Antero-lateral transthoracic endoscopic approach for a calcified thoracic disc herniation.

Thoracic disc herniation is one of the most therapeutically challenging spine conditions. A myriad of surgical approaches have been described in the literature, including posterior, anterior, and combined techniques. However, transthoracic and retropleural approaches are currently deemed the most effective techniques to successfully obtain anterior decompression. Herein the authors describe a 65-year-old female patient who underwent a transthoracic endoscopic approach to remove a calcified herniated thoracic disc that caused spinal cord compression. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID221.

Non-pharmacologic direct cost of a simplified strategy with glecaprevir/pibrentasvir for 8 weeks in naïve non-cirrhotic patients with hepatitis C implemented in clinical practice. The Just SIMPLE Study.

BACKGROUND AND OBJECTIVE: The emergence of highly tolerable, effective, and shorter duration direct-acting antivirals (DAAs) regimens offers the opportunity to simplify hepatitis C virus management but medical costs are unknown. Thus, we aimed to determine the direct medical costs associated with a combo-simplified strategy (one-step diagnosis and low monitoring) to manage HCV infection within an 8-week glecaprevir/pibrentasvir (GLE/PIB) regimen in clinical practice in Spain. PATIENTS AND METHODS: Healthcare resources and clinical data were collected retrospectively from medical charts of 101 eligible patients at 11 hospitals. Participants were adult, treatment naïve subjects with HCV infection without cirrhosis in whom a combo-simplified strategy with GLE/PIB for 8 weeks were programmed between Apr-2018 and Nov-2018. RESULTS: The GLE/PIB effectiveness was 100% (CI95%: 96.2-100%) in the mITT population and 94.1% (CI95%: 87.5-97.8%) in the ITT population. Three subjects discontinued the combo-simplified strategy prematurely, none of them due to safety reasons. Five subjects reported 8 adverse events, all of mild-moderate intensity. Combo-simplified strategy mean direct costs were 754.35±103.60€ compared to 1689.42€ and 2007.89€ of a theoretical 12-week treatment with 4 or 5 monitoring visits, respectively; and 1370.95€ and 1689.42€ of a theoretical 8-week with 3 or 4 monitoring visits, respectively. Only 4.9% of the subjects used unexpected health care resources. CONCLUSIONS: 8-week treatment with GLE/PIB combined with a combo simplified strategy in real-life offers substantial cost savings without affecting the effectiveness and safety compared to traditional approaches.

Conocimientos, actitudes y prácticas sobre la teniosis-cisticercosis en una comunidad altoandina rural peruana, año 2012 / Knowledge, attitudes and practices about teniosis-cysticercosis in a rural highland community of Peru, 2012

Objetivo: determinar el estado basal de los conocimientos, actitudes y prácticas (CAP) en los pobladores de un distrito alto andino rural de la región Ayacucho. Métodos: Se realizó un estudio observacional de tipo transversal en pobladores residentes del distrito de Luricocha, Ayacucho. Se enroló una cuota de 40 participantes de cada una de las 14 localidades del distrito mediante selección muestral no probabil¡stico por conveniencia. Personal de salud aplicó un cuestionario de conocimientos, actitudes y prácticas previo consentimiento informado oral. Resultados: Se incluyeron en el estudio 426 participantes. 63,6% de pobladores conoce el modo de infecció del cerdo, 66,7% conoce que el cisticerco puede ser visualizado a nivel sub-lingual y 58,0% sabe que la forma de infección humana es la v¡a fecal-oral. El 74,4% refiere haber visto carne de cerdo con “triquina”, 31,3% refiere sospecha de haber comido carne con “triquina”. Respecto a las prácticas, 77,1% refiere sacrificar y enterrar al cerdo cuando se le detecta “triquina”. Un 80,1% dejar¡a que las autoridades decomisen un cerdo afectado con “triquina”, y 4,2% considera que est  bien que los cerdos coman heces de humano. Conclusiones: Existe una brecha cognitiva, actitudinal y pragmática entre los pobladores estudiados que favorecer¡a la persistencia de la endemicidad de la teniosis/cisticercosis. Entre las personas con mejores niveles de conocimiento se observan prácticas y actitudes puntuales que facilitar¡an la adherencia a intervenciones de eliminación de este problema de salud pública.

Objective: To determine the baseline of knowledge, attitudes and practices (KAP) in residents of a highland andean rural district of Ayacucho. Methods: We performed a cross-sectional observational study in residents of Luricocha district, Ayacucho. We joined a quota of 40 participants from each of the 14 villages of the district by a non-probability sample selection by convenience. Health personnel administered a questionnaire of knowledge, attitudes and practices after oral informed consent. Results: The study included 426 participants. 63,6% of people know the mode of infection of pigs, 66,7% know that the cysticerci can be viewed at the sub-lingual and 58,0% know that the way of human infection is the fecal-oral route. 74,4% reported having seen pork with "trichina", 31,3% reported having eaten meat suspected to "trichina". Regarding practices, 77,1% refers to the pig slaughter and bury when he detects "trichina". A 80,1% would let the authorities to confiscate a pig affected with "trichina", and 4,2% think it's okay that pigs eat human feces. Conclusions: There is a cognitive, attitudinal and pragmatic gap among the people surveyed that would favor the persistence of endemicity of taeniasis/cysticercosis. Among people with higher levels of knowledge, attitudes and practices that facilitate adherence to interventions for eliminating this public health problem are observed.

Consideraciones anatomoquirúrgicas sobre el seno sagital superior / Anatomicosurgical considerations regarding the superior sagittal sinus

Objetivo: conocer la anatomía de los senos de la duramadre, especialmente del seno sagital superior (SSS) y sus relaciones con las estructuras lindantes. Material y método: se utilizaron 39 encéfalos inyectados y formalizados, disecándose con técnicas microscópicas y con lupas de 2.5X el seno sagital superior y estructuras lindantes comparándose los resultados con angiografías normales. Resultados: la longitud del SSS osciló entre 20-27 cm (media 23.58 cm). Observamos que el tercio medio mayormente se desplaza a derecha, siendo 100% concordante con la sutura sagital a nivel de su desembocadura distal. En 28 casos (71.8%) había comunicación con el seno sagital inferior, conformando plexos venosos. Las lagunas se posicionaron en forma variable, ubicándose mayormente en relación al tercio medio, y ninguna en el tercio posterior. Las venas emisarias parietales drenan en el tercio medio del seno sagital superior en el 100%, mientras que las venas nasales fueron encontradas sólo en 5 casos (12,82%). Conclusión: consideramos que el conocimiento anatómico del seno sagital superior es vital en la táctica quirúrgica a fin de evitar y prever complicaciones en las cirugías que impliquen patologías de la línea media.