Primary headache disorders in Latin America and the Caribbean: A meta-analysis of population-based studies.

BACKGROUND: In this manuscript, we aim to systematically estimate the pooled prevalence and incidence of primary headaches and its subtypes (migraine, tension-type headache, and chronic headaches) in Latin America and the Caribbean, describing its epidemiological profile and associated factors. METHODS: We systematically searched PubMed/MEDLINE, Scopus, and LILACS (From conception to March 2021), for populational studies reporting the epidemiology of primary headaches and their associated factors in Latin America and the Caribbean. The data extraction was conducted independently. We performed random-effect model meta-analysis of prevalence (overall primary headaches and by subtypes) and associated factors, assessed potential sources of heterogeneity, the risk of bias, publication bias, and the evidence certainty (GRADE methodology). RESULTS: We included 32 populational studies (38 subpopulations, n = 63,813). The prevalence of primary headaches was 41.4% (95% CI 31.1-52.2%; n = 54,357), 15% for migraine (95% CI 12.0-18.3; n = 53,658 individuals), 20.6% for tension-type headache (95% CI 12.4-30.2; n = 25,840), and 6% for chronic headaches (95% CI 3.3-9.6; n = 21,720), with high between-study heterogeneity. No incidence data was found. Female sex, white ethnicity, high BMI, comorbid mental health disorders, and low-back pain were associated with higher prevalence of primary headaches. The prevalence was less in rural areas. CONCLUSION: In Latin America and the Caribbean, primary headaches are highly prevalent affecting young females disproportionally. The prevalence of chronic headaches is higher than in other systematic global and regional estimations. The presence of comorbidities as modifiable risk factors should encourage their integration as targets for community-based preventive and therapeutic interventions. PROTOCOL REGISTRATION NUMBER: CRD42018105116.

Is Surfer's myelopathy an acute hyperextension-induced myelopathy? A systematic synthesis of case studies and proposed diagnostic criteria.

BACKGROUND: Surfer's myelopathy is a rare complication of spinal hyperextension originally described in novice surfers. However, reports from patients practicing different activities had risen. AIM: To systematically synthesize the epidemiological and clinical evidence on acute hyperextension-induced myelopathy ("Surfer's myelopathy") and propose new diagnostic criteria. METHODS: We systematically searched four databases for all observational and case studies on the topic. We performed a narrative synthesis to propose diagnostic criteria and tested the criteria retrospectively on the included cases. A case report is also presented. RESULTS: Forty-two articles reporting 104 cases (median age 19 years, slightly male predominance) were included. All cases reported a nontraumatic hyperextension event (58% after surfing). All of the cases presented pain of hyperacute onset. The most frequent clinical feature was bladder or bowel dysfunction (84%). The thoracic region was the most frequently affected (87%) with longitudinal involvement until the conus (67%). At discharge or follow-up, 52% partially recovered. We propose five diagnostic criteria with three levels of certainty (definite, probable, and possible): (1) nontraumatic spine hyperextension activity (in individuals with no pre-existent spinal disease); (2) hyperacute onset (with acute pain onset); (3) spinal cord injury clinic (motor, sensory, or autonomic deficit); (4) MRI findings with central spinal cord abnormalities (multiple segments); and (5) no other alternative diagnosis. We identified 88% definite and 12% probable/possible cases. CONCLUSION: The acute hyperextension-induced myelopathy could occur not only during surfing but also during other activities. Therefore, increased awareness and education among sports communities and general physicians are needed.

Implementing epidemic intelligence in the WHO African region for early detection and response to acute public health events.

Epidemic intelligence activities are undertaken by the WHO Regional Office for Africa to support member states in early detection and response to outbreaks to prevent the international spread of diseases. We reviewed epidemic intelligence activities conducted by the organisation from 2017 to 2020, processes used, key results and how lessons learned can be used to strengthen preparedness, early detection and rapid response to outbreaks that may constitute a public health event of international concern. A total of 415 outbreaks were detected and notified to WHO, using both indicator-based and event-based surveillance. Media monitoring contributed to the initial detection of a quarter of all events reported. The most frequent outbreaks detected were vaccine-preventable diseases, followed by food-and-water-borne diseases, vector-borne diseases and viral haemorrhagic fevers. Rapid risk assessments generated evidence and provided the basis for WHO to trigger operational processes to provide rapid support to member states to respond to outbreaks with a potential for international spread. This is crucial in assisting member states in their obligations under the International Health Regulations (IHR) (2005). Member states in the region require scaled-up support, particularly in preventing recurrent outbreaks of infectious diseases and enhancing their event-based surveillance capacities with automated tools and processes.

Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies.

OBJECTIVE: This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. METHODS: Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. RESULTS: Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. SIGNIFICANCE: The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.

Collaborative scientific production of epilepsy in Latin America from 1989 to 2018: A bibliometric analysis.

Socioeconomic and cultural factors coupled with an inability to control many endemic and emerging diseases have resulted in a growing incidence of epilepsy cases in Latin America. This study aimed to analyze and describe scientific research output trends in epilepsy research for the period 1989-2018. Publications were extracted from Scopus indexed journals. Bibliometric analysis was used to analyze scientific output including number of annual publications, documents, and publication characteristics. A mapping analysis using VOSviewer software visualized collaborative network analysis, co-citation analysis, and keyword co-occurrence analysis. SciVal quantitatively analyzed distribution of countries, institutions, citation counts, H-index, and research collaborative partnerships. A total of 176507 records were initially retrieved after which 5636 were analyzed. Overall, an increasing trend for publication output was observed from 19 articles in 1989 to 342 in 2018; the number of publications significantly increased over the past 20 years (p = 0.0065). The majority of publications were original articles (74.4%). Brazil had the most scientific production (55.2%), followed by Mexico (15.4%) and Argentina (10%). Extra-regional collaboration was primarily with the United States, United Kingdom, and Canada; intraregional collaboration was low. The most common area of investigation by co-occurrences was "diagnostic research" (37.2%), with studies based on electroencephalography and nuclear magnetic resonance. Epilepsy research in Latin America has seen a steady growth with significant increases over the past 20 years. Brazil, Mexico, and Argentina are the most productive countries in the field collaborating primarily with extra-regional countries of high-income.

Multiple tuberculomas in an immunocompetent patient and their diagnostic challenge in a high prevalence country: Case report and literature review.

CONTEXT: Intracranial tuberculomas are rare yet lethal forms of tuberculosis. Diagnosis is often difficult because of its nonspecific symptoms and radiological findings. AIM: This study aims to perform a literature review of multiple tuberculomas to improve disease recognition and management in immunocompetent patients along with presenting a case report on the topic. DATA SOURCES: Scopus, LILACS, Ovid MEDLINE and EMBASE. STUDY SELECTION: Case reports and case series up to December 2018 in English, Spanish, and Portuguese focusing on intracranial tuberculomas in adult and pediatric immunocompetent patients. Data on presentation, diagnostic workup, and treatment was analyzed. DATA EXTRACTION: Cochrane Collaboration/Cochrane Handbook and PRISMA guidelines. RESULTS: Twenty reports involving 21 patients were included. Most patients were male (57.14%). The average age at diagnosis was 26.9 ± 14.9 years. Headache was the most common presenting symptom (52.4%; 11/21), followed by motor weakness (47.6%; 10/21) and vomiting (23.8%; 5/21). MRI was the most used image technique (17/21). Most lesions occurring in the cerebral hemispheres (16/21); we found five or more lesions in 66.6% (14/21) of the patients. The majority treated with anti-tuberculous drugs resulted in a favorable outcome. CONCLUSIONS: Immunocompetent patients living in TB endemic areas whose clinical evaluation and neuroimaging findings are compatible with tuberculoma should undergo anti-tubercular treatment despite a lack of bacteriological confirmation.

Validation of the RUDAS for the Identification of Dementia in Illiterate and Low-Educated Older Adults in Lima, Peru.

Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) in discriminating between controls and patients with mild cognitive impairment (MCI) and dementia in an illiterate population with low-levels of education. Methods: We compared the cognitive performance of 187 elderly subjects who were illiterate (controls n = 60; MCI n = 64; dementia n = 63). Neuropsychological measures included the RUDAS-PE, Mini-Mental State Examination (MMSE), INECO Frontal Screening (IFS), and Pfeffer Functional Activities Questionnaire (PFAQ). The results were compared to a neuropsychological evaluation (gold standard), including use of Clinical Dementia Rating (CDR) scores. Results: We found a Cronbach's alpha was 0.65; Spearman's correlation coefficient was 0.79 (p < 0.01). The area under the receiver operating characteristics curve for the RUDAS to discriminate dementia from MCI was 98.0% with an optimal cut-off <19 (sensitivity 95%, specificity 97%); whereas, to differentiate MCI and controls was 98.0% with an optimal cut-off <23 (sensitivity 89%, specificity 93%). Conclusions: Based on its excellent psychometric properties, we find the RUDAS-PE suitable to aid in the opportune detection of dementia in a geriatric illiterate population with low-levels of education.

Brief cognitive tests validated in Peru for detection of cognitive impairment A systematic mapping of the scientific literature.

Brief cognitive tests (BCTs) are necessary for early detection of cognitive impairment, particularly in primary care settings. OBJECTIVE: This report describes a systematic review of BCTs evaluated in Peruvian populations. METHODS: We used systematic mapping techniques to identify articles on screening tests for cognitive impairment involving Peruvian subjects. We included studies published in English and Spanish up to 2018. We reviewed 6 reference databases within the Virtual Health Library network, as well as the Web of Science, Scopus (MEDLINE), and EMBASE databases. RESULTS: Ten out of 447 articles met the inclusion criteria. Studies included both outpatient (9) and community-based (2) samples. Eligibility criteria of the studies were similar. Although different protocols were applied, the diagnostic criteria were standardized. For discrimination between dementia and controls, IFS (AUC: 0.99) and ACE (AUC: 0.95 to 1.00) showed superior performance, as did the M@T (AUC: 1.00) and CDT-Mv (AUC: 0.94 to 1.00) for discriminating between Alzheimer's disease (AD) and controls. CONCLUSION: The available evidence is limited. However, our analysis of national data suggests that the ACE may be a good choice whenever it can be applied to Peruvian patients. Alternatively, the M@T and IFS can be used for screening patients with suspected AD or FTD, respectively.

Testes cognitivos breves (TCBs) são necessários para a detecção precoce do comprometimento cognitivo, particularmente nos serviços de atenção primária. OBJETIVO: Este artigo descreve uma revisão sistemática dos TCBs avaliados em populações peruanas. MÉTODOS: Utilizamos técnicas de mapeamento sistemático para identificar artigos sobre testes de triagem para comprometimento cognitivo envolvendo indivíduos peruanos. Incluímos estudos publicados em inglês e espanhol até 2018. Revisamos 6 bancos de dados de referência na rede da Biblioteca Virtual em Saúde e no Web of Science; Scopus (MEDLINE) e banco de dados EMBASE. RESULTADOS: Dez dos 447 artigos preencheram os critérios de inclusão. Os estudos incluíram amostras ambulatoriais (9) e comunitárias (2). Os critérios de elegibilidade entre os estudos foram semelhantes. Embora os diferentes protocolos tenham sido aplicados, os critérios diagnósticos foram padronizados. Para a discriminação entre demência e controles, INECO Frontal Screening (IFS) (AUC: 0.99), Addenbrooke's Cognitive Examination (ACE) (AUC: 0.95 to 1.00) mostraram desempnho superior, assim como o Memory Alteration Test (M@T) (AUC: 1.00) o Desenho do relógio (CDT-Mv) (AUC: 0,94 a 1,00) para discriminação entre a doença de Alzheimer (DA) e os controles. CONCLUSÃO: As evidências disponíveis são limitadas. No entanto, nossa análise com dados nacionais sugere que o ACE pode ser uma boa opção sempre que possível com pacientes peruanos. Alternativamente, o M @ T e o IFS podem ser usados ​​para rastrear pacientes com suspeita de DA ou DFT, respectivamente.

Brief cognitive tests validated in Peru for detection of cognitive impairment A systematic mapping of the scientific literature / Testes cognitivos breves validados no Peru para detecção de comprometimento cognitivo: um mapeamento sistemático da literatura científica

Abstract. Brief cognitive tests (BCTs) are necessary for early detection of cognitive impairment, particularly in primary care settings. Objective: This report describes a systematic review of BCTs evaluated in Peruvian populations. Methods: We used systematic mapping techniques to identify articles on screening tests for cognitive impairment involving Peruvian subjects. We included studies published in English and Spanish up to 2018. We reviewed 6 reference databases within the Virtual Health Library network, as well as the Web of Science, Scopus (MEDLINE), and EMBASE databases. Results: Ten out of 447 articles met the inclusion criteria. Studies included both outpatient (9) and community-based (2) samples. Eligibility criteria of the studies were similar. Although different protocols were applied, the diagnostic criteria were standardized. For discrimination between dementia and controls, IFS (AUC: 0.99) and ACE (AUC: 0.95 to 1.00) showed superior performance, as did the M@T (AUC: 1.00) and CDT-Mv (AUC: 0.94 to 1.00) for discriminating between Alzheimer's disease (AD) and controls. Conclusion: The available evidence is limited. However, our analysis of national data suggests that the ACE may be a good choice whenever it can be applied to Peruvian patients. Alternatively, the M@T and IFS can be used for screening patients with suspected AD or FTD, respectively.

Resumo. Testes cognitivos breves (TCBs) são necessários para a detecção precoce do comprometimento cognitivo, particularmente nos serviços de atenção primária. Objetivo: Este artigo descreve uma revisão sistemática dos TCBs avaliados em populações peruanas. Métodos: Utilizamos técnicas de mapeamento sistemático para identificar artigos sobre testes de triagem para comprometimento cognitivo envolvendo indivíduos peruanos. Incluímos estudos publicados em inglês e espanhol até 2018. Revisamos 6 bancos de dados de referência na rede da Biblioteca Virtual em Saúde e no Web of Science; Scopus (MEDLINE) e banco de dados EMBASE. Resultados: Dez dos 447 artigos preencheram os critérios de inclusão. Os estudos incluíram amostras ambulatoriais (9) e comunitárias (2). Os critérios de elegibilidade entre os estudos foram semelhantes. Embora os diferentes protocolos tenham sido aplicados, os critérios diagnósticos foram padronizados. Para a discriminação entre demência e controles, INECO Frontal Screening (IFS) (AUC: 0.99), Addenbrooke's Cognitive Examination (ACE) (AUC: 0.95 to 1.00) mostraram desempnho superior, assim como o Memory Alteration Test (M@T) (AUC: 1.00) o Desenho do relógio (CDT-Mv) (AUC: 0,94 a 1,00) para discriminação entre a doença de Alzheimer (DA) e os controles. Conclusão: As evidências disponíveis são limitadas. No entanto, nossa análise com dados nacionais sugere que o ACE pode ser uma boa opção sempre que possível com pacientes peruanos. Alternativamente, o M @ T e o IFS podem ser usados ​​para rastrear pacientes com suspeita de DA ou DFT, respectivamente.

Validation of the RUDAS in Patients With a Middle-Level Education in Lima, Peru.

OBJECTIVES: To assess the psychometric properties of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) to discriminate controls from patients with mild cognitive impairment (MCI) and early dementia (ED) in a population with a mid-level education. METHODS: A total of 133 patients from a memory clinic were administered the RUDAS-PE, INECO Frontal Screening, Addenbrooke's Cognitive Examination, and Mini-Mental State Examination. Results were compared against a neuropsychological evaluation (gold standard). Validity measures, internal consistency, and concurrent validity were calculated. RESULTS: Cronbach's α was 0.68; Pearson's ratio was 0.79 (P < .01). The area under the receiver-operating characteristics curve of the RUDAS to discriminate between ED and MCI was 89.0% (optimal cutoff at <21), whereas between MCI and controls, it was 99.0% (optimal cutoff at <24). CONCLUSIONS: The RUDAS-PE has acceptable psychometric properties performing well in its ability to discriminate controls from patients with MCI and ED.

A Bibliometric Analysis of the Latin American Research on Stroke 2003-2017.

BACKGROUND: Stroke is a leading cause of mortality and disability worldwide. Research activity in Latin American countries might be the key to solving, or at least improving, the understanding of stroke-related issues in the region. Our aim was to describe and analyze the research output on stroke in Latin America. METHODS: We performed a bibliometric analysis of studies on stroke in Latin America reported from 2003 to 2017 in Scopus-indexed journals. We extracted the annual research, countries, journals, authors, institutions, citation frequency, and journal metrics. The data were quantitatively analyzed. Publication activity was adjusted to the countries by population size. Also, the results from an author and country co-occurrence analysis are presented as network visualization maps using VOSviewer. RESULTS: A total of 2298 Latin American stroke-related reports were identified, most were original research reports (72%). The number of reported studies had increased from 2003 to 2017 (P < 0.001). Brazil was the country with the greatest production with 1273 reports (55.4%), followed by Argentina and Mexico. No association was found between stroke prevalence and mortality and the scientific production of the country. Six universities and three hospitals were the most prolific institutions. A collaborative relationship was found between the United States and Brazil, Argentina, and Mexico. The intraregional collaboration of research on stroke was low among Latin American countries. CONCLUSIONS: Despite the continuous increase in research output from Latin American countries, more effort is needed to strengthen the research capacity by developing networks and collaborative research projects, ideally among the Latin American countries themselves.

Mortality in hospitalized patients with tuberculous meningitis.

BACKGROUND: To evaluate the mortality in hospitalized patients with tuberculous meningitis and describe factors associated with an increased risk of mortality. METHODS: Retrospective study of hospitalized patients with tuberculous meningitis between 2006 and 2015 in Peru performing a generalized linear regression to identify factors predictive of in-hospital mortality. RESULTS: Of 263 patients, the median age was 35 years, 72.6% were men, 38% were positive for HIV upon admission, 24% had prior TB infections and 2.3% had prior MDR-TB infections. In-hospital mortality was 30.4% of all study patients with a final diagnosis of TBM. When multivariable analysis was applied, significant associations with in-hospital mortality were seen among patients with HIV (RR 2.06; Confidence Interval 95% (95% CI) 1.44-2.94), BMRC II (RR 1.78; 95% CI 1.07-2.97), BMRC III (RR 3.11; 95% CI 1.78-5.45) and positive CSF cultures (RR 1.95; 95% CI 1.39-2.74). CONCLUSIONS: In-hospital mortality is higher among patients with HIV infections, age over 40 years, positive CSF TB culture and BMRC stage II or III.

Evaluation of the GeneXpert MTB/RIF in patients with presumptive tuberculous meningitis.

BACKGROUND: Meningitis caused by Mycobacterium tuberculosis is a major cause of morbidity and mortality worldwide. We evaluated the performance of cerebrospinal fluid (CSF) testing with the GeneXpert MTB/RIF assay versus traditional approaches for diagnosing tuberculosis meningitis (TBM). METHODS: Patients were adults (n = 37) presenting with suspected TBM to the Hospital Nacional Dos de Mayo, Lima, Peru, during 12 months until 1st January 2015. Each participant had a single CSF specimen that was divided into aliquots that were concurrently tested for M. tuberculosis using GeneXpert, Ziehl-Neelsen smear and culture on solid and liquid media. Drug susceptibility testing used Mycobacteria Growth Indicator Tube (MGIT 960) and the proportions method. RESULTS: 81% (30/37) of patients received a final clinical diagnosis of TBM, of whom 63% (19/30, 95% confidence intervals, CI: 44-80%) were HIV-positive. 22% (8/37, 95%CI: 9.8-38%), of patients had definite TBM. Because definite TBM was defined by positivity in any laboratory test, all laboratory tests had 100% specificity. Considering the 30 patients who had a clinical diagnosis of TBM: diagnostic sensitivity was 23% (7/30, 95%CI: 9.9-42%) for GeneXpert and was the same for all culture results combined; considerably greater than 7% (2/30, 95%CI: 0.82-22%) for microscopy; whereas all laboratory tests had poor negative predictive values (20-23%). Considering only the 8 patients with definite TBM: diagnostic sensitivity was 88% (7/8, 95%CI: 47-100%) for GeneXpert; 75% (6/8, 95%CI: 35-97%) for MGIT culture or LJ culture; 50% (4/8, 95%CI 16-84) for Ogawa culture and 25% (2/8, 95%CI: 3.2-65%) for microscopy. GeneXpert and microscopy provided same-day results, whereas culture took 20-56 days. GeneXpert provided same-day rifampicin-susceptibility results, whereas culture-based testing took 32-71 days. 38% (3/8, 95%CI: 8.5-76%) of patients with definite TBM with data had evidence of drug-resistant TB, but 73% (22/30) of all clinically diagnosed TBM (definite, probable, and possible TBM) had no drug-susceptibility results available. CONCLUSIONS: Compared with traditional culture-based methods of CSF testing, GeneXpert had similar yield and faster results for both the detection of M. tuberculosis and drug-susceptibility testing. Including use of the GeneXpert has the capacity to improve the diagnosis of TBM cases.