Ischemic Stroke in Dengue Fever: Unusual Complication of a Common Disease

Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.

A Case Report of Ischemic Stroke in an Adult Patient of Dengue Fever with Thrombocytopenia

Neurological complications in Dengue patients are extremely rare with 0.5-6% incidence including encephalopathy, Guillain Barre Syndrome, Brachial neuritis, Myelitis, Encephalomyelitis. Stroke as a neurological complication is extremely rare with very few cases reported previously. We present the case of a 69-year-old male with Dengue fever where the patient presented with persistent hiccups was found to have pontine infarct.

Neurologic involvement in children with coronavirus disease 2019 / 中国小儿急救医学

The clinical manifestations of neuropathies associated with novel coronavirus infection are diverse, including headache, mental disorders, acute encephalitis(meningitis), acute disseminated cerebrospinal meningitis, Guillain-Barre syndrome, acute encephalopathy and even acute (hemorrhagic) necrotic encephalopathy, which can be attributed to a variety of potential pathophysiological mechanisms.The severity of cytokine storm, vascular endothelial cell injury (including blood-brain barrier) and hypoxic ischemic injury determines the prognosis of infected patients.The treatment mainly includes general supportive therapy and immune regulation.Clinicians need to monitor and evaluate the degree of brain dysfunction and prognosis, and ensure timely treatment.

Neurological disease in the time of COVID-19. A case series

Introduction: we present a series of patients with neurological problems and SARS-CoV-2 infection, and review the respective evidence. Patients and methods: a retrospective descriptive study of consecutive RT-PCR SARS-CoV-2-positive patients in a neurology department from August 1 to December 31, 2020. Results: we recorded 30 patients: 16 men (53%), with a mean age of 65±17.3. In 53%, the neu rological problem preceded the respiratory symptoms and SARS-CoV-2 infection diagnosis. At the syndromic level, the following were found: CVAs 43% (13), seizures 10% (3), posterior reversible encephalopathy 10% (3), encephalopathy 7% (2), brief psychotic disorder 7% (2), myelopathy 3% (1), Guillain-Barré syndrome 3% (1), headache 3% (1), vasculitis 3% (1), intracerebral hemorrhage 3% (1), myasthenic crisis 3% (1) and recurrent optic neuritis 3% (1). Conclusions: SARS-CoV-2 induced neurological problems produce a wide variety of symptoms and may be the first manifestation, even without the development of respiratory symptoms from this infection. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2233).

Introducción: se presenta una serie de pacientes con compromiso neurológico e infección por SARS-CoV-2 y se revisa la evidencia al respecto. Pacientes y métodos: estudio descriptivo, retrospectivo de pacientes consecutivos RT-PCR positivos para SARS-CoV-2 del servicio de neurología desde el 1° de agosto hasta 31 de diciembre de 2020. Resultados: registramos 30 pacientes, 16 hombres (53%), edad media: 65±17.3. En el 53% el compromiso neurológico antecedió los síntomas respiratorios y el diagnóstico de infección por SARS-CoV-2. A nivel sindromático se observó: ACV 43% (13), crisis convulsivas 10% (3), encefalopatía posterior reversible 10% (3), encefalopatía 7% (2), trastorno psicótico breve 7% (2), mielopatía 3% (1), síndrome de Guillain-Barré 3% (1), cefalea 3% (1), vasculitis 3% (1), hemorragia intracerebral 3% (1), crisis miasténica 3% (1) y neuritis óptica recurrente 3% (1). Conclusiones: el compromiso neurológico por el SARS-CoV-2 produce una gran variedad de síntomas y puede ser la primera manifestación incluso sin el desarrollo de síntomas respiratorios por esta infección. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2233).

Ischemic Stroke in Dengue Fever: Unusual Complication of a Common Disease

Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.

The correlation between intraoperative temperature and postoperative neurological prognosis in aortic arch surgery: a single-center retrospective cohort study / 中华胸心血管外科杂志

Objective:To explore the correlation between intraoperative cooling temperature and postoperative neurological prognosis in aortic arch surgery.Methods:We observed and collected data from 118 patients who underwent open arch replacement surgery by a single surgeon with mild-to-moderate hypothermic circulatory arrest, from January 2017 to December 2020, in Beijing Anzhen Hospital. According to the bladder temperature during the circulation arrest, 118 patients were divided into 3 groups: T1 group[n=39, (25.58±0.64)℃]; T2 group[n=39, (28.21±0.77)℃]; T3 group[n=40, (30.95±0.97)℃]. Clinical data and operative data were analyzed to assess difference between these 3 groups. Analyze the risk factors of postoperative neurological complications, and explore further the correlation between intraoperative core temperature and postoperative neurological prognosis.Results:Among the 118 patients, the average operation, cardiopulmonary bypass (CPB), block, circulatory arrest, and selective cerebral perfusion (SCP) time were 6.64 h, 188.5 min, 104.19 min, 23.93 min, 28.81 min, respectively. The in-hospital death occurred in 8 patients(6.78%), and permanent neurological dysfunction (PND) in 13 patients(11.02%), transient neurological dysfunction (TND) in 25 patients(21.19%). There was no significant difference in the deaths among the three groups. The incidence of TND and PND in the T3 group was significantly reduced ( P=0.042; P=0.045). In addition, the volume of drainage during the first 24 h and the incidence of re-exploration for bleeding had a relatively obvious decreasing trend ( P=0.005; P=0.012). Through multiple regression analysis, under the adjusted model, the core temperature was independently correlated with the incidence of postoperative PND ( OR=0.51; 95% CI: 0.27-0.97; P=0.0389); in group comparison, the relatively higher core temperature was an independent protective factor for postoperative PND ( OR=0.04; 95% CI: 0.00-0.91; P=0.0434). Conclusion:Our research had preliminary proved that in the open arch replacement surgery, mild hypothermia can reduce the incidence of some complications of deep hypothermia, at the same time improve the prognosis of the neurological prognosis, reduce the incidence of postoperative PND.

Factores neurológicos asociados a la mortalidad en pacientes con accidente cerebrovascular y ventilación mecánica artificial / Neurological factors associated to mortality in patients with cerebrovascular accident and artificial mechanical ventilation

Introducción: El accidente cerebrovascular es una de las causas más comunes de mortalidad a nivel mundial. Objetivo: Determinar la asociación existente entre el desarrollo de afecciones neurológicas y la necesidad de ventilación mecánica con el aumento de la incidencia de mortalidad en la unidad de cuidados intensivos. Métodos: Estudio observacional, prospectivo de corte transversal, realizado en la unidad de cuidados intensivos de un hospital de atención secundaria. La población de estudio estuvo constituida por 52 pacientes con accidente cerebrovascular los cuales recibieron soporte respiratorio artificial entre los años 2018 y 2020. La variable de interés final fue la mortalidad. Los factores neurológicos estudiados fueron el tipo de accidente cerebrovascular, puntuación de la escala de coma de Glasgow, ausencia de reflejos de tallo encefálico, anisocoria y complicaciones neurológicas. El nivel de significación se halló según p valor ≤ 0,05 a través de Chi cuadrado de independencia. Resultados: La mortalidad proporcional predominó en el accidente cerebrovascular hemorrágico tipo hemorragia intracraneal no traumática (p= 0,118), ausencia de reflejos del tallo encefálico (p=0,000), anisocoria (p=0,000), escala de coma de Glasgow <8 puntos (p=0,000) y complicaciones neurológicas como la hipertensión endocraneana (p=0,010). Conclusiones: Los factores neurológicos asociados a la mortalidad fueron la ausencia de reflejos del tallo encefálico, anisocoria, escala de coma de Glasgow <8 puntos y complicaciones neurológicas como la hipertensión endocraneana(AU)

Introduction: Cerebrovascular accident is one of the commonest causes of mortality in the world. Objective: To determine the association between development of neurological disorders and the need for mechanical ventilation with an increased incidence of mortality in the intensive care unit. Methods: An observational, prospective and cross-sectional study was carried out in the intensive care unit of a secondary care hospital. The study population consisted of 52 patients with cerebrovascular accident who received artificial respiratory support between 2018 and 2020. The final variable of interest was mortality. The neurological factors studied were type of cerebrovascular accident, score according to the Glasgow coma scale, absence of brainstem reflexes, anisocoria, and neurological complications. The level of significance was determined according to P ≤ 0.05, through chi-square of independence. Results: Proportional mortality prevailed in hemorrhagic cerebrovascular accident of nontraumatic intracranial hemorrhage type (P=0.118), absence of brainstem reflexes (P=0.000), anisocoria (P=0.000), score of less than eight points according to the Glasgow coma scale (P=0.000), and neurological complications such as endocranial hypertension (P=0.010). Conclusions: The neurological factors associated with mortality were absence of brainstem reflexes, anisocoria, score of less than eight points according to the Glasgow coma scale, and neurological complications such as endocranial hypertension(AU)

Complicaciones neurológicas asociadas a la COVID-19 en pediatría

En la población pediátrica se han reportado casos de la COVID-19 con complicaciones neurológicas. El objetivo fue describir las complicaciones neurológicas en los pacientes pediátricos con la COVID-19 que acudieron a la emergencia del HUC. Estudio observacional, descriptivo, retrospectivo, de corte transversal, se revisaron 104 historias médicas del Servicio de Emergencia Pediátrica, durante marzo a noviembre 2020. Se incluyeron 15 pacientes que presentaron complicaciones neurológicas en edades comprendidas entre 1 meses a 11 años (media 2,41 (±) años con desviación estándar de 3,3 años), siendo más frecuente, en los lactantes menores con 40,0 % (n=6). Entre las complicaciones neurológicas la más predominante fue la encefalitis/meningoencefalitis, siendo la sintomatología más descrita la crisis epiléptica sintomática aguda en 93 % (n=14), con estatus epiléptico en el 57 % (n=8). La mayoría de la muestra presentó desnutrición en 87 % (n=13) y comorbilidades neurológicas con 47 % (n=7), pulmonares en un 13 % (n=2), cardiopatías en 6,5 % (n=1) y genéticas con 6,5 % (n=1). Las complicaciones neurológicas asociadas a la COVID-19 tuvieron una incidencia de 14,4 % (n=15). Las crisis epilépticas y el status epiléptico fueron la sintomatología neurológica más frecuente. La severidad de la enfermedad pudiera estar condicionada a un estado de desnutrición.

In the pediatric population, cases of COVID-19 with neurological complications have been reported. The objective was to describe the neurological complications in pediatric patients with COVID-19 who attended the HUC emergency. Observational, descriptive, retrospective, cross-sectional study, 104 medical records of the Pediatric Emergency Service were reviewed, during March to November 2020. 15 patients who presented neurological complications between 1 months and 11 years of age were included (mean 2.41 (±) years with standard deviation of 3.3 years), being more frequent, in infants under 40.0 % (n = 6). Among the neurological complications, the most predominant was Encephalitis / Meningoencephalitis, with the most described symptoms being acute symptomatic seizures in 93 % (n = 14), with status epilepticus in 57 % (n = 8). Most of the sample presented malnutrition in 87 % (n = 13) and neurological comorbidities with 47 % (n = 7), pulmonary in 13 % (n = 2), heart disease in 6.5 % (n = 1) and genetic with 6.5 % (n = 1). Neurological complications associated with COVID-19 had an incidence of 14.4 % (n = 15). Epileptic seizures and status epilepticus were the most frequent neurological symptoms. The severity of the disease could be conditioned to a state of malnutrition.

The reduction of coagulation factor activity R before surgery increases the risk of postoperative neurological complications in patients with acute type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To analyze the risk factors for neurological complications after emergency surgery of acute type A aortic dissection. Methods    The clinical data of 51 patients with acute Stanford type A aortic dissection who were admitted to Shanghai Delta Hospital from October 2018 to May 2019 were retrospectively analyzed. There were 37 males (72.5%) and 14 females (27.5%), aged 29-85 (55.1±12.3) years. The patients were divided into two groups, including a N1 group (n=12, patients with postoperative neurological insufficiency) and a N0 group (n=39, patients without postoperative neurological insufficiency). The clinical data of the two groups were compared and analyzed. Results    There were statistical differences in age (62.6±11.2 years vs. 51.7±11.4 years, P=0.003), preoperative D-dimer (21.7±9.2 μg/L vs.10.8±10.7 μg/L, P=0.001), tracheal intubation time (78.7±104.0 min vs. 19.6±31.8 min, P=0.003), ICU stay time (204.1±154.8 min vs. 110.8±139.9 min, P=0.037) and preoperative coagulation factor activity R (4.0±1.5 vs. 5.1±1.6, P=0.022). Preoperative coagulation factor activity R was the independent risk factor for neurological insufficiency after emergency (OR=2.013, 95%CI 1.008-4.021, P=0.047). Conclusion    For patients with pre-emergent acute aortic dissection who are older (over 62.6-64.5 years), with reduced coagulation factor R (less than 4.0), it is recommended to take more active brain protection measures to reduce the occurrence of postoperative neurological complications in patients with acute aortic dissection, and further improve the quality of life.

Injuria encefálica aguda en el posoperatorio de cirugía cardíaca / Acute brain injury in the postoperative period of cardiac surgery / Lesão encefálica aguda no pós-operatório de cirurgia cardíaca

Resumen: La injuria encefálica aguda es una de las complicaciones más devastadoras en el posoperatorio de cirugía cardíaca, siendo responsable de un mayor tiempo de asistencia respiratoria mecánica, infecciones pulmonares y por catéteres, dehiscencia esternal, mayor tiempo de estadía hospitalaria, aumento de mortalidad y de costos sanitarios. En el presente trabajo se discuten las diferentes formas de presentación, los factores predisponentes, su fisiopatología, las medidas de prevención y el tratamiento.

Summary: Acute brain injury is one of the most devastating complications in the postoperative period of cardiac surgery, being responsible for a longer time of mechanical ventilation, lung and catheter infections, sternal dehiscence, longer hospital stay, increased mortality and healthcare costs. The present work discusses the different forms of presentation, predisposing factors, their pathophysiology, prevention measures and treatment.

Resumo: O dano cerebral agudo é uma das complicações mais devastadoras no pós-operatório de cirurgia cardíaca, sendo responsável por maior tempo de ventilação mecânica, infecções pulmonares, infecções de cateter, deiscência esternal, maior tempo de internação, aumento da mortalidade e custos de saúde. O presente trabalho discute as diferentes formas de apresentação, fatores predisponentes, sua fisiopatologia, medidas de prevenção e tratamento.

Stroke in sickle cell disease: case report

Sickle cell disease is an inherited blood disorder that affects red blood cells. It is characterized by polymerization of haemoglobin, erythrocyte stiffening, and subsequent vaso-occlusions. These can lead to microcirculation obstructions, tissue ischemia, infarction and acute stroke. Transient ischemic attack, Ischaemic stroke, haemorrhagic stroke, silent cerebral infarction, headache, Moyamoya disease, neuropathic pain, and neurocognitive impairment are neurological complications of sickle cell disease. Here we report a case of ischemic stroke in a patient of sickle cell disease. For early diagnosis and proper management of sickle cell disease neurological complications require specialised haematological and neurological expertise. The newly used medications under ongoing research will be the hope to overcome this devastating disease and its complications.

Predictors of acute neurological complication following tetralogy of Fallot operation in Serdang Hospital, Malaysia

@#Background: The long waiting time for Tetralogy of Fallot (TOF) operation may potentially increase the risk of hypoxic insult. Therefore, the objective of this study is to determine the frequency of acute neurological complications following primary TOF repair and to identify the peri-operative risk factors and predictors for the neurological sequelae. Methods: A retrospective review of the medical and surgical notes of 68 patients who underwent TOF repair in Hospital Serdang, from January 2013 to December 2017 was done. Univariate and multivariate analyses of demographics and perioperative clinical data were performed to determine the risk for the development of acute neurological complications (ANC) among these patients. Results: ANC was reported in 13 cases (19.1%) with delirium being the most common manifestation (10/68, 14.7%), followed by seizures in 4 (5.9%) and abnormal movements in two patients (2.9%). Univariate analyses showed that the presence of right ventricular (RV) dysfunction, prolonged duration of inotropic support (≥7 days), prolonged duration of mechanical ventilation (≥7 days), longer length of ICU stays (≥7 days), and longer length of hospital stay (≥14 days), were significantly associated with the presence of ANCs (p<0.05). However, multivariate analyses did not show any significant association between these variables and the development of ANC (p>0.05). The predictors for the development of postoperative delirium were pre-operative oxygen saturation less than 75% (Odds Ratio, OR=16.90, 95% Confidence Interval, 95%CI:1.36, 209.71) and duration of ventilation of more than 7 days (OR=13.20, 95%CI: 1.20, 144.98). Conclusion: ANC following TOF repair were significantly higher in patients with RV dysfunction, in those who required a longer duration of inotropic support, mechanical ventilation, ICU and hospital stay. Low pre-operative oxygen saturation and prolonged mechanical ventilation requirement were predictors for delirium which was the commonest neurological complications observed in this study. Hence, routine screening for delirium using an objective assessment tool should be performed on these high-risk patients to enable accurate diagnosis and early intervention to improve the overall outcome of TOF surgery in this country

Research on rules of medication for diabetes mellitus based on analysis on 755 traditional Chinese medicine prescriptions / 中草药

To explore the rules of medication for diabetes and diabetic complications based on analysis on 755 traditional Chinese medicine (TCM) prescriptions. The information in 755 papers published from 1995 to 2016 was got including 755 herbal prescriptions, 367 herbs, 33 330 effective cases. Based on the above information, usage frequency of single herb, efficiency and the rules of formulating prescription for different types of diabetes were analyzed and compared using Microsoft Excel 2010 and Clementine 12.0 software. In the treatment of diabetes and its complications, the top four diabetes symptoms are about diabetes, diabetic neurological complications, diabetic nephropathy and diabetic cardiovascular complications, and accounting for 31.62%, 29.82%, 8.87%, and 6.47% of the total number of effective cases. Further analysis of the top four illnesses found that single herb commonly used in the treatment of diabetes was Astragali Radix, Dioscoreae Rhizoma, Rehmanniae Radix, Trichosanthis Radix, Ophiopogonis Radix, etc. The commonly used drugs categories were tonic herbs, heat-clearing herbs and blood activating herbs; The single medicine commonly used in the treatment of diabetic neurological complications was Astragali Radix, Angelicae Sinensis Radix, Chuanxiong Rhizoma, Radix Salviae Miltiorrhizae et Rhizoma, Cinnamomi Ramulus, etc. The commonly used drugs categories were tonic herbs, blood activating herbs and heat-clearing herbs; The single herb commonly used in the treatment of diabetic nephropathy was Astragali Radix, Dioscoreae Rhizoma, Salviae Miltiorrhizae Radix, Poria, Fructus Corni, etc., the commonly used drugs categories were tonic herbs, blood activating herbs and damp-clearing herbs. The single herb commonly used in the treatment of diabetic cardiovascular complications was Astragali Radix, Salviae Miltiorrhizae Radix, Angelicae Sinensis Radix, Carthami Flos, Chuanxiong Rhizoma, etc., the commonly used drugs categories were blood activating herbs, tonic herbs and heat-clearing herbs. The rules of medication of TCM for diabetes, diabetic neurological complications, diabetic nephropathy and diabetic cardiovascular complications showed similar characteristics, tonic herbs were used the most frequently, supplemented by blood activating herbs, heat-clearing herbs and damp-clearing herbs. However, the principle of formula is a little different for different types of diabetes and diabetic complications, specifically. The prescriptions for diabetes and diabetic neurological complications consist of tonic herbs as the principal, supplemented by blood activating herbs and heat-clearing herbs; The prescriptions for diabetic nephropathy are composed of tonic herbs as the principal, supplemented by blood activating herbs and damp-clearing herbs, as well as tonic herbs and blood activating herbs were equal components in the prescriptions for diabetic cardiovascular complications, supplemented by heat-clearing herbs.

¿Es útil la monitorización con espectroscopia de infrarojo cercano en la cirugía artroscópica de hombro con anestesia regional y sedación? / Is near-infrared spectroscopy (NIRS) monitoring useful for patients undergoing shoulder surgery under regional anaesthesia and sedation?

BACKGROUND: Shoulder surgery in beach chair position is a very common procedure in our daily practice. It has been associated to regional cerebral saturation impairment detected by near-infrared spectroscopy (NIRS) under general anaesthesia. Severe neurological complications were previously reported, even in previously healthy patients. An anaesthetic protocol under regional anaesthesia and biespectral index (BIS) guided sedation seems to be a safer strategy in order to prevent complications. OBJECTIVE: To find out, in a group of patients undergoing shoulder surgery in beach chair position under regional anaesthesia and sedation, the prevalence of cerebral desaturation events detected by NIRS (defined as a decrease ≥ 20% from baseline or absolute value < 55%). MATERIAL AND METHOD: In this descriptive study, 30 patients undergoing shoulder surgery in beach chair position under regional anaesthesia (ultrasound guided interescalene brachial plexus block) and propofol infusion BIS guided sedation were enrolled to assess the prevalence of cerebral desaturation events. The baseline data for regional cerebral oxygen saturation and bispectral index and non invasive blood pressure measured at heart level were taken prior to surgery after beach chair positioning and thereafter all 5 min until discharge. RESULTS: No cerebral desaturation events were detected during this study. CONCLUSIONS: Although monitoring regional cerebral saturation with NIRS detects decreased cerebral perfusion allowing a rapid intervention, we consider it is not essential under this anaesthesia regimen, considering that no cerebral desaturation events were reported.

La cirugía de hombro en posición de sentado constituye un procedimiento frecuente en la práctica diaria. Bajo anestesia general, se ha asociado con caída de la saturación regional cerebral de oxígeno (Src02) detectada por espectrospcopia infraroja (NIRS), reportándose complicaciones neurológicas severas, incluso en pacientes previamente sanos. El empleo de una técnica de anestesia regional más sedación titulada con índice biespectral (BIS) parecería ser una estrategia más segura a fin de evitar dichos eventos. OBJETIVO: Conocer, en pacientes sometidos a artroscopia de hombro en posición de sentado bajo anestesia regional más sedación, la prevalencia de episodios de desaturación cerebral (ECDs) determinada por NIRS (SrcO2 inferior a 55% o disminución del 20% respecto al basal). MATERIAL Y MÉTODO: Se realizó un estudio descriptivo en 30 pacientes sometidos a artroscopía de hombro en posición de sentado bajo anestesia regional (bloqueo interescalénico ecoguiado) más sedación titulada (infusión de propofol guiada por BIS). Se tomaron valores de referencia de Src02, BIS y presión no invasiva a nivel del corazón luego del posicionamiento y, consecutivamente en forma continua para las primeras dos variables y cada 5 minutos hasta el final para la última. Se ocultaron a los anestesiólogos los valores de Src02. RESULTADOS: No se ha detectado ningún EDC en la población estudiada. CONCLUSIÓN: Consideramos que el monitoreo de la perfusión cerebral con tecnología NIRS resulta útil aunque no imprescindible bajo este protocolo anestésico, dada la incidencia casi nula de eventos.

Complicações neurológicas pós-cirurgia bariátrica: uma revisão de literatura / Neurological complications post-bariatric surgery: a review of the literature

A obesidade é um grave problema de saúde em todo o mundo. Apresenta alta prevalência e grande impacto sobre a mortalidade. A cirurgia bariátrica é cada vez mais utilizada no tratamento de obesidade mórbida por se mostrar o mais eficaz tratamento mantendo a perda de peso sustentada e diminuindo a incidência das comorbidades associadas. Complicações neurológicas agudas e crônicas têm sido relatadas após este procedimento, e podem resultar principalmente por deficiência nutricional. Objetivo: Destacar as complicações neurológicas comuns e raras que podem ocorrer após cirurgia bariátrica. Metodologia: Revisão narrativa da literatura. Resultados: Complicações neurológicas pós-cirurgia bariátrica podem ocorrer em qualquer nível do neuroeixo ou em músculos. As mais comuns são por deficiências nutricionais, mas outros mecanismos mais raros podem ocorrer como inflamatórios mecânicos. Conclusão: Com o aumento de incidência da obesidade, a cirurgia bariátrica tem se tornado cada vez mais frequente para perda de peso. É importante avaliar corretamente a indicação desse procedimento uma vez que ele não é isento de complicações. Embora a maioria das complicações do sistema nervoso central, periférico e musculoesquelético após a cirurgia bariátrica seja devido a deficiências nutricionais, existem outras neuropatias associadas com envolvimento inflamatório do nervo periférico. Um processo autoimune tem sido aceito como fisiopatologia subjacente. (AU)

Obesity is a serious health problem throughout the world. It has high prevalence and significant impact on mortality. Bariatric surgery is increasingly used in the treatment of morbid obesity out to be the most effective treatment maintaining sustained weight loss and decreasing the incidence of comorbidities. Acute and chronic neurological complications have been reported after this procedure, and may result primarily by nutritional deficiency. Objective: To emphasize the common and rare neurological complications that may occur after bariatric surgery. Methodology: Narrative review of the literature. Results: Neurological complications after bariatric surgery can occur at any neuraxial level or muscle. The most common are by nutritional deficiency, but other rarer mechanisms may occur, like mechanical or inflammatory. Conclusion: With increasing incidence of obesity, bariatric surgery has become increasingly common for weight loss. It is important to properly evaluate the indication for this procedure since it is not without complications. Although most of the central and peripheral nervous system and musculoskeletal complications after bariatric surgery are due to nutritional deficiencies, there are other neuropathies associated with inflammatory involvement of the peripheral nerve. An autoimmune process has been accepted as an underlying pathophysiology. (AU)

Enfermedad por virus de Zika y sus complicaciones neurológicas / Zika virus disease and its neurological complications

Resumen El virus de Zika es un Flavivirus, transmitido por picadura de mosquito, descubierto en África en 1947. La mayoría de personas afectadas con la infección por virus de Zika no tienen síntomas y cuando estos se presentan son generalmente leves e incluyen ebre, exantema máculo-papular, artralgia y conjuntivitis. Desde el comienzo del año 2015 el virus se ha diseminado a través de las Américas a más de 31 países y territorios hasta comienzos de este año. Personas de toda edad pueden enfermar con esta infección incluyendo fetos por transmisión materno-fetal. La evidencia sugiere que cuando el feto está expuesto al virus durante el embarazo, particularmente en los primeros meses, se asocia con microcefalia y otras malformaciones del sistema nervioso central. Las secuelas a largo plazo sin embargo de las presentaciones: congénita, perinatal y pediátrica son desconocidas. No existe vacuna disponible para prevenir la infección por este virus y el tratamiento es sólo de soporte. Este artículo revisa algunas características epidemiológicas, clínicas, exámenes de laboratorio, tratamiento y prevención con atención a los problemas neurológicos hasta la fecha.

Abstract Zika virus is a mosquito-borne avivirus identi ed in Africa in 1947. Most a ected people has no symptoms and when present they are mild and include: fever, maculopapular rash, athralgias, and myalgias. Since 2015 the virus has spread through the Americas to more than 31 countries and territories until the beginning of this year. People of all ages could be a ected by Zika including fetus. Maternal-fetal transmission has been documented. Evidence suggest that congenital Zika virus occurs when the fetus is exposed to the virus during the rst few months of gestation and is associated with microcephaly and other central nervous system malformations. Zika long term sequelae of congenital, perinatal and pediatric diseases are largely unknown. No vaccine to prevent Zika virus infection is available and the treatment is only of support. This review article is an update regarding the main epidemiologic, clinical, laboratory testing, treatment and prevention with particular attention to the neurological complications.

Advances in research on Zika virus

Zika virus (ZIKV) is rapidly spreading across the America and its devastating outcomes for pregnant women and infants have driven this previously ignored pathogen into the limelight. Clinical manifestations are fever, joint pain or rash and conjunctivitis. Emergence of ZIKV started with a first outbreak in the Pacific area in 2007, a second large outbreak occurred in the Pacific in 2013/2014 and subsequently the virus spread in other Pacific islands. Threat of explosive global pandemic and severe clinical complications linked with the more immediate and recurrent epidemics necessitate the development of an effective vaccine. Several vaccine platforms such as DNA vaccine, recombinant subunit vaccine, ZIKV purified inactivated vaccine, and chimeric vaccines have shown potent efficacy in vitro and in vivo trials. Moreover, number of drugs such as Sofosbuvir, BCX4450, NITD008 and 7-DMA are ready to enter phase I clinical trial because of proven anti-ZIKV activity. Monoclonal based antibodies offer promise as an intervention effective for use in pregnant women. In this review, we describe the advances in research on ZIKV such as research strategies for the development of antiviral drugs & vaccines, molecular evolution, epidemiology emergence, neurological complications and other teratogenic outcomes as well as pathogenesis.

Advances in research on Zika virus

Zika virus (ZIKV) is rapidly spreading across the America and its devastating outcomes for pregnant women and infants have driven this previously ignored pathogen into the limelight. Clinical manifestations are fever, joint pain or rash and conjunctivitis. Emergence of ZIKV started with a first outbreak in the Pacific area in 2007, a second large outbreak occurred in the Pacific in 2013/2014 and subsequently the virus spread in other Pacific islands. Threat of explosive global pandemic and severe clinical complications linked with the more immediate and recurrent epidemics necessitate the development of an effective vaccine. Several vaccine platforms such as DNA vaccine, recombinant subunit vaccine, ZIKV purified inactivated vaccine, and chimeric vaccines have shown potent efficacy in vitro and in vivo trials. Moreover, number of drugs such as Sofosbuvir, BCX4450, NITD008 and 7-DMA are ready to enter phase I clinical trial because of proven anti-ZIKV activity. Monoclonal based antibodies offer promise as an intervention effective for use in pregnant women. In this review, we describe the advances in research on ZIKV such as research strategies for the development of antiviral drugs & vaccines, molecular evolution, epidemiology emergence, neurological complications and other teratogenic outcomes as well as pathogenesis.

Surgical Outcomes of Schwannoma Occurring at Major Peripheral Nerves of Extremity: A Single Institution Analysis / 대한정형외과학회잡지

PURPOSE: We analyzed the surgical result of schwannoma occurring in the major peripheral nerves of the extremity and factors that influence these surgical results. MATERIALS AND METHODS: Fifty-one patients, who were followed for more than 1 year, were included. The mean age was 51 years. There were 23 male cases and 28 female cases. There were 27 cases of schwannoma in the upper extremity and 24 cases in the lower extremity. The involved nerves were classified. The maximal diameter of excised tumors was measured. Clinical and neurological symptoms were analyzed at preoperative, postoperative, and final follow-up. Risk factors of neurological complications were also analyzed. RESULTS: The mean follow-up period was 20 months. The average maximal diameter of tumors was 2.9 cm. The most affected nerve in the upper extremity was the ulnar nerve in 10 cases, and tibial nerve in the lower extremity in 10 cases. The most prevalent preoperative symptom was Tinel in 38 cases. Clinical symptoms were improved in more than 90% of patients following the surgery. There were 13 cases with preoperative sensory deficits. Symptom improvement after surgery was observed in 9 cases; and symptoms persisted in 4 cases following surgery. At the final follow-up, sensory deficits disappeared in 2 cases and persisted in 2 cases. There were 2 cases of preoperative motor deficits. There was improvement in 1 case following the surgery and persisted in 1 case until the final follow-up. There was a statistical significance between maximal diameter of schwannoma and postoperative neurological deficits (p<0.05). CONCLUSION: Schwannoma at the major peripheral nerves of the extremity can be excised with acceptable risk for neurological deficits. Meticulous dissection is required to avoid injuries of the involved nerves.