Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation.

Seizure frequency reduction after posteromedial hypothalamus deep brain stimulation in drug-resistant epilepsy associated with intractable aggressive behavior.

OBJECTIVES: The aim of this study was to analyze the impact of deep brain stimulation (DBS) of the posteromedial hypothalamus (pHyp) on seizure frequency in patients with drug-resistant epilepsy (DRE) associated with intractable aggressive behavior (IAB). METHODS: Data were collected retrospectively from nine patients, who received bilateral stereotactic pHyp-DBS for the treatment of medically intractable aggressive behavior, focusing on five patients who also had DRE. All patients were treated at the Colombian Center and Foundation of Epilepsy and Neurological Diseases-FIRE (Chapter of the International Bureau for Epilepsy), in Cartagena de Indias, Colombia from 2010 to 2014. Each case was evaluated previously by the institutional ethical committee, assessing the impact of aggressive behavior on the patient's family and social life, the humanitarian aspects of preserving the safety and physical integrity of caregivers, and the need to prevent self-harm. Epilepsy improvement was measured by a monthly seizure reduction percentage, comparing preoperative state and outcome. Additional response to epilepsy was defined by reduction of the antiepileptic drugs (AEDs). Aggressive behavior response was measured using the Overt Aggression Scale (OAS). RESULTS: All the patients with DRE associated with IAB presented a significant decrease of the rate of epileptic seizures after up to 4 years follow-up, achieving a general 89.6% average seizure reduction from the state before the surgery. Aggressiveness was significantly controlled, with evident improvement in the OAS, enhancing the quality of life of patients and families. SIGNIFICANCE: In well-selected patients, DBS of the pHyp seems to be a safe and effective procedure for treatment of DRE associated with refractory aggressive behavior. Larger and prospective series are needed to define the pHyp as a target for DRE in different contexts.

[Endovascular coiling of a «true¼ posterior communicating artery aneurysm]. / Tratamiento endovascular de un aneurisma «verdadero¼ de la arteria comunicante posterior.

True posterior communicating artery aneurysms originate exclusively from the wall of this artery and should be differentiated from aneurysms of the posterior communicating segment of the distal carotid artery. As these lesions are rare, their anatomical relationships have been poorly described; likewise, reports concerning their endovascular treatment are extremely rare and the technical aspects poorly detailed. A case of a patient with a true aneurysm of the left posterior communicating artery treated by endovascular coiling is presented. A literature review was also conducted to illustrate the anatomical and technical details relevant to achieving its successful treatment.

[Postoperative bed header position after burr-hole drainage of chronic subdural haematoma: systematic review and meta-analysis of randomised controlled trials]. / Posicionamiento postoperatorio de la cabecera tras drenaje de hematomas subdurales crónicos por trepanación: Revisión sistemática y metaanálisis de estudios controlados aleatorizados.

INTRODUCTION: Several studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis. METHODS: All randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals. RESULTS: A total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P=.11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P=.89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P=.58). No statistically significant heterogeneity was found in any of the analyses. CONCLUSION: There were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available.

[CHRONIC SUBDURAL HEMATOMA: PHYSIOPATHOLOGY AND SURGICAL MANAGEMENT]. / HEMATOMA SUBDURAL CRONICO: FISIOPATOLOGIA Y MANEJO QUIRURGICO.

Chronic subdural hematoma is an encapsulated collection of blood underneath the Dura, essentially characterized by the presence of a membrane. It usually occurs in the elderly considered as a sentinel event. Simple brain computed tomography is the current imaging aid of choice for the diagnosis of this entity. It should be suspected especially in patients who present with dementia syndrome. Although less frequent, it should be investigated in patients with transient neurologic deficit. There is still no consensus regarding the ideal surgical modality of treatment. The procedure that seems most recommended is closed suction drainage through burr holes. It has been controversial whether intraoperative washing of such collection improves outcomes.

[Multimodal monitoring in severe craniocerebral trauma: state the art]. / Neuromonitoreo multimodal en trauma craneoencefalico severo: estado del arte.

Traumatic brain injury is a public health problem and leading cause of death. In the context of a severe head injury, monitoring strategies give us the option to analyze the posterior intracranial alterations to the primary lesion. Neuromonitoring allows us to identify the deterioration of neurological function and the presence of secondary brain injury that may benefit from a therapeutic intervention letting us know pathophysiological changes that occur in a patient with brain injury. Understanding the physiological data allow to individualize therapies and interpret variables that ultimately help us choice a better treatment.

[Pediatric Gliosarcoma: Case Report and Literature Review]. / Gliosarcoma pediatrico: Reporte de un Caso y Revisión de la Literatura.

Brain gliosarcoma is a rare variant of glioblastoma multiforme that occurs primarily between the sixth and seventh decades of life. Few cases have been reported in patients younger than nineteen years. We report a four-year-old male with clinical, imaging and pathology compatible with brain gliosarcoma. Beside surgery he was managed with adjuvant radiotherapy and after follow-up is free of recurrence or neurologic deficit. Brain gliosarcoma is highly aggressive and the median survival is related to the extent of surgical resection.

[Seizure outcomes of cerebral hemispherectomy in adults: A systematic review and individual patient data meta-analysis]. / Control de las crisis epilépticas con la hemisferectomía cerebral en adultos: revisión sistemática y metaanálisis con datos de pacientes individuales.

OBJECTIVE: The objective of our study was to determine the seizure control rate of cerebral hemispherectomies in adult patients with drug-resistant epilepsy. MATERIALS AND METHODS: A systematic review and individual patient data meta-analysis was carried out. Seven international databases and scientific meeting proceedings were reviewed. Individual patient data were analysed to establish potential factors associated with postoperative seizure control. RESULTS: Eight articles that satisfied the pre-established selection criteria were identified. After a median follow-up of 70 months (interquartile range, 29-175.5), 79.4% of patients remained seizure-free. There were no statistically significant differences in age at onset of epilepsy, duration of epilepsy, age at surgery, time of follow-up, gender, surgical-laterality, aetiology and ictal EEG abnormalities between seizure-free patients and those with recurrences. CONCLUSIONS: Cerebral hemispherectomy has a high seizure control rate in adult patients with drug-resistant epilepsy. None of the variables analysed in the present study were associated with surgical success.

[Resection of frontal lobe epileptogenic foci identified after corpus callosotomy: long term results]. / Resección de focos epileptogénicos frontales identificados tras la callosotomía: resultados a largo plazo.

OBJECTIVES: To analyse the results of resective surgery in patients in whom it was possible to identify a frontal epileptogenic focus through corpus callosotomy. MATERIAL AND METHODS: Data from patients suffering drug-resistant epilepsy showing persistence of disabling seizures after undergoing corpus callosotomy and subsequent treatment with frontal lobe resective surgery were prospectively reviewed. Classifications according to Engel's scale before and after each intervention were evaluated, as were the percentages of seizure reduction. Additionally, the satisfaction of family members with surgical outcomes was also assessed. RESULTS: Eleven patients were identified. After a median follow-up period of 7 years (IQR: 3-8 years), 63.6% of patients showed improvement of seizures according to Engel's scale, 27.2% remained unchanged and one worsened. One patient was categorised as class i, 8 as class ii, one as class iii and one as class iv. The percentage reduction in the number of seizures was over 90% in 54.5% of patients, between 50% and 90% in 36.4% and less than 50% in 9.1%. Family satisfaction was reported as good or excellent in 90.9% of cases. CONCLUSIONS: In addition to providing better seizure control, corpus callosotomy also appears to be a diagnostic tool allowing the identification of potential targets for resective surgery. Therefore, it should be considered upon suspicion of a frontal epileptogenic focus which could be surgically treated.

[Congenital agenesis of cranial bones associated with hydrocephalus: a case report]. / Agenesia congénita de huesos craneales asociada a hidrocefalia: reporte de caso.

The absence of the cranial bones is a rare entity usually incompatible with life. Agenesis of parietal bones has been rarely reported in the literature. A case of a neonate with bilateral parietal agenesis associated hydrocephalus is reported. The cranial defect was managed conservatively. To our knowledge we present the first case of congenital agenesis of the parietal bone associated with hydrocephalus.

[Embolization of skull-base hypervascular tumors: description of a series of cases and proposal of a therapeutic algorithm]. / Embolizacion de tumores hipervasculares de la base del craneo: descripción de una serie de casos y propuesta de un algoritmo terapéutico.

UNLABELLED: Preoperative embolization allows reducing intraoperative blood loss caused by hypervascular intracranial tumors and its undesirable consequences. AIM: To describe the experience with preoperative endovascular embolization of hypervascular skull base tumors, and to develop a therapeutic algorithm. MATERIALS AND METHODS: A retrospective examination of preoperative neuroimaging and results of preoperative embolization was carried out. RESULTS: Fifteen cases were identified, with a median age of 36 years old, most of them harboring meningiomas, nasopharyngeal angiofibromas or paragangliomas. The external carotid artery was involved in 93% of cases and was the only afferent to 60%. In 27%, there were branches from the internal and external carotid arteries simultaneously. An extensive or complete occlusion grade was achieved in 95% of the branches of the external carotid artery. No branch of the internal carotid artery was treated, because poor contribution to tumor irrigation or was not possible to catheterize the pedicle. There were not recorded procedure-related complications. CONCLUSION: Based on the unification of the experiences described in this study and using data from published series, we present an algorithm for rational selection of skull base tumors that can benefit from preoperative embolization.

[Cerebral artery infarction presented as an unusual complication of acute middle otitis]. / Infarto arterial cerebral: una rara complicación de la otitis media aguda.

BACKGROUND: acute otitis media is a frequent disease in the pediatric age. About 2 % of all cases develop intracranial complications such as meningitis. The cerebral infarction originates meningitis and usually occurs in the venous system. The presence of a cerebral artery infarction secondary to acute otitis media is a rare cause described in the literature. CLINICAL CASE: a girl of 12 months who presented a febrile syndrome due to acute otitis media and mental confusion. On physical examination, she appeared sleepy with anisocoria, mydriasis in the right eye and left hemiparesis. The computed tomography examination showed extensive cerebral artery infarction. The patient's parents refused the proposed surgical treatment and the girl died 48 hours later. CONCLUSIONS: regardless of the current technological advances, the clinical prognosis of cerebral infarction associated with acute otitis media is bad. The focused neurological signs and progressive clinical deterioration should raise suspicion that antimicrobial therapy is not effective.

Introducción: la otitis media aguda es una inflamación del oído medio frecuente en la edad pediátrica. Aproximadamente 2 % de todos los casos desarrolla complicaciones intracraneales, más específicamente meningitis; por lo general, los infartos cerebrales originados por esta última son venosos. Rara vez se ha descrito la ocurrencia de un infarto arterial cerebral como complicación directa de la otitis media aguda. Caso clínico: niña de 12 meses de edad quien fue llevada a un servicio de urgencias por síndrome febril secundario a otitis media aguda y alteración del estado de conciencia. A la exploración física se identificó que estaba somnolienta, con anisocoria, midriasis en el ojo derecho y hemiparesia izquierda. Con la tomografía axial computarizada de cerebro se apreció un infarto arterial cerebral extenso. Los padres no autorizaron la craniectomía descompresiva y la paciente falleció a las 48 horas de su ingreso hospitalario. Conclusiones: a pesar de los recursos tecnológicos con los que se dispone actualmente, el infarto cerebral relacionado con la otitis media aguda tiene una evolución tórpida. Los signos neurológicos focalizadores y el deterioro progresivo deben apuntar a la ineficacia del tratamiento antimicrobiano instaurado.

[Vagus nerve stimulation therapy in patients with drug-resistant epilepsy and previous corpus callosotomy]. / Terapia con estimulación del nervio vago en pacientes con epilepsia fármaco-resistente y callosotomía previa.

OBJECTIVE: To analyse the results of vagus nerve stimulation in patients with drug-resistant epilepsy and previous corpus callosotomy. MATERIALS AND METHODS: We prospectively reviewed data from patients with drug-resistant epilepsy who showed persistence of disabling seizures after undergoing corpus callosotomy, in whom it was not possible to identify an epileptogenic focus and who were subsequently treated with vagus nerve stimulation. Variables analysed included: age, gender, aetiology of epilepsy, frequency and characteristics of the crises and Engel scale classification, before and after vagal stimulator implant. Furthermore, the percentage differences in seizure frequency changes were also calculated. RESULTS: Four patients were identified: two male and two female. The total seizure frequency had decreased between 20% and 81% after corpus callosotomy in three patients and one of them did not show any favourable response (Engel IVB). Following implantation of the stimulator they became reduced to between 57% and 100% after a mean follow-up period of 8.3 months (range: 3 to 12 months). Generalised seizures decreased between 71.4% and 100%, and focal seizures between 57.7% and 100%. CONCLUSIONS: Vagus nerve stimulation therapy proved to be an alternative for the reduction of seizure frequency in patients with drug-resistant epilepsy who suffered disabling seizures despite undergoing corpus callosotomy as primary surgery.

[Late onset of cerebrospinal fluid post-traumatic fistula: a case report]. / Fistula postraumatica de liquido cefalorraquideo con aparicion tardia: reporte de caso.

A frequent complication after head trauma is cerebrospinal fluid fistulas. They usually resolve spontaneously. Rhinorrhea is a cardinal sign that suggest the presence of such fistula. We review the case of a 47 year-old-female with a five-month history of rhinorrhea after moderate head trauma 20 year before. The patient initially managed with medical therapy needed a lumbar-peritoneal derivation that satisfactorily cured her rhinorrhea

[Synchronous bilateral gangliobasal hemorrhage in a student with sickle cell anemia: a case report]. / Hemorragia gangliobasal bilateral sincronica en una escolar con anemia de celulas falciformes: reporte de caso.

Sickle cell anemia is a common genetic condition that may have ischemic brain infarct and hemorrhagic complications, these being known as major complications. The incidence of stroke in children with sickle cell anemia is similar to that presented by the elderly in the general population. A case of a schoolchild that debuted with synchronous bilateral intracerebral hemorrhage is discussed. To our knowledge this is the first report in the literature of synchronous bilateral gangliobasal bleeding in a schoolchild with sickle cell anemia.

[Orbital tumors: experience with 35 cases]. / Tumores de orbita: experiencia en 35 casos.

Tumors of the orbit are pathology of considerable complexity in management due to the diverse anatomic and muscular, vascular, cartilagenous and neural components present. We review a series of 35 cases managed at the National Institute of Cancer in Bogota, Colombia. We determine variables such as age, sex, symptoms, histology, location and surgical procedure of these tumors. This review suggest that this complex pathology should be managed by a multidisciplinary team with extensive neurosurgical experience to obtain satisfactory results.

[Cerebral infarction in an adolescent with AIDS: a case report]. / Infarto cerebral en una adolescente con sida: reporte de caso.

HIV/AIDS corresponds to a systemic disease whose pathogenic mechanism by direct cellular infection by the virus followed by high levels of viral replication and a severe state of immunosuppression predisposes to numerous opportunistic infections as well as tumor and autoimmune disease. The association of AIDS and stroke in young patients is rare. We present a case of a 16 year-old-female with a diagnosis of HIV infection and massive infarct of the left cerebral hemisphere and right basal ganglia segment with herniation We conduct a review of the association of HIV infection and cerebrovascular disease in children.

[The influence of climate on the onset of intracranial hemorrhages]. / Variaciones climáticas y hemorragias intracraneales.

BACKGROUND: there are not studies exploring the potential role of weather conditions in the incidence of intracranial hemorrhages in Latin America. METHODS: a descriptive study was carried out in an emergency room from Cartagena de Indias (Colombia). Data for all adult patients with intracranial hemorrhage and meteorological variables of the days when intracranial hemorrhages occurred were recorded and compared to with those where not a single case. RESULTS: the differences between the average temperature, maximum and minimum temperatures, barometric pressure, relative humidity and wind speed were non statistically significant. However, when comparing the temperature differences day of the event over the previous days, those met the pre-established criteria of statistical significance. Furthermore, differences in barometric pressure, relative humidity, maximum and minimum temperature over the previous day, also reached this criterion. CONCLUSIONS: the results of this study suggest the existence of a climatic profile associated with the onset of intracranial hemorrhages.

[Brain stem compression preceded by trigeminal neuralgia in a patient with vertebro-basilar and bilateral carotid dolichoectasia]. / Compresión tronco-encefálica precedida por neuralgia del trigémino en un paciente con dolicoectasia vertebro-basilar y carotidea bilateral.

We described a patient who had left trigeminal neuralgia by vertebro-basilar dolichoectasia, who underwent microvascular decompression separating the basilar artery of the trigeminal nerve by interposing a vascular graft piece. Symptoms resolved completely after surgery. Nine years later, he has a recurrence of facial pain associated with rapidly progressive brainstem compressive symptoms. The brain MRI showed the vertebro-basilar dolichoectasia exerting compression on the ventral-lateral aspect of the pons and the medulla. In cerebral angiography confirmed the presence of dilated tortuous vertebral arteries, basilar, and of both internal carotid. To our knowledge this is the first case of brain stem compression syndrome preceded by NT in patients with vertebro-basilar dolichoectasia and one of the few cases with coexistence of vertebro-basilar and bilateral carotid dolichoectasia.

[Intracerebral hemorrhages following drainage of chronic subdural hematomas]. / Hemorragia intracerebral posterior a drenado de hematomas subdurales crónicos.

BACKGROUND: postoperative intracerebral hemorrhage after drainage of chronic subdural hematoma is a rarely reported complication; however, its incidence, according to different series may be underestimated. CASE REPORT: this report presents a 77 year old male patient who, after the drainage of bilateral chronic subdural hematomas, developed an extensive hemorrhage in the thalami, basal ganglia, midbrain and pons, with extension into the ventricles and obstructive hydrocephalus. CONCLUSIONS: compression by extra-axial collection decreases cerebral blood flow on the affected hemisphere and alters its vascular self-adjustment. The rapid increase in cerebral blood flow in brain areas with altered vascular self-adjustment appears to be the precipitating mechanism of intracerebral hemorrhage after surgical evacuation of chronic subdural hematomas.