Síndrome de Tolosa-Hunt con remisión espontánea y recurrencia / Tolosa-Hunt syndrome with spontaneous remission and recurrence

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Recanalization and mortality rates of thrombectomy with stent-retrievers in octogenarian patients with acute ischemic stroke.

BACKGROUND: Our objective was to evaluate the effect of treatment with stent-retrievers in octogenarians suffering an acute ischemic stroke. METHODS: A total of 150 consecutive patients with acute stroke who were treated with stent-retrievers between April 2010 and June 2012 were retrospectively reviewed. Patients were divided into those <80 years old (n = 116) and those ≥80 (n = 34). Baseline characteristics, procedure data, and endpoints (postprocedural NIHSS, death, and mRS at 3 months) were compared. RESULTS: High blood pressure, atrial fibrillation, and anticoagulation were more frequent in octogenarians (p = 0.01, 0.003, and 0.04 respectively). There were no differences between both groups regarding previous intravenous thrombolysis (32.4 vs. 48.3 %, p = 0.1), preprocedural NIHSS (18.1 vs. 16.8, p = 0.3), procedure time (74.5 (40-114) min vs. 63 (38-92) min, p = 0.2), revascularization time (380.5 (298-526.3) min vs. 350 (296.3-452.8), p = 0.3), TICI ≥ 2B (88.2 vs. 93.9 %, p = 0.1), and symptomatic haemorrhage (5.9 vs. 2.6 %, p = 0.3). Discharge NIHSS was higher in octogenarians (9.7 vs. 6.5, p = 0.03). Death and 3-month mRS ≥3 were more frequent in octogenarians (35.3 vs. 17.2 %, p = 0.02 and 73.5 vs. 37.1 %, p = 0.02). ICA-involvement and prolonged revascularization involved higher mortality (66.7 vs. 27.6 %, p = 0.03) and worse mRS (50 vs. 24.4 %, p = 0.06) in octogenarians. CONCLUSIONS: In our series, treatment with stent-retrievers in octogenarians with acute ischemic stroke achieved good rates of recanalization but with a high mortality rate. ICA involvement and revascularization times beyond 6 hours associated to a worse prognosis. These data might be of value in the design of prospective studies evaluating the clinical efficacy of the endovascular treatments in octogenarians.

Short-term stability of amino acids and acylcarnitines in the dried blood spots used to screen newborns for metabolic disorders.

OBJECTIVE: Tandem mass spectrometry is increasingly used in the Middle East in newborn screening for inborn errors of metabolism using dried blood spots. The sensitivity and specificity of this system for analyzing fatty and amino acids, screening for more than 40 metabolic conditions, is known. However, the short term stability of acylcarnitines and amino acids in dried blood spots in extreme heat and humid conditions is not well documented. We examined the short term effect of heat and humidity on the levels of 7 amino acids and 10 acylcarnitines used in newborn screening for inherited metabolic disorders. METHODS: Dried blood spots were exposed with humidity <30% to temperatures of 4, room temperature, 37° C, and 45, and also with humidity >70% at 37° C and 45. Amino acids and acylcarnitines in the dried blood spots were analyzed by tandem mass spectrometry. RESULTS: During the eight days of the study in high temperature and high humidity storage, most acylcarnitines and amino acids lost almost 50% of initial concentration. After eight days' exposure at 37 and 45 with humidity >70%, methionine was determined to be the most sensitive, and phenylalanine and leucine were the least sensitive amino acids. At 37 with humidity >70% C6 was the most sensitive and free carnitine (C0) was the least sensitive acylcarnitine; at 45 with humidity >70% C16 was the most sensitive and C0 was the least sensitive. CONCLUSION: Low humidity and low temperature conditions are required for transportation and storage of dried blood spots.

Selective newborn screening of inborn errors of amino acids, organic acids and fatty acids metabolism in the Kingdom of Bahrain.

Mandatory newborn screening for metabolic disorders has not been implemented in most Middle Eastern countries. Early detection and treatment of inborn errors of metabolism can reduce mortality and minimize morbidity. Preliminary studies conducted in some parts of Middle East suggest that the incidences of inborn errors of metabolism are reported to be higher in the region than anywhere else in the world due to the consanguinity. In this study the incidence of inborn errors of amino acids, organic acids and fatty acids oxidation disorders was investigated from the results of blood spot analysis of 1986 symptomatic children from 1st January 2008 to 31st of December 2011. Out of 1986 newborns screened 25 infants were diagnosed and confirmed with amino acids (n=11), organic acids (n=9) and fatty acids oxidation (n=5) disorders. Overall incidences based on number of live birth between 2008 and 2011 inclusive were 1:6000, 1:8000 and 1:14,000 for amino acids, organic acids and fatty acids oxidation disorders; respectively. Out of 25 infants diagnosed, 21 were the children of first cousin marriages. Results from this study suggest high incidence of inborn errors of amino acids, organic acids and fatty acids oxidation metabolism in Bahrain and significant contribution of consanguinity in inherited metabolic disorders. Mandatory screening for inborn errors of metabolism in Bahrain is highly recommended.

Self-apodization of low-resolution pixelated lenses.

We show that a pixelated lens with appropriate parameters exhibits an apodized point-spread function that originates in the finite size of the pixel's pupil. We evaluate numerically the degree of apodization and the enlargement associated with the point-spread function in terms of the parameters that characterize the pixelated lens.

[A giant follicular cyst of the ovary in a newborn infant]. / Quiste folicular gigante de ovario en una recién nacida.

The tumoral lesions proceeding of ovary in the newborns are the 3-6% of all abdominal tumors. The most frequent tumor is ovarian follicular cyst which will be diagnosed prenatally. As a result of ovarian stimulation by fetal gonadotrophins, maternal estrogen and placenta + gonadotrophins. Maternal antecedents reported diabetes, toxemia and isoimmunization. The most frequent complication is torsion. We present the case of one female newborn, with abdominal mass present by abdominal palpation referred of the first gestation of mother with 27 years of age, with primary sterility of 11 years without treatment, with toxemia during the pregnancy. The abdominal x-film show a intraperitoneal mass the ultrasound show cystic and solid mass, without determined origin, and the scan magnetic resonance (MR) a tumoral mass with origin in the pelvic hole with extension to the infrahepatic zone. The surgical finding was left ovarian cyst with left oophorectomy and salpingectomy.

Grandparent/caretaker education session.

The education session was well received. Including the session in the youth conference encouraged the whole extended family of the diabetic child to attend. The participants had fun learning together and sharing experiences in addition to learning the basics of how to care for the child with diabetes.