Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses.

BACKGROUND: Childhood maltreatment is common globally and impacts morbidity, mortality, and well-being. Our understanding of its impact is constrained by key substantive and methodological limitations of extant research, including understudied physical health outcomes and bias due to unmeasured confounding. We address these limitations through a large-scale outcome-wide triangulation study. METHODS: We performed two outcome-wide analyses (OWAs) in the UK Biobank. First, we examined the relationship between self-reported maltreatment exposure (number of maltreatment types, via Childhood Trauma Screener) and 414 outcomes in a sub-sample of 157,316 individuals using generalized linear models ("observational OWA"). Outcomes covered a broad range of health themes including health behaviors, cardiovascular disease, digestive health, socioeconomic status, and pain. Second, we examined the relationship between a polygenic risk score for maltreatment and 298 outcomes in a non-overlapping sample of 243,006 individuals ("genetic OWA"). We triangulated results across OWAs based on differing sources of bias. RESULTS: Overall, 23.8% of the analytic sample for the observational OWA reported at least one maltreatment type. Of 298 outcomes examined in both OWAs, 25% were significant in both OWAs and concordant in the direction of association. Most of these were considered robust in the observational OWA according to sensitivity analyses and included outcomes such as marital separation (OR from observational OWA, ORo = 1.25 (95% CI: 1.21, 1.29); OR from genetic OWA, ORg = 1.06 (1.03, 1.08)), major diet changes due to illness (ORo = 1.27 (1.24, 1.29); ORg = 1.01 (1.00, 1.03)), certain intestinal diseases (ORo = 1.14 (1.10, 1.18); ORg = 1.03 (1.01, 1.06)), hearing difficulty with background noise (ORo = 1.11 (1.11, 1.12); ORg = 1.01 (1.00, 1.01)), knee arthrosis (ORo = 1.13 (1.09, 1.18); ORg = 1.03 (1.01, 1.05)), frequent sleeplessness (ORo = 1.21 (1.20, 1.23); ORg = 1.02 (1.01, 1.03)), and low household income (ORo = 1.28 (1.26, 1.31); ORg = 1.02 (1.01, 1.03)). Approximately 62% of results were significant in the observational OWA but not the genetic OWA, including numerous cardiovascular outcomes. Only 6 outcomes were significant in the genetic OWA and null in the observational OWA; these included diastolic blood pressure and glaucoma. No outcomes were statistically significant in opposite directions in the two analyses, and 11% were not significant in either OWA. CONCLUSIONS: Our findings underscore the far-reaching negative effects of childhood maltreatment in later life and the utility of an outcome-wide triangulation design with sensitivity analyses for improving causal inference.

Social features in internet-based programs to prevent alcohol consumption among adolescents: a scoping review.

Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF, and that target adolescents. Web of Science, Scopus and Google Scholar were electronically searched for all articles published between January 2011 and December 2020. Articles reporting on school-based, web-based interventions for adolescents to prevent alcohol consumption and that encouraged any kind of interaction between users ('social interactions') were eligible for inclusion. Fourteen articles were included in the review. These articles assessed eight preventive programs. Six programs showed positive results on outcome variables. In two of them, it was possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but the current evidence of their effectiveness is scarce. More evidence is required to assess the effectiveness of these features and to improve programs having the objective of preventing the consumption of alcohol among young people.

Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF and target adolescents. Thus, we conducted a scoping review with the aim to identify online and mobile psychosocial preventive interventions that use SIF to reduce adolescent drinking behavior. Our literature review identified eight different programs. Six of them showed positive results on outcome variables. However, only in two of these programs was it possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but more evidence with appropriate research methods is required to assess these social features' effectiveness to improve web-based prevention programs for young people.

Activities and relationships with parents as key ecological assets that encourage personal positive youth development.

Scientific literature has shown contextual factors that predict youth development, and family variables are the most important ones. In this study, we propose a model that explains the relation between family variables (relationship with parents and family activities) and Personal Positive Youth Development (assessed through Life satisfaction, Interiority, and Self-control), across different cultures. We recruited 2867 adolescents aged 12-18 years (52% female) from three countries: Spain, Mexico, and Peru. They completed an anonymous questionnaire. We run exploratory and confirmatory factor analyses, and structural equation modelling, testing for invariance across countries and sexes. In all subsamples, positive family relationships were associated with adolescents' Life Satisfaction. In addition, time invested on family activities was associated with Interiority and with Self-control. However, some differences across cultures and sex were found in the specific associations. Theoretical and practical implications are discussed regarding how to improve adolescent development through family life.

Flow ventricular catheters for shunted hydrocephalus: initial clinical results.

BACKGROUND: The non-homogenous flow of the cerebrospinal fluid within the ventricular catheter is one of the causative factors in shunt obstructions during the treatment of hydrocephalus. Previously, we studied the flow in ventricular catheters under the steady and pulsatile boundary conditions by means of computational fluid dynamics (CFD) in three-dimensional paradigms. Subsequently, several catheter designs with homogeneous flow patterns were developed out of which one prototype was chosen after a validation study. OBJECTIVE: To test the effectiveness of the flow ventricular catheter in a prospective, multicenter, comparative study. METHODS: Eligible centers were three pediatric hospitals: two with sole adult practice and one a mixed pediatric-adult. Standard silicone material was used to develop a parametric catheter model with homogenous flow characteristics. The flow catheters were inserted in pediatric (n = 30) and adult (n = 10) patients with all types of hydrocephalus. Simultaneously, regular ventricular catheters were inserted in another 43 control patients in the participating centers. Catheter positioning was standardized according to the Schaumann and Thomale classification. RESULTS: All ventricular catheters had a cephalad grade I or II positioning, and caudally, its extension had a peritoneal location. Programmable valves were utilized in 70% and antisiphon devices in 20% of the cases. Regular differential pressure valves were utilized in the remaining. No case of flow catheter obstruction was identified during a mean follow-up period of 2 years at the time of this writing. There were four catheter obstructions in the control cohort, all pediatric cases, during the first year. Shunt infections occurred in two cases in the control group, while there was one recurrent case of adult ventriculitis in the flow catheter group. CONCLUSIONS: This prototype model represents the next generation of ventricular catheters with a homogeneous flow pattern. The flow catheter can be inserted safely in hydrocephalic patients, and this preliminary prospective comparative study showed a possible obstruction-free functionality.

Functional recovery following resection of large Tarlov cyst malformation: a multicentre longitudinal cohort study.

OBJECTIVE: The authors report their experience with 44 consecutive patients who underwent cyst fenestration and wall repair or cerebrospinal fluid communication closure for the management of sacral Tarlov cysts. METHODS: The procedure was performed on 32 women and 12 men with a mean age of 42 years. Clinical complaints in all patients included lumbar-sacral aching, sphincter dysfunction perineal pain, and sexual intercourse pain. The patients' symptoms had developed within a mean time period of 45 months. Five patients had a previous cyst puncture. In all patients, the cyst was exposed through a sacral laminectomy. In 30 patients, the cyst was partially resected its wall repaired, and in the remaining patients, the cyst was fenestrated, and the cerebrospinal fluid communication was located and tamponaded. Thirty-seven patients had intraoperative EMG monitoring. While the perineal pain, urinary, or sexual dysfunction improved in all patients, eleven patients reported lasting pain control following surgery. The cyst was reduced in all resected cases and seven of 14 patients with CSF tamponade. The mean length of the follow-up period was 57 months. CONCLUSIONS: Either cyst repair or CSF tamponade can be sufficient for alleviating symptoms in patients with Tarlov cyst. Advice should be given to patients regarding expectations for pain improvement after surgery.

Does the MIND diet decrease depression risk? A comparison with Mediterranean diet in the SUN cohort.

PURPOSE: To prospectively evaluate the association of the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet and the Mediterranean diet (and their components), and depression risk. METHODS: We followed-up (median 10.4 years) 15,980 adults initially free of depression at baseline or in the first 2 years of follow-up. Food consumption was measured at baseline through a validated food-frequency questionnaire, and was used to compute adherence to the MIND and the Mediterranean diets. Relationships between these two diets and incident depression were assessed through Cox regression models. RESULTS: We identified 666 cases of incident depression. Comparing the highest versus the lowest quartiles of adherence, we found no association of the MIND diet and incident depression. This relation was statistically significant for the Mediterranean diet {hazard ratio (HR) 0.75, [95% confidence interval (95% CI) 0.61, 0.94]; p < 0.01}, although with departure from linearity. A reduced depression risk was associated with higher consumption of both fruits and nuts [HR 0.82 (95% CI 0.69, 0.96); p = 0.02], moderate nuts consumption [HR 0.77 (95% CI 0.64, 0.93); p = 0.01], and avoidance of fast/fried food [HR 0.63 (95% CI 0.41, 0.96); p = 0.03]. CONCLUSIONS: The Mediterranean diet was associated with reduced depression risk, but we found no evidence of such an association for the MIND diet.

A Proposed Intention-to-Treat Anatomical Classification of Spinal Dural Tears.

To clarify outcomes and develop a novel classification according to CSF fistula in a selective cohort with intraoperative spinal dural tear, we examined 72 consecutive patients who underwent spinal dural repair after microdiscectomy (n=42) or lumbar spinal decompression (n=30). Group 1 consisted of 25 patients with Type I (mild) dural tear who were treated with either tissue-glue-coated collagen sponge or fibrin glue. Group 2 consisted of 26 patients with Type II (moderate) dural tear who were treated with both tissue-glue-coated collagen sponge and fibrin glue. Group 3 consisted of 21 patients with Type III (severe) dural tear who were treated with polypropylene suture along with tissue-glue-coated collagen sponge and/or fibrin glue. Evident postoperative internal or external CSF leak was used to determine the patient's postoperative result. Postoperative internal or external CSF leak was not evident during a minimum 1-year follow-up in Group 1. In contrast, internal CSF leak was evident in both Groups 2 (n=3) and 3 (n=3) during the same follow-up. No external CSF leak was noted in any of the patients. Three patients underwent re-do spinal surgery for CSF leak repair. Patients in all groups satisfactorily avoided CSF leak. According to the intraoperative findings of a distinct dural tear, patients can be treated adequately with a specific surgical technique.

May the Mediterranean diet attenuate the risk of type 2 diabetes associated with obesity: the Seguimiento Universidad de Navarra (SUN) cohort.

It is likely that the Mediterranean diet (MedDiet) may mitigate the adverse effects of obesity on the incidence of type 2 diabetes mellitus (T2DM). We assessed this hypothesis in a cohort of 18 225 participants initially free of diabetes (mean age: 38 years, 61 % women). A validated semi-quantitative 136-item FFQ was used to assess dietary intake and to build a 0-9 score of adherence to MedDiet. After a median of 9·5-year follow-up, 136 incident cases of T2DM were confirmed during 173 591 person-years follow-up. When MedDiet adherence was low (≤4 points), the multivariable-adjusted hazard ratios (HR) were 4·07 (95 % CI 1·58, 10·50) for participants with BMI 25-29·99 kg/m2 and 17·70 (95 % CI 6·29, 49·78) kg/m2 for participants with BMI≥30 kg/m2, (v.4 points), these multivariable-adjusted HR were 3·13 (95 % CI 1·63, 6·01) and 10·70 (95 % CI 4·98, 22·99) for BMI 25-30 and ≥30 kg/m2, respectively. The P value for the interaction was statistically significant (P=0·002). When we assessed both variables (BMI and MedDiet) as continuous, the P value for their interaction product-term was marginally significant (P=0·051) in fully adjusted models. This effect modification was not explained by weight changes during follow-up. Our results suggest that the MedDiet may attenuate the adverse effects of obesity on the risk of T2DM.

Healthy-eating attitudes and the incidence of cardiovascular disease: the SUN cohort.

There is an emerging use of brief dietary questionnaires to investigate diet-health relation. We prospectively assess the association between eating attitudes (yes/no) and incident cardiovascular disease (CVD) in 19,138 participants of the Seguimiento Universidad de Navarra (SUN) Cohort. We calculated a baseline healthy-eating attitudes score (in quartiles), positively weighting answers on more fruit, vegetables, fish and fiber and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. We observed 139 incident cases of CVD. A higher score was associated with a lower risk of CVD [3-5 points Hazard Ratio (HR): 0.38 (95% confidence interval: 0.18-0.81); 6-8 points: 0.57 (0.29-1.12); 9-10 points: 0.31 (0.15-0.67), compared to 0-2 points]. Key contributors were the attitude to increase fruit [HR: 0.59 (0.40-0.87)], vegetables [HR: 0.57 (0.29-1.12)] and fiber intake [HR: 0.69 (0.48-0.98)]. Brief questionnaire on attitudes towards healthy-eating may be a useful tool for the primary prevention of CVD.

A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib.

BACKGROUND & AIMS: Sorafenib (SOR) is the standard of care for patients with hepatocellular carcinoma (HCC) and portal vein invasion (PVI), based on the results of phase 3 trials. However, radioembolization (RE) using yttrium-90 microspheres has been shown to achieve higher response rates and better survival in large cohorts and phase 2 trials. This study aimed to compare survival of HCC patients with PVI treated by RE or SOR. METHODS: Survival among patients with HCC and PVI treated with RE or SOR in four Spanish hospitals between 2005 and 2013 was analysed retrospectively. Kaplan-Meier survival curves were plotted and baseline variables tested for prognostic value using the log-rank test. A multivariate prognostic model including variables identified in the univariate analysis and adjusted by a propensity score based on factors that may determine the probability of exposure to RE was generated using Cox regression analyses. RESULTS: After a median follow-up of 6 months, 60 deaths had occurred: 38 and 22 in SOR and RE groups respectively. Median survival was 6.7 months (95%CI 5.2-8.1 months) for the entire cohort, and 8.8 months (95%CI 1.8-15.8) in the RE group and 5.4 months (95%CI 2.7-8.1) in the SOR group (P = 0.047). The difference in survival was still statistically significant when 13 patients in the RE group who started SOR after a median time of 8 months were censored from the analysis. CONCLUSIONS: In a cohort of patients with HCC and PVI treatment with RE was associated with a more prolonged survival compared with SOR.

Neurotrophic bone marrow cellular nests prevent spinal motoneuron degeneration in amyotrophic lateral sclerosis patients: a pilot safety study.

The objective of this article is to assess the safety of intraspinal infusion of autologous bone marrow mononuclear cells (BMNCs) and, ultimately, to look for histopathological signs of cellular neurotrophism in amyotrophic lateral sclerosis (ALS) patients. We conducted an open single arm phase I trial. After 6 months observation, autologous BMNCs were infused into the posterior spinal cord funiculus. Safety was the primary endpoint and was defined as the absence of serious transplant-related adverse events. In addition, forced vital capacity (FVC), ALS-functional rating scale (ALS-FRS), Medical Research Council scale for assessment of muscle power (MRC), and Norris scales were assessed 6 and 3 months prior to the transplant and quarterly afterward for 1 year. Pathological studies were performed in case of death. Eleven patients were included. We did not observe any severe transplant-related adverse event, but there were 43 nonsevere events. Twenty-two (51%) resolved in ≤2 weeks and only four were still present at the end of follow-up. All were common terminology criteria for adverse events grade ≤2. No acceleration in the rate of decline of FVC, ALS-FRS, Norris, or MRC scales was observed. Four patients died on days 359, 378, 808, and 1,058 post-transplant for reasons unrelated to the procedure. Spinal cord pathological analysis showed a greater number of motoneurons in the treated segments compared with the untreated segments (4.2 ± 0.8 motoneurons per section [mns per sect] and 0.9 ± 0.3 mns per sect, respectively). In the treated segments, motoneurons were surrounded by CD90+ cells and did not show degenerative ubiquitin deposits. This clinical trial confirms not only the safety of intraspinal infusion of autologous BMNC in ALS patients but also provides evidence strongly suggesting their neurotrophic activity.

Mediterranean Alcohol-Drinking Pattern and Arterial Hypertension in the "Seguimiento Universidad de Navarra" (SUN) Prospective Cohort Study.

Alcohol drinking patterns may determine the risk of hypertension and may also modify the detrimental effect of high alcohol intake. We prospectively evaluated the effect of the Mediterranean alcohol-drinking pattern and its interaction with the amount of alcohol consumed on the incidence of arterial hypertension. In the "Seguimiento Universidad de Navarra" (SUN) cohort, we followed-up 13,805 participants, all of them initially free of hypertension, during a maximum period of 16 years. Information about diet, chronic diseases, lifestyle and newly diagnosed hypertension was collected using validated questionnaires. We used a 7-item score (0 to 9 points) that jointly considered moderate alcohol consumption, distributed over the week, with meals, and a preference for red wine and avoidance of binge-drinking. During 142,404 person-years of follow-up, 1443 incident cases of hypertension were identified. Low adherence (score < 2) to the Mediterranean alcohol-drinking pattern was significantly associated with a higher incidence of hypertension (multivariable-adjusted hazard ratio 1.81, 95% confidence interval 1.09−2.99) as compared to the high-adherence (score > 7) category. Among alcohol consumers, a high adherence to the MADP is associated with a lower incidence of hypertension. Compared with abstinence, a high adherence did not seem to differ regarding its effect on hypertension risk.

Associations of lockdown stringency and duration with Google searches for mental health terms during the COVID-19 pandemic: A nine-country study.

OBJECTIVES: We examined the associations of lockdown stringency and duration with Google searches for four mental health concepts (i.e., "Anxiety," "Depression," "Suicide," "Mental Health") in nine countries (i.e., Hungary, India, Iran, Italy, Paraguay, Serbia, South Africa, Spain, Turkey) during the COVID-19 pandemic. METHODS: We retrieved national-level data for each country from Google Trends and the Global Panel Database of Pandemic Policies. In our primary analysis, we used data from all countries to estimate a set of multilevel regression models examining associations of overall lockdown stringency and lockdown duration with relative search volumes for each mental health term. We repeated the models after replacing overall lockdown stringency with each of the lockdown stringency components. RESULTS: A negative association was found between overall lockdown stringency and "Depression." Lockdown duration and the most stringent stay-at-home requirements were negatively associated with "Anxiety." Policies that recommended or required the cancelation of public events evidenced negative associations with "Depression," whereas associations between policies that required some or all levels of schooling to close and "Depression" were positive. Policies that recommended or required workplaces to close and those that enforced quarantines on non-citizens arriving from high-risk regions or closed borders entirely were negatively associated with "Suicide." CONCLUSIONS: Lockdown duration and some lockdown policies during the COVID-19 pandemic were generally associated with significantly lower, rather than higher, Google searches for selected mental health terms. These findings could be used alongside other evidence to develop future lockdown strategies that are sensitive to mental health issues during public health crises.

Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives.

INTRODUCTION: Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS: PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS: The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). CONCLUSIONS: Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.

Chiari type 1 anomaly in pseudohypoparathyroidism type Ia: pathogenetic hypothesis.

AIM: This study aims to report a patient with Chiari type 1 malformation (CM1) occurring in the context of pseudohypoparathyroidism type 1a (PHP-Ia) that we believe represents the first instance of this association in the current literature. CASE REPORT: The authors describe the case of a 6-year-old girl diagnosed with PHP-Ia who presented an associated tonsillar descent. During the follow-up, the skull vault and the occipital squama became extremely thickened at the same time as the tonsillar herniation showed a marked regression. DISCUSSION: Chronic tonsillar descent has been reported in diverse genetic and metabolic diseases of bone. A constant finding in PH-Ia consists of changes that mainly involve the bones of the patients' hands and feet. Cerebral anomalies have also been documented in PHP-Ia, especially cerebral calcifications, but in contrast involvement of the skull bones has seldom been described in this condition. The authors briefly discuss the probable role played by the observed skull changes in the origin and subsequent regression of the tonsillar descent in this child. CONCLUSIONS: We suggest that CM1 may develop in patients with PHP-Ia and that it should be actively sought, especially in individuals diagnosed with PHP-Ia presenting with neurological manifestations. Probably, the seeming rarity of chronic tonsillar descent in PHP-Ia is due to the fact that many patients with this condition are rarely investigated with magnetic resonance.

Assessing Adolescent Dating Violence in the YourLife Project: Proposal of an Instrument for Spanish-Speaking Countries.

BACKGROUND: Several instruments have been developed to assess adolescent dating violence but only few have been validated in Spanish-speaking settings. Some instruments are too long and may not be feasible to include them in a multipurpose questionnaire. We developed an instrument to be used in the YourLife project, an international project about young people lifestyles. OBJECTIVE: We aimed to analyze the psychometric properties of this instrument in three Spanish-speaking countries (Chile, Ecuador, and Spain). METHOD: We included 1049 participants, aged 13-18 years. Exploratory and confirmatory factor analyses were conducted. Associations between dating violence and variables expected to covariate with it (substance use, school peer aggression, justification of dating violence, and relationship power imbalance), were tested. RESULTS: Two different constructs (psychological and physical/sexual) for suffered and perpetrated violence were identified and confirmed in the three countries. The dating violence subscales had Cronbach's alpha scores higher than 0.85. The strongest associations between dating violence and variables related to it were found within the relationship power imbalance items, suggesting that these items may be useful to detect adolescent dating violence when a specific questionnaire cannot be implemented. CONCLUSION: This instrument seems to be adequate to assess suffered and perpetrated adolescent dating violence within a multipurpose questionnaire among schooled adolescents.

Cavernous hemangiomas of the cranial vault in infants: a case-based update.

BACKGROUND: Mass lesions arising in the scalp or the cranial vault of children require a significant diagnostic work-up but their nature, in most instances, can only be clarified after histopathological study. Tumors of osseous consistency or merging from within cranial bones are seldom susceptible of fine needle aspiration biopsy and require excision. Ossified cephalhematoma is a rare entity that is usually related to perinatal or accidental trauma. Exceptionally, ossified cephalhematoma has a non-traumatic origin and arises from a different condition, as vascular tumor or malformation. DISCUSSION: Cavernomas of the skull are infrequent and occur in middle-aged individuals. Skull cavernomas in infants lack the sunburst radiographic pattern seen in adults and may present as a bone-like tumor whose appearance is identical to that of ossified cephalhematoma. A literature search showed only two previous reports of patients younger than 1 year with skull cavernomas presenting with associated ossified cephalhematomas. We hypothesize that this type of skull cavernomas are congenital in origin and that they manifest precociously due to the occurrence of early bleeding. CASE ILLUSTRATION: We report a 12-month-old boy presenting with a hard tumor arising on his right parietal bone that was present since birth. After diagnostic work-up, the bone tumor and the associated intraosseous hematoma were removed. Interestingly, the source of the hematoma was a cavernous hemangioma originating in the skull. CONCLUSIONS: Calvarial cavernous hemangiomas may bleed precociously, even before birth, and manifest as large intraosseous hematomas. Differential diagnosis against ossified cephalhematoma can only be established through histopathological study.

Factors predicting outcome of surgical treatment of spontaneous spinal hematomas: a retrospective cohort study in four tertiary reference centers.

BACKGROUND: Spontaneous spinal extradural hematoma (SSEH) is a rare but disabling disorder. Most of the previous assumptions regarding the factors that contribute to poor neurological recovery from SSEH are based on small case samples or conditions with similar clinical presentations but different physiopathologies. Our goal was to find the most relevant prognostic factors for neurological recovery in patients suffering SSEH treated with surgical evacuation. METHODS: From a retrospective database of 29 surgical patients with SSEH, several clinical and radiological variables were recorded. These variables were compared between patients with good and poor neurological recovery, considering good as an improvement by at least one point in the ASIA Scale. RESULTS: Among the patients included, morbidity and mortality rate was 6.9% and 3.4%, respectively, with a mean follow-up of 7.1 months. Neurological full recovery was experienced by 33% of the patients included, and 86% of individuals had an improvement in their neurological condition at last follow-up. Lesser intramedullary lesions were significantly associated with greater chances of improvement in ASIA Scale at discharge and at follow-up. Surgical decompression within the first 24 hours of onset of symptoms were correlated with better neurological outcomes at follow-up. CONCLUSIONS: MRI is a powerful tool to predict the neurological outcome in SSEH patients, and it should be considered as an another resource to better know the patients with greater chances of having neurological recovery, especially in cases where the neurological examination is not reliable at the initial exam.

Leisure activities and alcohol consumption among adolescents from Peru and El Salvador.

INTRODUCTION: Structured and unstructured leisure are known protective and risk factors, respectively, for alcohol consumption during adolescence. However, little is known about the interaction between the two leisure types and alcohol consumption. METHOD: A cross-sectional study was performed among high-school students in El Salvador and Peru. Schooled adolescents, aged 13-18 (N = 5640), completed a self-administered questionnaire about risk behaviors, including their leisure activities and whether they had consumed alcoholic beverages. They were classified into tertiles of the amount of time of both structured and unstructured activities. A non-conditional multivariate logistic regression was conducted to evaluate the association of both types of leisure with alcohol consumption. We also used a likelihood ratio test to assess the potential interaction of structured and unstructured leisure time in alcohol consumption. RESULTS: Alcohol consumption was much more frequent among adolescents in the highest tertile of unstructured leisure time compared to the lowest one (Adjusted OR: 5.52; 95% CI: 4.49-6.78), and less frequent among those from the highest tertile of structured leisure time compared to the lowest one (Adjusted OR: 0.66; 95% CI: 0.55-0.80). We did not find an interaction effect between structured and unstructured leisure time with regard to initiation of alcohol consumption. DISCUSSION: The study suggests that structured leisure is not enough to compensate for the possible harmful effect of unstructured leisure. Parents, educators and policy makers might be advised to discourage unstructured leisure among adolescents, and not simply to encourage structured leisure.

Evaluation and management of small dural tears in primary lumbar spinal decompression and discectomy surgery.

Incidental dural tear is one of the most common intraoperative complications in lumbar spine surgery. Yet, its technical management for the prevention of CSF leak is controversial. The technique of managing dural tears depends on the location of the dural tears as well on the length and anatomical characteristics of the dural tear. We propose an anatomical classification for small (less than one cm) dural tears and report on the outcome of managing these dural tears types using different technique for different type. 62 patients underwent spinal dural repair after microdiscectomy or lumbar spinal decompression. Group 1 consisted of 20 patients, with Type I or mild dural tear who had tissue-glue coated collagen sponge or fibrin glue application. Group 2 comprised 21 patients with Type II or moderate dural tear who had both tissue-glue coated collagen sponge and fibrin glue application. Group 3 comprised 21 patients with Type III or severe dural tear who had polypropylene suture and tissue-glue coated collagen sponge and/or fibrin glue application. Evident postoperative CSF leak was used to determine the patient's postoperative result. Postoperative CSF leak was not evident during a minimum 1 year follow up in group 1. Internal CSF leak was evident in group 2 (n = 3) and group 3 (n = 3) during same follow up. Three patients underwent re-do spinal surgery for CSF leak repair. We recommend different management technique depending on the type of tear. For type I, we recommend the use of tissue-glue coated collagen sponge or fibrin glue application, without dural suturing.