How the characteristics of pediatric neurologists in Latin America influence the communication of sudden unexpected death in epilepsy to patients and caregivers.

OBJECTIVE: This study aimed to describe the characteristics of pediatric neurologists (PNs) in Latin America (LA) who attend to children and adolescents with epilepsy and convey to them the risk of sudden unexpected death in epilepsy (SUDEP). METHODS: Personal data and details of discussion of SUDEP with families, including relevance of SUDEP disclosure, frequency of such communication, perceived benefits and risks of disclosure, extent of training received on such disclosure, and professional experience with SUDEP, were collected through an online survey of PNs from LA. Their personal experience in carrying out this conversation was obtained through responses to an open question, further used to identify the main barriers. RESULTS: Of the 442 surveys received, 367 (83%) were analyzed. Most participants (73.8%) responded that the communication of SUDEP risk was relevant or very relevant; however, only 17.9% reported communicating it always or very frequently. Factors that increased the frequency of SUDEP communication included patients with higher levels of complexity (OR = 2.18, P = .003) and the physician's personal experience with SUDEP (OR = 2.305, P < .001). Direct questions from the family and avoiding scaring them about a rare outcome were the main motivations behind discussing and not discussing SUDEP, respectively. In the open question, respondents identified worries about the patient's ability to understand the information and cultural gaps as barriers. "Informing with the intention of improving adherence to treatment" and "establishing an empathic relationship" were significantly related. Further, the concept of "do not scare" was significantly related to "personal difficulties in discussing SUDEP." SIGNIFICANCE: Although most PNs agree that communication about SUDEP is relevant, only a minority actually engages in it. Participants identified a lack of appropriate training in such communication as a barrier. A better understanding of communication expectations, education of health professionals, and communication techniques have a strong relevance in diminishing the gap between guidelines and practice.

Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients.

BACKGROUND: Neurological events after aortic valve interventions are associated with increased mortality and morbidity. Transcatheter aortic valve replacement (TAVR) is increasingly offered for lower-risk patients with severe aortic stenosis, previously considered candidates for surgical aortic valve replacement (SAVR). Differences in post-procedural neurological events have important implications in treatment allocation. OBJECTIVES: The authors sought to analyze the neurological events in the randomized SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. METHODS: Patients with severe, symptomatic aortic stenosis at intermediate surgical risk were randomized 1:1 to TAVR or SAVR. The rates of neurological events and quality of life were analyzed at 30 days, and 6 and 12 months post-procedure in a modified intention-to-treat population (mean age 79.8 ± 6.2 years; N = 1,660). RESULTS: The rates of early (30-day) stroke and post-procedural encephalopathy were higher after SAVR versus TAVR (5.4% vs. 3.3%; p = 0.031; and 7.8% vs. 1.6%; p < 0.001, respectively). At 12 months, the rate of stroke was not different between SAVR and TAVR (6.9% vs. 5.2%; p = 0.136). Early stroke and early encephalopathy resulted in an elevated mortality at 12 months in both treatment groups. Quality of life after an early stroke was significantly lower in SAVR versus TAVR patients at 30 days and was similar at 6 and 12 months. CONCLUSIONS: The early stroke rate was lower after TAVR than SAVR. In patients with early strokes, QOL improved earlier after TAVR. At 12-month follow-up, stroke rates and QOL were not different between TAVR and SAVR patients. (Surgical Replacement and Transcatheter Aortic Valve Implantation [SURTAVI]; NCT01586910).

Real world ocean rogue waves explained without the modulational instability.

Since the 1990s, the modulational instability has commonly been used to explain the occurrence of rogue waves that appear from nowhere in the open ocean. However, the importance of this instability in the context of ocean waves is not well established. This mechanism has been successfully studied in laboratory experiments and in mathematical studies, but there is no consensus on what actually takes place in the ocean. In this work, we question the oceanic relevance of this paradigm. In particular, we analyze several sets of field data in various European locations with various tools, and find that the main generation mechanism for rogue waves is the constructive interference of elementary waves enhanced by second-order bound nonlinearities and not the modulational instability. This implies that rogue waves are likely to be rare occurrences of weakly nonlinear random seas.

Application of the kernel method to the inverse geosounding problem.

Determining the layered structure of the earth demands the solution of a variety of inverse problems; in the case of electromagnetic soundings at low induction numbers, the problem is linear, for the measurements may be represented as a linear functional of the electrical conductivity distribution. In this paper, an application of the support vector (SV) regression technique to the inversion of electromagnetic data is presented. We take advantage of the regularizing properties of the SV learning algorithm and use it as a modeling technique with synthetic and field data. The SV method presents better recovery of synthetic models than Tikhonov's regularization. As the SV formulation is solved in the space of the data, which has a small dimension in this application, a smaller problem than that considered with Tikhonov's regularization is produced. For field data, the SV formulation develops models similar to those obtained via linear programming techniques, but with the added characteristic of robustness.

Separation of Leishmania-infected macrophages by step-SPLITT fractionation.

After a primary infection protocol of macrophages with Leishmania amazonensis, the percentage of infection drops as infection progresses and the uninfected population of macrophages mask the effects of infection for electrophysiological studies. In order to increase or maintain the infection percentage, we introduce an enrichment process after primary infection, which increases the possibility of following the infection longer times than any known process. A membraneless separation technique, step-SPLITT fractionation, implying flow and transverse gravity field in a ribbon-like channel, was used for enriching samples of macrophages infected with particles and with L. amazonensis. We demonstrate the capability of the s-SPLITT of generating, from a mixture resulting from a primary infection, an enriched and a depleted fraction with infected cells, without using any selective labeling pre-processing. It is also shown that a continuous sorting is possible without damaging cells and the losses of matter into the separation chamber is minimal.

Mecanismos de sllida de parásitos intracelulares de su célula hospedrra / Exit Mechanisms of Intracellular Parasites from their Host Cells

Algunos parásitos intracelulares durante la infección en hospederos vertebrados se localizan al interior de sus células hospederas en un compartimiento intracelular rodeado por membrana denominado vacuola parasitófora. Para el sostenimiento e incremento de las infecciones causadas por estos parásitos es necesario que se dé un evento de liberación/salida de las formas infectivas, para que estas reinicien la infección en nuevas células. Para dicho fenómeno de liberación se han planteado dos mecanismos básicos: 1. la salida se da por eventos de ruptura de la membrana de la vacuola parasitófora (MVP) y de la membrana plasmática de la célula hospedera y/o 2. la salida se da por un proceso de fusión entre la MVP y la membrana de la célula hospedera, de forma que la luz de la VP y el espacio extracelular se hacen continuos, permitiendo la liberación del parásito. En esta revisión se presenta la evidencia que apoya estos modelos en bacterias y protozoarios intracelulares obligatorios, con especial énfasis en la salida de Leishmania.

Some intracellular parasites inhabit intracellular compartments known as parasitophorous vacuoles. To maintain and amplify infection, infective forms of the parasite must exit from the host cell to infect new cells. During parasite egress, two main mechanisms have been proposed: lysis of the membranes of the parasitophorus vacuole and the plasma membrane of the cell host, or fusion of these two membranes providing continuity between the lumen of the parasitophorous vacuole and the extracellular compartment. In this review we present evidence supporting these models for intracellular parasites of human importance with particular emphasis on Leishmania exit.

Prevalencia de infección por Tripanosoma cruzi en pacientes tratados con diálisis crónica en Colombia

Objetivo: determinar la prevalencia de la infección por Tripanosoma cruzi en pacientes tratados con dialisis cronica en Colombia. Metodos: se realizo un estudio de corte transversal entre febrero y julio de 1997. Se incluyeron 1360 pacientes ubicados en 31 unidades de dialisis localizadas en 5 zonas del pais. Region 1 (Bogotá, Neiva). region 2 (Bucaramanga, Cucuta). region 3 (Barranquilla, Cartagena, Valledupar, Sincelejo y Cereté). Region 4 (Medellin, Manizales, Armenia, Pereira). Region 5 (Cali, popayan, Pasto). Se realizó una encuesta epidemiologica y serologica a cada paciente. Resultados:847 (62,28 porciento) pacientes fueron del sexo masculino. La edad osciló entre 9 y 85 años (promedio:48); 76,3 porciento eran atendidas en zonas no endemicas para enfermedad de Chagas. La causa de IRC fue: desconocida 28,09 porciento,nefropatia hipertensiva: 25,29 porciento, nefropatia diabetica: 19,63 porciento y glomerulonefritis: 12,21 porciento. De los encuestados 987 (72,57 porciento) habian sido tratados solo con hemodialisis y 104 casos solo con CAPD; los restantes habian recibido ambas formas de tratamiento. 68 porciento llevaban entre 6 meses y dos años de tratamiento; 23,5 porciento nunca habian sido transfundidos y 20 porciento estaban recibiendo eritropoyetina. De 1.312 pacientes 88 fueron positivos para T. cruzi (6,71 porciento). La prevalencia por regiones fue region 1 : 8,87 porciento; region 2: 9,67 porciento; region 3: 4,09 porciento; region 4: 8,33 porciento; region 5: 2,02 porciento. Conclusiones: La infección por T. cruzi presenta una alta prevalencia en los pacientes tratados con dialisis cronica comparada con otras poblaciones y varia en las diferentes zonas geograficas de Colombia

Cefalea postbloqueo subaracnoideo: presentación de caso clínico / Subarachnoideal postblock cephalea: case report

Se trata de una paciente de 25 años, con diagnóstico de embarazo a término más deproporción cefalopélvica, sometida a operación cesárea bajo anestesia raquídea bloqueo subaracnoideo. En este caso se presenta sintomatología secundaria a esta técnica anestésica, observándose como complicación principal la cefalea. Se discute el breve resumen del cuadro clínico y tratamiento.

La anestesia de la embarazada cardiópata: presentación de un caso / Anesthesia in cardiopathic pregnant: case report

Paciente de 22 años, con embarazo de 40 semanas + desproporción céfalo pélvica + Estenosis aórtica. Es ingresada en el área de Emergencia del departamento de Gineco – Obstetricia del Hospital Teodoro Maldonado Carbo del IESS de la ciudad de Guayaquil, es sometida a cesárea de emergencia bajo anestesia general con resultados satisfactorios para la madre y el producto.

22 years old patient with 40 weeks pregnancy, cephalo-pelvic disproportion and aortic stenosis. She is admitted to the Emergency service of the Gyn-Obstetric department at the Teodoro Maldonado Carbo Hospital in Guayaquil; she was submitted to emergency c-section under general anesthesia with satisfactory results from mother and product.