transcultural nursing models with students. CONCLUSIONS: Culturally competent professionals are needed to train nurses about the demands of a globalized and culturally diverse world. Training is required in both humanized care competencies and cross-cultural nursing. Improving cultural competence among nurses and nurse educators would improve patients' health outcomes and would allow preventative intervention, therefore reducing treatment failures and further complications.

[Evaluation of the quality of life of patients with a Chiari type I malformation. A pilot study in a cohort of 67 patients]. / Evaluación de la calidad de vida en los pacientes con una malformación de Chiari tipo I. Estudio piloto en una cohorte de 67 pacientes.

INTRODUCTION: The Chiari type I malformation (CM-I) is a low prevalence disorder whose manifestations vary highly, depending on the associated malformative complex. The people with a CM-I can suffer anxiety, depression symptoms and an un-defined loss of quality of life. The main purpose of this study is to establish the impact of CM-I on quality of life, as well as the presence of anxiety and depression in these patients. PATIENTS AND METHODS: Prospective study of a cohort of 67 patients suffering from CM-I who undergo an evaluation by means of the SIP scale (Sickness Impact Profile), STAI (State-Trait Anxiety Inventory) and BDI (Beck's Depression Inventory) of their quality of life and of the presence of anxiety and depressive symptoms respectively. For every patient the degree of cerebellar tonsillar ectopia and the presence of syringomyelia and/or hydrocephalus were registered. RESULTS: The impact of the CM-I on the quality of life was none for 6 patients (9%), mild for 36 (53.7%), moderate for 17 (25.4%) and severe for 8 (11.9%). The most affected area of activity was work. A total of 86.6% of the patients presented a moderate or high anxiety level. In 25.4% of the patients moderate or severe depressive symptoms were also acknowledged. CONCLUSIONS: The great majority of patients with a CM-I consider that their disorder implies a loss of their quality of life which, in many cases, is associated with high anxiety and depressive symptoms.

Normal hypocretin-1 (orexin A) levels in cerebrospinal fluid in patients with idiopathic intracranial hypertension.

AIM: Low levels of hypocretin-1 (HC-1) have been associated with hypersomnia, obesity, depression, and chronic headaches. These conditions are frequently present in patients with idiopathic intracranial hypertension (IIH) and may be associated with abnormalities of the hypocretin system. The aim of this study was to determine HC-1 concentrations in cerebrospinal fluid (CSF) in a series of patients with IIH and to compare these concentrations with those in a control group with no neurological alterations. PATIENTS AND METHODS: This prospective study included a cohort of 26 consecutive patients with IIH who were mostly women (25 vs. 1) with a mean age of 42.5 ± 13.2. CSF samples were obtained from a lumbar puncture performed between 08:00 and 10:00 a.m. HC-1 was determined by a competitive radioimmunoassay (RIA) using I(125) as the isotope. Samples of normal CSF were obtained during spinal anesthesia for urological, general or vascular surgery from 40 patients (10 women and 30 men with a mean age of 63.7 ± 14.8) with no previous neurological or psychiatric history, a normal neurological examination, and MMSE scores of ≥ 24. RESULTS: No statistically significant differences were found between HC-1 levels in the CSF of patients with IIH (119.61 ± 21.63 pg/mL) and those of the control group (119.07 ± 20.30 pg/mL; p = 0.918). CONCLUSIONS: HC-1 is not associated with the clinical symptoms present in patients with IIH.