Robot-assisted insular stereoelectroencephalography in pediatric drug-resistant epilepsy: accuracy and diagnostic value.

BACKGROUND: Insular epilepsy is a well-known cause of drug-resistant epilepsy (DRE) in the pediatric population. It can be a source of surgical epilepsy treatment failures when not ruled out pre-operatively. Non-invasive methods often provide limited information about its existence, being the invasive methods necessary to diagnose it in the vast majority of cases. The most used is stereoelectroencephalography (SEEG). We report a series of DRE pediatric patients in which insular SEEG was performed to rule out insular epilepsy. METHOD: We performed a retrospective review of pediatric DRE patients operated on SEEG including insular electrodes between April 2016 and September 2022. We described the different trajectories used (orthogonal or oblique) and surgical techniques. After implantation, we assessed electrodes' precision using three measures: entry point location error (EPLE), target point location error (TPLE), and target deviation (TD). We also reported complications that occurred with this technique as well as the diagnostic information provided. RESULTS: Overall, 32 DRE patients were operated on SEEG including insular electrodes. Four hundred one electrodes were implanted, 148 (39.91%) of whom were directed to the insula. One hundred twelve followed an orthogonal trajectory, and 36 were oblique. The mean EPLE was 1.45 mm, TPLE was 1.88 mm and TD was 0.71 mm. Three patients suffered from frontal hematoma, two of them diagnosed on post-operative MRI and one who required surgery, with no sequelae. One patient suffered from meningitis treated with antibiotics with no permanent sequelae. Nine patients (28.13%) had the insula included in the epileptogenic zone. CONCLUSIONS: Insular epilepsy has to be ruled out in DRE patients when little suspicion is obtained after non-invasive testing. This is especially important in the pediatric population, in which seizure semiology is more difficult to characterize and failures to control epilepsy have devastating consequences in neurocognitive development and scholarship. Given its relative low rate of relevant complications and potential benefits, we should consider widening the inclusion criteria for insular SEEG monitoring.

Seizure prophylaxis in meningiomas: a systematic review and meta-analysis.

INTRODUCTION: No formal indication currently exists for seizure prophylaxis in neurosurgical oncology patients. Neither have specific recommendations been made on the use of antiepileptic drugs (AED) in seizure-free patients with meningiomas scheduled for surgery. AEDs are generally prescribed on a discretionary basis, taking into consideration a range of clinical and radiological risk factors. We present a systematic review and meta-analysis exploring the effectiveness of antiepileptic prophylaxis in patients with meningioma and no history of seizures. METHODS: We performed a systematic review of the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and clinicaltrials.gov databases. Of a total of 4368 studies initially identified, 12 were selected for extraction of data and qualitative analysis. Based on the clinical data presented, we were only able to include 6 studies in the meta-analysis. We performed heterogeneity studies, calculated a combined odds ratio, evaluated publication bias, and conducted a sensitivity analysis. RESULTS: AED prophylaxis in patients with meningioma and no history of seizures did not significantly reduce the incidence of post-operative seizures in comparison to controls (Mantel-Haenszel combined odds ratio, random effects model: 1.26 [95% confidence interval, 0.60-2.78]; 2041 patients). However, we are unable to establish a robust recommendation against this treatment due to the lack of prospective studies, the presence of selection bias in the studies reviewed, the likelihood of underestimation of seizure frequency during follow-up, and the strong influence of one study on the overall effect. CONCLUSIONS: Despite the limitations of this review, the results of the meta-analysis do not support the routine use of seizure prophylaxis in patients with meningioma and no history of seizures.

Malaria y COVID-19 en comunidades nativas de Amazonas, Perú / Malaria and COVID-19 in native communities of Amazonas, Peru

Introducción En los últimos años, el número de casos de malaria en las comunidades nativas de Condorcanqui, Amazonas ha aumentado considerablemente. La malaria por Plasmodium vivax es endémica en la región y en 2019 fue reportada la reintroducción de P. falciparum. Métodos En este estudio, recopilamos y analizamos los datos de malaria y COVID-19 reportados por la Dirección Regional de Salud (DIRESA) durante el 2020. Además, realizamos un análisis de razón de posibilidades "odds ratio" para evaluar las asociaciones significativas entre los síntomas de la COVID-19 y las infecciones previas de malaria. Resultados En el 2020, se reportaron 1547 casos de malaria (97% por P. vivax) y 5968 de COVID-19. Por otro lado, 96 pacientes contrajeron COVID-19 después de contraer una infección de malaria. De éstos, 87 eran sintomáticos (90,6%) y en su mayoría adultos de 30 a 59 años (62,3%). Además, encontramos que las infecciones previas de malaria están asociadas a la presencia de síntomas como fiebre, tos, dolor de garganta y dificultad respiratoria. Sin embargo, no hubo asociación significativa entre estos casos y la hospitalización o la muerte. Conclusión Nuestro análisis sugiere que las infecciones previas por malaria podrían afectar la sintomatología de la COVID-19, lo que destaca la importancia de un programa continuo de control y vigilancia de la malaria para evitar posibles sindemias con la COVID-19.

Introduction In recent years, the number of malaria cases in native communities from Condorcanqui, Amazonas has considerably increased. Plasmodium vivax malaria is endemic in the region and the re-introduction of P. falciparum was reported in 2019. Methods Here, we compiled and analyzed malaria and COVID-19 data reported by the Regional Direction of Health (DIRESA) during the 2020. Additionally, we performed an odds ratio analysis to evaluate significant associations between COVID-19 symptoms and previous malaria infections. Results In 2020, 1547 malaria (97% were P. vivax) and 5968 COVID-19 cases were reported. Furthermore, 96 patients got COVID-19 after getting a malaria infection. From these, 87 were symptomatic (90.6%), and mostly adults, ages 30 to 59 (62.3%). Also, we found that malaria previous infections represent a risk for the presence of symptoms such as fever, cough, throat pain, and respiratory difficulty. Nevertheless, there was no significant association between these cases and hospitalization or death. Conclusion Our analysis suggests that previous malaria infections might affect COVID-19 symptomatology, which highlights the importance of a continuing control and surveillance malaria program to avoid potential syndemics with COVID-19.

Increased levels of soluble fms-like tyrosine kinase-1 are associated with adverse outcome in pregnant women with COVID-19.

OBJECTIVE: In addition to the lungs, the placenta and the endothelium can be affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are markers of endothelial dysfunction and could potentially serve as predictors of severe coronavirus disease 2019 (COVID-19). We aimed to investigate the association of serum concentrations of sFlt-1 and PlGF with the severity of COVID-19 in pregnancy. METHODS: This was a prospective cohort study carried out in a tertiary care hospital in Mexico City, Mexico. Symptomatic pregnant women with a positive reverse-transcription quantitative polymerase chain reaction test for SARS-CoV-2 infection who fulfilled the criteria for hospitalization were included. The primary outcome was severe pneumonia due to COVID-19. Secondary outcomes were intensive care unit (ICU) admission, viral sepsis and maternal death. sFlt-1 levels were expressed as multiples of the median (MoM). The association between sFlt-1 and each adverse outcome was explored by logistic regression analysis, adjusted for gestational age for outcomes occurring in more than five patients, and the predictive performance was assessed by receiver-operating-characteristics-curve analysis. RESULTS: Among 113 pregnant women with COVID-19, higher sFlt-1 MoM was associated with an increased probability of severe pneumonia (adjusted odds ratio (aOR), 1.817 (95% CI, 1.365-2.418)), ICU admission (aOR, 2.195 (95% CI, 1.582-3.047)), viral sepsis (aOR, 2.318 (95% CI, 1.407-3.820)) and maternal death (unadjusted OR, 5.504 (95% CI, 1.079-28.076)). At a 10% false-positive rate, sFlt-1 MoM had detection rates of 45.2%, 66.7%, 83.3% and 100% for severe COVID-19 pneumonia, ICU admission, viral sepsis and maternal death, respectively. PlGF values were similar between women with severe and those with non-severe COVID-19 pneumonia. CONCLUSION: sFlt-1 MoM is higher in pregnant women with severe COVID-19 and has the capability to predict serious adverse pregnancy events, such as severe pneumonia, ICU admission, viral sepsis and maternal death. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Seizure prophylaxis in meningiomas: A systematic review and meta-analysis. / Profilaxis antiepiléptica en meningiomas: revisión sistemática y metaanálisis.

INTRODUCTION: No formal indication currently exists for seizure prophylaxis in neurosurgical oncology patients. Neither have specific recommendations been made on the use of antiepileptic drugs (AED) in seizure-free patients with meningiomas scheduled for surgery. AEDs are generally prescribed on a discretionary basis, taking into consideration a range of clinical and radiological risk factors. We present a systematic review and meta-analysis exploring the effectiveness of antiepileptic prophylaxis in patients with meningioma and no history of seizures. METHODS: We performed a systematic review of the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and clinicaltrials.gov databases. Of a total of 4368 studies initially identified, 12 were selected for extraction of data and qualitative analysis. Based on the clinical data presented, we were only able to include 6 studies in the meta-analysis. We performed heterogeneity studies, calculated a combined odds ratio, evaluated publication bias, and conducted a sensitivity analysis. RESULTS: AED prophylaxis in patients with meningioma and no history of seizures did not significantly reduce the incidence of post-operative seizures in comparison to controls (Mantel-Haenszel combined odds ratio, random effects model: 1.26 [95% confidence interval, 0.60-2.78]; 2041 patients). However, we are unable to establish a robust recommendation against this treatment due to the lack of prospective studies, the presence of selection bias in the studies reviewed, the likelihood of underestimation of seizure frequency during follow-up, and the strong influence of one study on the overall effect. CONCLUSIONS: Despite the limitations of this review, the results of the meta-analysis do not support the routine use of seizure prophylaxis in patients with meningioma and no history of seizures.

Corneal epithelial thickness one year after myopic LASIK surgery, measured by anterior segment optical coherence tomography combined with Placido disk. / Grosor epitelial corneal un año después de la cirugía de LASIK miópico, medido mediante tomografía de coherencia óptica de segmento anterior combinado con disco de Plácido.

OBJECTIVE: To compare corneal epithelial thickness (CET) between patients who underwent LASIK surgery for the correction of myopia at least one year ago and healthy subjects. METHODS: A retrospective observational study was conducted that included 93 healthy subjects (186eyes) and 26 subjects (52eyes) that underwent myopic LASIK surgery. OCT-SA, combined with Placido disk, was performed on all subjects, and CET maps were measured. Statistical analysis was performed to analyse differences between groups. Multivariate analysis was also performed to look for possible predictors of final CET. RESULTS: There was no statistically significant differences between the groups in the demographic (age, sex) or anterior segment parameters (spherical equivalent, pachymetry) (all P>.05). Statistically significant differences (P<.05) were obtained between both groups when comparing CET, including central, internal, and external rings (higher in patients that underwent LASIK surgery ≥1year). With the exception of the time elapsed since surgery (P=.00), no correlation was found between the CET and age, sex, ablated dioptres, or other variables studied (P<.05). CONCLUSIONS: CET values measured by the OCT-SA were higher in patients that underwent LASIK surgery ≥1year. The only variable that correlated with the CET after LASIK was the time elapsed since surgery. CET changes should be taken into consideration when planning refractive surgery due to its implications on the final outcome.

Spitz Nevus and Other Spitzoid Tumors in Children -Part 1: Clinical, Histopathologic, and Immunohistochemical Features. / Nevo de Spitz y otros tumores spitzoides en la infancia. Parte 1: aspectos clínicos, histológicos e inmunohistoquímicos.

A Spitz nevus is a melanocytic neoplasm of epithelioid and/or spindle cells that usually appears in childhood. These lesions are by nature benign, but their features can sometimes make them difficult to distinguish from melanomas. Spitzoid melanocytic lesions have been grouped into 3 types in recent decades: Spitz nevi, atypical Spitz tumors, and spitzoid melanomas. Atypical Spitz tumors are spitzoid melanocytic proliferations that have atypical histopathologic features that are insufficient to support a diagnosis of melanoma. The malignant potential of these lesions is at present uncertain. This review examines the clinical, dermoscopic, and histopathologic features of this group of lesions.

Spitz Nevus and Other Spitzoid Tumors in Children. Part 2: Cytogenetic and Molecular Features. Prognosis and Treatment. / Nevo de Spitz y otros tumores spitzoides en la infancia. Parte 2: características citogenéticas y moleculares. Pronóstico y tratamiento.

Melanocytic neoplasms with spitzoid morphology (Spitz nevi, atypical Spitz tumors, and spitzoid melanomas) may be benign or malignant. Because the malignant potential of atypical Spitz tumors is uncertain, the proper therapeutic approach has been much debated over the years. Promising new techniques for molecular analysis have enabled better predictions of the biological behavior of these tumors. We review their cytogenetic features and prognosis and also provide an update of the most recent recommendations for management.

Cellular Myxoma of the Vocal Cord: A Case Report and Review of the Literature.

Myxomas are rare in the vocal cords. A 69-year-old man was admitted with one-year history of progressive dysphonia. Laryngoscopy revealed a polypoid mass on the right vocal cord. The diagnosis was cellular myxoma. A review of the literature including the present case revealed eleven reported cases of myxoma. Ten cases were classic myxoma. To the best of our knowledge, cellular myxoma has not been previously reported in the vocal cord. Hypercellularity does not affect the behavior of cellular myxoma. However, its recognition is important to prevent confusion with the group of low-grade myxoid sarcomas. Cellular myxoma should be considered in the differential diagnosis of any vocal cord mass.

Role of VEGF in the differential growth between the fetal and placental ends of the umbilical cord.

INTRODUCTION: The umbilical cord (UC) is a vital structure; its alterations affect the newborn and neurological impact can be permanent. Paradoxically, factors that determine it remain unknown. We explore the differential VEGF protein expression in the UC's proximal and distal portions in relation to the hypothesis that the UC has differential growth and that VEGF plays a role in it. METHODS: An observational analytical study was performed. One UC segment was taken proximal to fetus and another distal; both were randomly processed; VEGF immunohistochemical analysis was performed; two blinded pathologists read results. RESULTS: Forty-eight newborns were included. Protein expression between the two edges of the umbilical cord, in any kind of cells, was interpreted. Endothelium, amnion, and stromal cells expressed VEGF; the first two were not different between opposite ends. Stromal cells had differential expression: higher in the proximal to the fetus portion. CONCLUSION: Knowledge of molecular factors is necessary. UC cells widely expressed VEGF, possibly contributing to UC growth. Even though stromal cell expression was different, the interaction with activity close to the fetus must be explored.

Incidental, low-fat variant of spindle cell lipoma: a novel tumour of the small intestine.

A woman underwent surgical intervention for a carcinoma of the ovary. In the intervention, a submucosal nodule of the ileum was found. Pathological study revealed a spindle cell lipoma (SCL). This case revealed the presence of CD34-positive spindle and stellate cells with dendritic cytoplasmic prolongations, a feature shared with dendritic fibromyxolipoma. Fluorescence in in situ hybridisation analysis showed 13q14 heterozygous deletion. Spindle cell lipoma of the small intestine has not been previously reported. Spindle cell lipoma, although rare, should be included among the benign mesenchymal lesions of the small intestine. This report extends the range of locations in which this tumour is found to arise.

Study of light-particle multiplicities in p + non-fissionable nuclei events in the 0.5 - 2 GeV energy range / Estudio de la multiplicidad de partículas ligeras en proto-reacciones con núcleos no fisionables en el rango energético 0.5 - 2 GeV

Abstract In recent years, the investigation of spallation reactions have caught the attention of scientific community due to their application in the transmutation of nuclear waste by using the Accelerator Driven System (ADS) reactors. Due to the experimental difficulties that nuclear reactions researches face; the study of spallation reaction by using simulation codes is more suitable for generating more complete database for different energy ranges. This work aims to study spallation reactions induced by protons at intermediate energies 0.5 - 2 GeV on non-fissionable nuclei by using the Monte Carlo code: CRISP (Collaboration Rio-Ilhéus-São Paulo). The target nuclei studied were: 184 W, 197 Au and 208 Pb, focusing on the last one. Multiplicity of light particles obtained with CRISP was compared with the available experimental data and other Monte Carlo codes involved in the study of spallation reactions, resulting on a quite satisfactory agreement.

Resumen En años recientes la investigación de las reacciones nucleares de "espalación" han causado atención en la comunidad científica debido a su aplicación en la transmutación de los residuos nucleares usando reactores ADS (AcceleratorDriven System). Debido a las dificultades experimentales en el estudio de las reacciones nucleares, su estudio vía simulación es adecuado para generar una base de datos más completa en un amplio rango de energía. Este trabajo tiene como objetivo principal el estudio de reacciones nucleares inducidas por protones a energías intermedias, 0.5 - 2 GeV, en núcleos no fisionables, utilizando el código de Monte Carlo: CRISP (Collaboration Rio-Ilhéus-São Paulo). Los núcleos estudiados fueron: 184W, 197Au y 208Pb, con un enfoque en el último. La multiplicidad de partículas ligeras obtenida con el CRISPfue comparada con los datos experimentales disponibles y con otros códigos de Monte Carlo y se obtuvieron resultados satisfactorios.

Assessment of cell death mechanisms triggered by 177Lu-anti-CD20 in lymphoma cells.

The aim of this research was to evaluate the cell cycle redistribution and activation of early and late apoptotic pathways in lymphoma cells after treatment with 177Lu-anti-CD20. Experimental and computer models were used to calculate the radiation absorbed dose to cancer cell nuclei. The computer model (Monte Carlo, PENELOPE) consisted of twenty spheres representing cells with an inner sphere (cell nucleus) embedded in culture media. Radiation emissions of the radiopharmaceutical located in cell membranes and in culture media were considered for nuclei dose calculations. Flow cytometric analyses demonstrated that doses as low as 4.8Gy are enough to induce cell cycle arrest and activate late apoptotic pathways.

Lymphocyte-rich capillary-cavernous hemangioma of the mitral valve: a case report and review of the literature.

Valvular hemangioma incidence is extremely low. In this report, we describe a 62-year-old man who presented with mild edema of the lower limbs. An echocardiogram revealed an incidental 1.3-cm diameter mass on the anterior mitral valve leaflet for which he underwent surgical resection and mitral valve replacement. Histopathological examination showed a lymphocyte-rich capillary-cavernous hemangioma. The exuberant lymphoid stroma is unusual for hemangioma and represents an undescribed pattern of cardiac hemangioma. Including the present report, only 13 cases of mitral valve hemangioma have been reported to date. Most patients are adult. Mitral hemangioma originates in the atrial aspect of the valve and involves more commonly the anterior leaflet. The average maximum diameter of the lesion is 1.7 (S.D.=0.75) cm. Pure cavernous hemangioma is the predominant type of mitral hemangioma. Most of them are described as pedunculated or polypoid. Surgical excision appears to be curative. Recurrences have not been reported. Lymphocyte-rich cardiac hemangioma represents a peculiar type of hemangioma which should be included in the differential diagnosis of other vascular lesions.

Feeding value of supplemental curcas crude oil in finishing diets for feedlot lambs.

The objective of this experiment was to determine the feeding value of a mechanically extracted nontoxic variety of oil (JCO) as source of energy for feedlot lambs. Twenty Pelibuey × Katahdin lambs were individually fed a dry-rolled-corn-based finishing diet supplemented with 0%, 2%, 4%, or 6% JCO (diet dry matter basis). Supplemental JCO replaced dry rolled corn in the basal diet. Fatty acid composition of JCO was C16:0, 14.0%; C18:0, 8.2%; C18:1, 26.0%; C18:2, 50.3%, and C18:3, 0.4%. Daily intakes of JCO averaged 24.7, 51.1, and 77.3 g/day or 0.57, 1.08, and 1.62 g/kg LW for the 2%, 4%, and 6% levels of supplementation, respectively. Supplemental JCO did not affect ( = 0.33) dry matter intake (DMI), but tended to increase (linear effect, = 0.06) average daily gain, efficiency of gain (linear effect, < 0.01), and dietary net energy (linear effect, < 0.01) and decreased (linear effect, < 0.01) the ratio of observed/expected DMI. At low levels (20 g/kg diet dry matter) of supplementation, the net energy (NE) value of JCO corresponds closely (0.99) to the NE value assigned by current standards (), and this NE value decreased linearly as the inclusion level of JCO increased. There were not treatment effects on plasma metabolites. Across treatments, the concentrations of hemoglobin (11.64 ± 1.08 g/dL), hematocrit (39.15 ± 3.67%), glucose (85.2 ± 17.64 mg/dL), creatinine (1.43 ± 0.28 mg/dL), and urea (20.70 ± 4.35 mg/dL) were within normal (9-15 g/dL, 27%-40%, 50-90 mg/dL, 1.0-1.8 mg/dL, and 15-50 mg/dL, for hemoglobin, hematocrit, glucose, creatinine, and urea, respectively) ranges for healthy lambs. Based on DMI, performance and plasma metabolites observed in this study, nontoxic JCO is a suitable source of energy in finishing diets for lambs.

Effects of different surface modifying agents on the cytotoxic and antimicrobial properties of ZnO nanoparticles.

Zinc oxide (ZnO) nanoparticles (NPs) have received considerable attention in the medical field because of their antibacterial properties, primarily for killing and reducing the activity of numerous microorganisms. The purpose of this study was to determine whether surface-modified ZnO NPs exhibit different properties compared with unmodified ZnO. The antimicrobial and cytotoxic properties of modified ZnO NPs as well as their effects on inflammatory cytokine production were evaluated. ZnO NPs were prepared using a wet chemical method. Then, the surfaces of these NPs were modified using 3-aminopropyltriethoxysilane (APTES) and dimethyl sulfoxide (DMSO) as modifying agents via a chemical hydrolysis method. According to infrared spectroscopy analysis (FTIR), the structure of the ZnO remained unchanged after modification. Antibacterial assays demonstrated that APTES modification is more effective at inducing an antimicrobial effect against Gram-negative bacteria than against Gram-positive bacteria. Cytotoxicity studies showed that cell viability was dose-dependent; moreover, pristine and APTES-modified ZnO exhibited low cytotoxicity, whereas DMSO-modified ZnO exhibited toxicity even at a low NP concentration. An investigation of inflammatory cytokine production demonstrated that the extent of stimulation was related to the ZnO NP concentration but not to the surface modification, except for IFN-γ and IL-10, which were not detected even at high NP concentrations.

[Prevalence of HPV high-risk serotypes detected by PCR in patients with normal cervical cytology at the Hospital Regional Adolfo López Mateos, ISSSTE]. / Prevalencia de genotipos de alto riesgo de VPH detectados por PCR en pacientes con citología normal del Hospital Regional Adolfo López Mateos, ISSSTE.

Background: Is fundamental to determine the prevalence of human papiloma virus (HVP) high-risk serotypes in local and regional population in order for health providers to offer patients, vaccines and treatments against specific population-based serotypes. Objetive: To determine the prevalence of HPV High risk serotypes detected by PCR in patients with normal cytology from the ISSSTE Adolfo Lopez Mateos Regional Hospital. Methods: An observational, descriptive, prospective study was conducted from cervical cytologies and high risk HPV test by PCR in patients from the Regional Hospital Adolfo López Mateos, ISSSTE, during the period January 2013-December 2015. Cases of patients with negative cervical cytology were included. Information about age, the result of cervical cytology and high risk HPV test by PCR was obtained. The overall prevalence of HPV infection and the most prevalent serotypes by age groups were calculated. Results: A total of 3258 cervical smears were performed, of which 2557 were negative (78.4%), from this, the global prevalence of HPV infection was 10.2% (n=262). We found that 1.8% (n = 45) of negative reports had HPV16 infection, 0.5% (n=13) had HPV18 and 8.9% (n = 227) were infected by Viral Pool of other high-risk serotypes. The prevalence of infection by viral pool of high risk serotypes was 11.5% in women <20 years, 12.9% in women between 20-29 years and 22.2% in women between 30-39 years. This prevalence was lower in patients older than 40 years (p<0.05). Conclusion: A higher prevalence of viral pool high risk serotypes was found in patients with normal cytology, than the HPV16 and HPV-8 prevalence, which was significantly higher in women younger than 40 years.