Translation, cross-cultural adaptation, and validation of a Latin American Spanish version of the ID Migraine screening test.

OBJECTIVE: To translate, culturally adapt, and validate a version of the ID Migraine into Latin American Spanish. BACKGROUND: Although still considered a common diagnosis, half of the patients with migraine in Latin America experience diagnostic delay. The ID Migraine is a test developed in 2003 as a valuable tool for the early diagnosis of migraine at the primary care level; however, there is no validated Spanish or culturally adapted version for the Spanish-speaking population. METHODS: This is an analytical, translation, and test-validation study. We performed back translation and cross-cultural adaptation. The Latin American Spanish version ID Migraine MX was applied to headache clinic patients from March 2021 to January 2022 to perform a validation process against the gold standard: blinded expert diagnosis according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), criteria. RESULTS: One hundred seventeen patients from the headache clinic of the National Institute of Neurology and Neurosurgery of Mexico City were screened. We found 62/117 (53%) patients positive for screening with ID Migraine MX, and 47/117 (40%) positive for migraine according to ICHD-3 criteria. A sensitivity (95% CI) of 0.91 (0.80-0.97), specificity of 0.73 (0.61-0.82), positive predictive value of 0.694 (0.57-0.794), and negative predictive value of 0.93 (0.83-0.97) were obtained. The positive likelihood ratio was 3.38 (2.27-4.99), and the negative likelihood ratio was 0.12 (0.04-0.30). After calling the patients 1 month after the first interview, the calculated Kappa test-retest was 0.75 (p = 0.001). CONCLUSION: A translated and cross-culturally adapted version into Spanish of the ID Migraine was obtained, with a diagnostic performance similar to the original instrument. Clinicians may use this test at the first level of care to reduce the rate of misdiagnosis and the time from onset of symptoms to diagnosis and treatment of migraine.

Asymptomatic Intracerebral Hemorrhage Following Endovascular Stroke Therapy Is Not Benign: A Systematic Review and Meta-Analysis.

BACKGROUND: Asymptomatic intracerebral hemorrhage (aICH) occurs in approximately 35% of patients with acute ischemic stroke after endovascular thrombectomy. Unlike symptomatic ICH, studies evaluating the effect of aICH on outcomes have been inconclusive. We performed a systematic review and meta-analysis to evaluate the long-term effects of postendovascular thrombectomy aICH. METHODS AND RESULTS: The meta-analysis protocol was submitted to the International Prospective Register of Systematic Reviews a priori. PubMed, Scopus, and Web of Science were searched from inception through September 2023, yielding 312 studies. Two authors independently reviewed all abstracts. Included studies contained adult patients with ischemic stroke undergoing endovascular thrombectomy with follow-up imaging assessment of ICH reporting comparative outcomes according to aICH versus no ICH. After screening, 60 papers were fully reviewed, and 10 studies fulfilled inclusion criteria (n=5723 patients total, 1932 with aICH). Meta-analysis was performed using Cochrane RevMan v5.4. Effects were estimated by a random-effects model to estimate summary odds ratio (OR) of the effect of aICH versus no ICH on primary outcomes of 90-day modified Rankin Scale 3 to 6 and mortality. The presence of aICH was associated with a higher odds of 90-day mRS 3 to 6 (OR, 2.17 [95% CI, 1.81-2.60], P<0.0001, I2 46% Q 19.15) and mortality (OR, 1.72 [95% CI, 1.17-2.53], P:0.005, I2 79% Q 27.59) compared with no ICH. This difference was maintained following subgroup analysis according to hemorrhage classification and recanalization status. CONCLUSIONS: The presence of aICH is associated with worse 90-day functional outcomes and higher mortality. Further studies to evaluate the factors predicting aICH and treatments aimed at reducing its occurrence are warranted.

Neurocysticercosis: A Review into Treatment Options, Indications, and Their Efficacy.

Neurocysticercosis, due to the localization of Taenia solium larvae in the Central Nervous System, is a neglected tropical disease still endemic in much of Latin America, Asia and sub-Saharan Africa. The therapeutic management of NC has gradually improved with the establishment of neuroimaging studies (CT and MRI) in endemic countries and with the demonstration of the efficacy of albendazole and praziquantel in the 1980s. But the morbidity and mortality of this preventable disease remain an unacceptable fact. In this scoping review, we will revise the different treatment options and their indications.

Impact of rituximab in Mexican patients with Multiple Sclerosis-A single-center retrospective study.

BACKGROUND: Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS). B cells have an essential role in the disease pathogenesis and therefore selective B-cell depletion are commonly used to treat the disease. Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody had demonstrated reduced inflammatory activity and radiological activity in MS patients. Due to economic constrains and treatment access limitations, RTX is often used as a treatment alternative in these patients. Here, we described our center experience in RTX -treated MS patients. METHODS: A single-center observational retrospective study was conducted in a Mexican cohort MS during 2010 to 2020. All patients had a confirmed MS diagnosis.All patients received fixed scheme involving induction with 1 g on day one and day 15, followed by 500 mg-1 g every six months for maintenance. Annual Relapse Rate (ARR), Progression index (PI), Expanded Disability Status Scale (EDSS) and MRI activity of the disease were evaluated. Comparison between naïve and non-naïve patients was also conducted. RESULTS: A total of 85 patients were included. The mean age at diagnosis was 33.13 (±8.90) years with 73 (85.9%) being RRMS. 39 (34.1%) were treatment-naïve. While treated with RTX, 62(72.9%) patients reached a free-of-relapse status, with statistically significant decrease in the mean ARR from 0.82 to 0.36 [0.14 (95%CI: 0.09-0.20), p = 0.0001 and EDSS [0.25 CI 0-0.5 (p = 0.034)] and a decrease in their T1 Gd-enhancing MRI lesions (1.64 vs. 0.12 CI 0.70-2.30, p = 0.004. 29 (29.4%) patients achieved NEDA-3. Among all patients, only 2 (2.4%) experienced infusion-related mild adverse events. No serious adverse events were reported. CONCLUSION: We found significant clinical and radiological improvement in naïve and non-naïve MS patients treated with RTX.

Neurocysticercosis in Latin America: Current epidemiological situation based on official statistics from four countries.

BACKGROUND: Neurocysticercosis (NC) is one of the major parasitic diseases affecting the central nervous system and is endemic in much of Asia, sub-Saharan Africa, and Latin America. Its epidemiology is difficult to assess, although official registries are available in Brazil, Colombia, Ecuador, and Mexico. METHODOLOGY/PRINCIPAL FINDINGS: Using official statistics, we assessed trends in NC hospitalization rates during 1998-2019 in Brazil and Ecuador, during 2004-2019 in Mexico, and during 2009-2019 in Colombia. We also assessed the trend in NC mortality in Brazil (1998-2019), the trend in hospitalizations for NC in a Mexican tertiary-level hospital (Instituto Nacional de Neurología y Neurocirugía [INNN]; 1995-2019), and in Mexican primary care ambulatory clinics (1995-2019). Associations between NC hospitalization rates and the human development index (HDI) were also examined. In Brazil, Ecuador, and Mexico, statistically significant decreases in NC hospitalization rates were observed. In Mexico, a significant increase in the age of patients at INNN was observed, suggesting a decreasing incidence of recent infection. Conversely, a significant increase in NC hospitalization rate was observed in Colombia. HDI was not significantly associated with NC hospitalization rates when adjusting for time. CONCLUSIONS: The downward trends in NC cases in Brazil, Ecuador, and Mexico are encouraging, especially in the context of the PAHO/WHO plan of action to eliminate neglected tropical diseases from the region. On the other hand, in Colombia, the increased NC hospitalization rate is concerning and needs further evaluation so that the authorities can take specific measures. These results should encourage health authorities in other endemic countries to establish a system of official registries to identify where the need for a control program is most urgent. However, it is also important to remember that NC persists, although less frequently in some Latin American countries, and efforts to achieve its control must continue.

Teaching Video NeuroImages: Posterior Cortical Atrophy Presenting With Balint Syndrome.

We present the case of a 68-year-old woman who developed progressive visuospatial deficits in a period of 18 months, leading to the loss of her independence for activities of daily living. After examination, she showed signs of Balint syndrome with optic ataxia, oculomotor apraxia, and simultanagnosia without visual acuity impairment. After brain imaging showing severe bilateral parieto-occipital association cortex atrophy, a diagnosis of posterior cortical atrophy was made according to the 2017 International Consortium's criteria.

Structural stages in the development of the long bones and epiphyses: a study in the New Zealand white rabbit.

BACKGROUND: Histologic delineation of the events involved in the development of long bones and the developmental age at which these events occur is needed to elucidate the genetic and molecular mechanisms associated with these events. This report describes the sequence of histologic events involved in the formation of long bones and their epiphyses in the New Zealand White rabbit. METHODS: Prenatal studies were performed on twelve, fourteen, fifteen, sixteen, eighteen, twenty-one, twenty-four, and twenty-seven-day-old rabbit embryos, and postnatal studies were performed on newborn rabbits and on three-to-four-day-old; one, two, four, and six-week-old; and two, three, four, six, and eight-month-old rabbits. Histologic specimens from embryos were embedded in plastic and stained with toluidine blue or safranin O-fast green, and specimens from postnatal rabbits were embedded in paraffin and stained with hematoxylin and eosin or safranin O-fast green. RESULTS: Studies of twelve-day-old embryos demonstrated upper and lower limb buds filled with undifferentiated mesenchymal cells, and studies of fourteen-day-old embryos showed mesenchymal condensation and beginning cartilage formation outlining major long bones. Long-bone and epiphyseal development progressed through sixteen structural stages, and the developmental age at which these stages occurred was determined. These stages included limb-bud formation with uniform distribution of mesenchymal cells and formation of an apical ectodermal ridge (stage 1); mesenchymal condensation (stage 2); cartilage differentiation (stage 3); formation of a primary center of ossification (stage 4a); epiphyseal cartilage vascularization with formation of cartilage canals (stage 7); vascular invasion of the developing secondary ossification center (stage 9); bone formation and marrow cavitation in the secondary ossification center with formation of hematopoietic marrow (stage 10); fullest relative extent of secondary-ossification-center development in epiphyseal cartilage (stage 14); thinning of the physis (stage 15); and resorption of the physis with establishment of continuity between epiphyseal and metaphyseal circulations (stage 16).

Endoscopic fundoplication for the treatment of gastroesophageal reflux disease: initial experience.

OBJECTIVE: Transoral incisionless fundoplication (TIF) is a promising approach for gastroesophageal reflux disease (GERD) that may decrease morbidity compared with conventional antireflux procedures. We report our initial experience with this minimally invasive approach. METHODS: Over a 24-month period, 46 patients (mean age, 49 years; 50% female) underwent 48 TIF procedures. All procedures were performed under general anesthesia. Two surgeons participated in all cases; one served as the endoscopist, and the other performed the partial fundoplication. Heartburn severity was measured using the GERD health-related quality of life (GERD-HRQL) instrument (best score = 0, worst score = 45), which includes an additional question assessing overall satisfaction. RESULTS: Preoperatively, 33 (72%) of 46 patients had small (<3 cm) hiatal hernias, and none had undergone any previous antireflux procedures. Preoperative workup included manometry and barium esophagogram, with pH testing reserved for patients with atypical symptoms or typical symptoms and a lack of response to proton-pump inhibitors. The mean procedure time was 83 minutes (range, 36-180 minutes). The mean procedure time decreased after the first 5 cases from 122 to 78 minutes (P = .001). Mean length of stay was 1.3 days. One patient was readmitted with aspiration pneumonia. Three patients had minor complications (1 had minor bleeding from a suture site and 2 had urinary retention). There were no perioperative deaths. Mean follow-up was 140 days. The mean GERD-HRQL scores improved significantly (23 vs 7; P < .001). There were 22 patients with follow-up greater than 90 days (mean follow-up, 240 days). GERD-HRQL scores remained significantly improved for these patients (23 vs 8; P = .001). Four patients from the entire group (8.6%) had no improvement, in 3 instances due to breakdown of the wrap. Two patients were treated with repeat endoscopic fundoplication and 1 was treated with laparoscopic Nissen fundoplication, and all had a significant improvement in symptoms after reoperation. CONCLUSIONS: TIF is effective at short-term follow-up and safe for patients with GERD. However, long-term follow-up and randomized trials are required to assess the efficacy and durability of this approach compared with conventional surgical repair.

The efficacy of electromagnetic navigation to assist with computed tomography-guided percutaneous thermal ablation of lung tumors.

OBJECTIVE: Electromagnetic (EM) navigation is increasingly used to assist with bronchoscopic interventions such as biopsy or fiducial placement. Electromagnetic navigation can also be a useful adjunct to computed tomography (CT)-guided thermal ablation and biopsy of lung tumors. This study compares procedures carried out using an EM navigation system (Veran Medical Technologies Inc, St Louis, MO) with procedures using CT fluoroscopy only. METHODS: Over a 23-month period, 17 patients scheduled for thermal ablation were prospectively enrolled in this study. The mean age was 72 years (range, 60-84 years). Seven patients were women. Patients were randomized to EM navigation (n = 7) or CT fluoroscopy alone (n = 10). In some cases, additional ablation or biopsies were performed with or without EM navigation depending on the randomization arm. All procedures were performed under general anesthesia either by a thoracic surgeon or a radiologist. RESULTS: A total of 23 procedures were performed in 17 patients: 20 were ablation procedures and 3 were biopsies. Fourteen were performed for non-small cell lung cancer, and 9 for pulmonary metastases from other organs. Despite randomization, patients receiving EM navigation had a trend for smaller tumors (mean diameter, 1.45 vs 2.90 cm; P = 0.06). For thermal ablation procedures, the time to complete intervention was significantly less when EM navigation was used (mean, 7.6 vs 19 minutes; P = 0.022). Although not statistically significant, there were fewer skin punctures (mean, 1 vs 1.25; P = 0.082), fewer adjustments (mean, 5.6 vs 11.8; P = 0.203), less CT fluoroscopy time (mean, 21.3 vs 34.3 seconds; P = 0.345), and fewer CT scans (mean, 7 vs 15; P = 0.204) whenever EM navigation was used. CONCLUSIONS: Electromagnetic navigation reduces the time to successfully place an ablation probe in a target tumor. Further study is required to determine whether EM navigation may also reduce the number of adjustments, skin punctures, and CT scans as well as decrease CT fluoroscopy time.

Feasibility of spray cryotherapy and balloon dilation for non-malignant strictures of the airway.

OBJECTIVE: Benign airway strictures can be complex and challenging to manage. Although resection is preferred, this is not always feasible, and hence, endoscopic therapies are often performed. However, endoscopic therapies can be problematic, with granulation tissue and fibrosis leading to early failure. Spray cryotherapy (SC) is a new approach that may modulate the healing response leading to less fibrosis and decrease the need or the duration of time to intervention. We report the initial results of SC for benign airway strictures. METHODS: Over a 22-month period, 35 patients underwent SC. Median age was 51(18-81) years. Prior therapy had been undertaken in 14 (41.2%) of patients. Stricture etiology included post intubation (n=5), prior tracheostomy (n=6), radiation induced (n=2), prior surgery (n=3), other causes (n=12), or unknown etiology (n=7). Airway narrowing was graded as follows: 1=0-25%, 2=26-50%, 3=51-75%, and 4=76-100%. For the purpose of analysis, this was treated as a continuous variable. The usual treatment algorithm consisted of ×3-4 SC cycles, followed by balloon dilation, and then by additional SC cycles. RESULTS: Stricture locations were subglottic (n=18), tracheal (n=9), and bronchial (n=8). Seventeen (49%) patients required additional SC therapy, resulting in a total of 63 SC treatment sessions. Only two (3.2%) complications occurred and these included pneumothorax (n=1) and intra-operative tracheostomy (n=1). Mean follow-up was available in 33/35 patients at a mean of 8.2 (1-19) months. Twelve (of 33) patients (36.4%) were asymptomatic, 16/33 (48.5%) were improved, 4/33(12.1%) had no improvement or were worse, and 1/33(3%) patient died from an unrelated cancer. On follow-up bronchoscopy, performed in 28 patients, airway narrowing improved significantly from 3.5 to 2.03 (p<0.001). CONCLUSIONS: Initial experience with SC for benign airway strictures suggests that this can be used safely. This is effective in improving symptoms and reducing the severity of airway narrowing. Re-intervention is still required. Further study should be undertaken to determine factors that may be associated with success or failure as well as the relative efficacy of SC compared with other endoscopic therapies.

Age-related vascular changes in the epiphysis, physis, and metaphysis: normal findings on gadolinium-enhanced MRI of piglets.

OBJECTIVE: We sought to study the normal enhancement patterns seen on MRIs of the epiphysis, physis, and metaphysis and age-related vascular changes in piglets using gadoteridol, a nonionic gadolinium chelate. MATERIALS AND METHODS: We quantitatively and qualitatively analyzed the normal changes on sequential T1-weighted images after the IV administration of gadoteridol. In an investigation approved by the research animal care committee at our hospital, we studied the proximal and distal femurs of 26 piglets 1-6 weeks old and correlated the enhanced images with findings on intermediate-weighted, T2-weighted, and gradient-recalled echo images and at histologic examination. RESULTS: We observed early enhancement of the epiphyseal vascular canals, the main physis, the physis of the secondary ossification center, and a metaphyseal band adjacent to the physis. Enhancement of the epiphyseal and metaphyseal marrow and of the epiphyseal cartilage was slower. In the epiphyseal cartilage, we saw three phases of enhancement: vascular, canalicular, and cartilaginous. As the piglets matured, enhancement of the epiphyseal cartilage decreased, and the epiphyseal vascular canals were less conspicuous. Physeal enhancement was greatest during the first week of life, declined at 3 weeks, and subsequently increased again as the physis came to lie adjacent to a larger segment of the epiphyseal ossification center. CONCLUSION: Gadoteridol-enhanced MRIs showed multiple cartilaginous and vascular structures of the growing skeleton. With maturity and progressive epiphyseal ossification, epiphyseal cartilage enhancement decreased, and physeal cartilage enhancement increased.

Cirugía carotídea: experiencia de 20 años / Carotid surgery: experience of the last 20 years

Se presenta la experiencia en endarterectomía carotídea de los servicios de Cirugía Cardiovascular del Hospital Británico y del Hospital Alemán en 20 años. Se realizaron 234 endarterectomías carotídeas en 140 pacientes. En el 25,13 por ciento el procedimiento fue bilateral y el 72,72 por ciento eran pacientes sintomáticos. Se operaron los pacientes sintomáticos cuando presentaban una estenosis mayor del 50 por ciento y los asintomáticos con más del 70 por ciento. La anestesia fue local en el 29 por ciento de los casos. El cierre de la arteria se realizó con parche en el 86 por ciento. La mortalidad fue del 1,28 por ciento, siendo la morbimortalidad general el 4,69 por ciento. Según el NASCET el riesgo que un paciente sintomático con lesión significativa padezca stroke es el 26 por ciento a los 2 años. Creemos que la endarterectomía carotídea realizada por un equipo quirúrgico experimentado disminuye las posibilidades de complicaciones cerebrovasculares en los pacientes con patología carotídea

Evaluación del riesgo cardíaco en los pacientes intervenidos en forma electiva por un aneurisma de la aorta abdominal / Evaluation of cardiac risk in patients undergoing abdominal aortic aneurysm resection

El aneurisma de la aorta abdominal (AAA) es la patología vascular que más ha aumentado en los últimos años. Ello se debe a un diagnóstico precoz por métodos no invasivos. La mortalidad del AAA complicado sigue siendo muy alta pero en forma electiva ha caído entre el 2 por ciento y el 4 por ciento. Las complicaciones cardíacas son el 50 por ciento de las causas de mortalidad postoperatoria. La detección de una coronariopatía isquémica se puede realizar mediante estudios de medicina nuclear fracción de eyección en reposo (FER) y esfuerzo (FEE) o centellograma de perfusión miocárdica con talio 201-dipiridamol (TD 201). Ellos son un paso previo a la coronariografía individualizando el grupo en alto riesgo de eventos coronarios. Se analizaron 82 pacientes, 46 con FER y FEE. En 14, se agregó un (TD 201) elevándose el valor predictivo de las pruebas. En 44 casos se utilizó el centellograma con TD 201. Si éste fue positivo o si la FER fue inferior a 0,50 y la FEE cayó más del 15 por ciento se indicó una coronariografía que determinó la necesidad de una revascularización coronaria previa al tratamiento del AAA. La mortalidad operatoria fue del 4,8 por ciento en un grupo de pacientes operados en forma consecutiva y en el que 47,7 por ciento era mayor de 70 años

Comisión de Trauma de la Asociación Argentina de Cirugía: experiencia de 10 años / Trauma Commission of Argentine Association of Surgery: ten years experience

La Comisión de Trauma de la Asociación Argentina de Cirugía, creada en 1983, tuvo como objetivos iniciales, los que se han ido cumpliendo, los siguientes: 1) Establecer y difundir normas de atención de pacientes traumatizados; 2) Fijar, adaptar y difundir normas de categorización de pacientes traumatizados y de centros de atención de esos pacientes; 3) Crear una base de datos para establecer un Registro Nacional de Traumatizados Adultos, con fines estadísticos; 4) Efectuar docencia en atención y organización de la atención de pacientes traumatizados; 5) Determinar y difundir normas de prevención de traumas y accidentes; 6) Crear vínculos y convenios de cooperación con entidades similares. Para el buen desrrollo de esa tarea es necesario promover la realización de reuniones fijas, periódicas y frecuentes, del comité o comisión en pleno. Además es conveniente crear subcomisiones que se ocupen de aspectos puntuales dentro de la temática general, que en el caso de la Comisión de Trauma han sido las Subcomisiones de Normatizaciones; de Docencia; de Informática y de Prevención. También es necesario que la misma Comisión busque los medios (financieros y de otros tipos) para editar y publicar la actividad de dichas subcomisiones. Es conveniente contar también con un Boletín informativo y de difusión de temas relacionados con la actividad específica. Es necesario promover la creación de organismos similares en ciudades del interior del país, con vínculos directos con la Comisión Central, como así también establecer vínculos con entidades similares de otras sociedades

Nuestra experiencia con el advanced trauma life support (ATLS) en Argentina / Advanced trauma life support course in Argentine: our experience

Entre abril de 1989 y marzo de 1992 se efectuaron 8 cursos ATLS para alumnos en el área metropolitana y 3 en el interior del país más un curso ATLS para instructores. El total de alumnos inscriptos fue de 248, 8 no se presentaron (3<2//). De los 240 restantes no aprobaron de entrada 21 (8,8//), es decir que fallaron en las evaluaciones teórica y práctica, 15 fallaron en el exámen escrito (6,3//) y 6 en el "moulage" (2,5//). Finalmente reprobaron definitivamente 12 (5//) y aprobaron 95// de los que se presentaron. De los alumnos presentados 60// fueron cirujanos, 20// intensivistas, 10// anestesiólogos, 5// traumatólogos y 5// intensivistas o cirujanos pediátricos. Existió una buena correlación entre el pre-test y el desempeño en las estaciones de habilidades 74 (30//) no aprobaron el Pre-test y, de ellos 50// tenía 3 0 más regulares o deficientes en dichas estaciones. Durante el curso fueron a "repechaje" con el "moulage" 44 alumnos (18,3//). Un alto porcentaje de los cursantes se fue compenetrado con la actividad luego del término del primer día, poniendo de manifiesto no sólo competitividad, sino también temor por la evaluación, dada la gran cantidad de información recibida. La actividad simulada "moulage" es la más estresante, ya que es en esta estación donde se evalúa la capacidad de síntesis del alumno y la puesta en práctica de sus conocimientos. Las quejas más frecuentes fueron: 1) diapositivas en inglés; 2) escasa duración del curso; 3) excesiva información; 4) rigidez conceptual; 5) gran exigencia docente