Implementing integrated hypertension and diabetes management using the World Health Organization's HEARTS model: protocol for a pilot study in the Guatemalan national primary care system.

BACKGROUND: The HEARTS technical package was developed by the World Health Organization to address the implementation gap in cardiovascular disease prevention in low- and middle-income countries. Guatemala is a middle-income country that is currently implementing HEARTS. National authorities in Guatemala are interested in exploring how hypertension and diabetes management can be integrated in HEARTS implementation. The objective of this study is to conduct a feasibility and acceptability pilot trial of integrated hypertension and diabetes management based on HEARTS in the publicly funded primary care system in Guatemala. METHODS: A single-arm pilot trial for 6 months will be carried out in 11 Ministry of Health primary care facilities starting in September 2023. A planned sample of 100 adult patients diagnosed with diabetes (n = 45), hypertension (n = 45), or both (n = 10) will be enrolled. The intervention will consist of HEARTS-aligned components: Training health workers on healthy-lifestyle counseling and evidence-based treatment protocols, strengthening access to medications and diagnostics, training on risk-based cardiovascular disease management, team-based care and task sharing, and systems monitoring and feedback, including implementation of a facility-based electronic monitoring tool at the individual level. Co-primary outcomes of feasibility and acceptability will be assessed using an explanatory sequential mixed-methods design. Secondary outcomes include clinical effectiveness (treatment with medication, glycemic control, and blood pressure control), key implementation outcomes (adoption, fidelity, usability, and sustainability), and patient-reported outcome measures (diabetes distress, disability, and treatment burden). Using an implementation mapping approach, a Technical Advisory Committee will develop implementation strategies for subsequent scale-up planning. DISCUSSION: This trial will produce evidence on implementing HEARTS-aligned hypertension and diabetes care in the MOH primary care system in Guatemala. Results also will inform future HEARTS projects in Guatemala and other low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06080451. The trial was prospectively registered on October 12, 2023.

An impact evaluation of conservation investments targeting long-distance migratory species.

We evaluated the impact of a philanthropic program investing in the conservation of sites along the Pacific Americas Flyway, which spans >16,000 km of coastline and is used by millions of shorebirds. Using a quasi-experimental, mixed methods approach, we estimated what would have happened to shorebird populations at 17 wintering sites without the sustained and additional investment they received. We modeled shorebird populations across the entire flyway and at sites with and without investment. Combining shorebird abundance estimates with a land-cover classification model, we used the synthetic control method to create counterfactuals for shorebird trends at the treatment sites. We found no evidence of an overall effect across three outcome variables. Species- and site-level treatment effects were heterogeneous, with a few cases showing evidence of a positive effect, including a site with a high level of overall investment. Results suggest six shorebirds declined across the entire flyway, including at many Latin American sites. However, the percentage of flyway populations present at the sites remained stable, and the percentage at the treatment sites was higher (i.e., investment sites) than at control sites. Multiple mechanisms behind our results are possible, including that investments have yet to mitigate impacts and negative impacts at other sites are driving declines at the treatment sites. A limitation of our evaluation is the sole focus on shorebird abundance and the lack of data that prohibits the inclusion of other outcome variables. Monitoring infrastructure is now in place to design a more robust and a priori shorebird evaluation framework across the entire flyway. With this framework, it will prove easier to prioritize limited dollars to result in the most positive conservation outcomes.

Evaluación del impacto de la inversión para la conservación enfocada en especies migratorias de largo recorrido Resumen Evaluamos el impacto de un programa filantrópico que invierte en la conservación de sitios a lo largo de la Ruta Migratoria Pacífico-Américas, la cual abarca >16,000 km de la línea costera y millones de aves playeras la usan. Estimamos con una estrategia cuasiexperimental y de métodos mixtos lo que habría pasado con las poblaciones de estas aves en 17 sitios invernales sin la inversión adicional y continua que recibieron. Modelamos estas poblaciones en toda la ruta y en sitios con y sin inversión. Combinamos las estimaciones de aves playeras con el modelo de clasificación de la cobertura del suelo y usamos el método de control sintético para crear contrafactuales para las tendencias de las aves playeras en sitios de tratamiento. No encontramos evidencia alguna de un efecto generalizado en las tres variables de los resultados. Los efectos del tratamiento de especies y de sitio fueron heterogéneos, con unos cuantos casos que mostraron evidencia de un efecto positivo, incluido un sitio con un nivel elevado de inversión general. Los resultados sugieren que seis especies de aves playeras declinaron a lo largo de toda la ruta, incluyendo en varios sitios de América Latina. Sin embargo, el porcentaje de poblaciones de la ruta presentes en los sitios permaneció estable y el porcentaje en los sitios de tratamiento (sitios de inversión) fue más elevado que en los sitios control. Muchos mecanismos son posibles detrás de nuestros resultados, incluidas las inversiones que todavía no han mitigado impactos y los impactos negativos en otros sitios que están causando las declinaciones en los sitios de tratamiento. Una limitación en nuestra evaluación es el enfoque único en la abundancia de aves playeras y la falta de datos que impiden la inclusión de otras variables de los resultados. El monitoreo de la infraestructura ahora está en una posición en la que puede diseñar un marco de evaluación más robusto y a priori de las aves playeras a lo largo de toda la ruta. Con este marco, será más fácil priorizar los dólares limitados para que los resultados de conservación sean lo más positivos posible.

Desafíos en el tratamiento de ortodoncia en paciente con síndrome de down, reporte de caso

RESUMEN: El Síndrome de Down es una condición genética que se identifica por la presencia de un grado variable de discapacidad cognitiva, rasgos y características físicas singulares, que también repercuten a nivel estomatognático. El objetivo de este reporte de caso es reflejar los desafíos terapéuticos que podemos enfrentar para lograr un tratamiento integral en estos pacientes. Madre de paciente consulta por apiñamiento dentario. Presenta enfermedades sistémicas asociadas al Síndrome de Down, alteraciones sensoriales, gingivitis generalizada, lesiones de caries, anomalías dentomaxilares y fibroma traumático en flanco lingual. El tratamiento incluyó adaptación a la atención odontológica, odontología preventiva y restauradora, periodoncia y ortodoncia. Luego de 25 meses de tratamiento, se logró el alta integral, debiendo modificar los objetivos del tratamiento y el manejo terapéutico ortodóncico en diversas ocasiones. Es posible realizar tratamientos integrales en pacientes con Síndrome de Down, considerando una buena adaptación, objetivos alcanzables y trabajo en equipo multidisciplinario.

ABSTRACT: Down Syndrome is a genetic condition identified by the presence of a variable degree of cognitive disability and unique physical characteristics and traits, which also have an impact on the stomatognathic system. The aim of this case report is to report the therapeutic challenges that we can face to achieve a comprehensive treatment. Patient's mothers consult for dental crowding. The patient presents systemic diseases associated with Down Syndrome, sensory anomalies, generalized gingivitis, dental caries lesions, maxillary dental anomalies, and traumatic fibroma in the tongue. The treatment included adaptation to dental care, preventive and restorative dentistry, periodontics and orthodontics. After 25 months of treatment, comprehensive discharge was achieved, with modifications in the treatment objectives and orthodontic therapeutic management in several occasions. Comprehensive treatment in patients with Down Syndrome is possible, considering a good adaptation to the treatment, achievable objectives and multidisciplinary teamwork.

Hypertension in Guatemala's Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework.

BACKGROUND: Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. METHODS: We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala's public system using the World Health Organization's health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. RESULTS: Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. CONCLUSIONS: This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala's public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach.

Desinfección de Alicates de Ortodoncia. Actualización de Recomendaciones en Contexto de COVID- 19. Revisión de la Literatura

RESUMEN: El adecuado conocimiento de definiciones, normas, procedimientos, uso de antisépticos y desinfectantes, permite contar con las herramientas para evitar la diseminación de agentes infecciosos y proporcionar el conocimiento para el uso racional de estos. El objetivo de este trabajo es presentar de manera estructurada y ordenada la información disponible respecto de la desinfección de alicates de ortodoncia y proporcionar una guía para el control óptimo de infecciones. Se realizó una búsqueda mediante PubMed, MEDLINE y Google Scholar, sin importar idioma, desde el año 2000 a abril 2021. Se establecieron los desinfectantes más recomendados para la desinfección de alicates de ortodoncia y las consideraciones en su uso. Además, se determinaron los riesgos de corrosión y recomendaciones para evitarlas. Es importante contar con información actualizada que se pueda utilizar para desarrollar un programa óptimo de asepsia, sobre todo en el contexto actual de pandemía.

ABSTRACT: Adequate knowledge of definitions, norms, procedures, use of antiseptics and disinfectants, allows to avoid the spread of infectious agents and provides knowledge for proper use of these aides. The objective of this study is to present the information available regarding the disinfection of orthodontic pliers in a structured and organized manner, and to provide a guide for optimal infection control. A search was carried out using PubMed, MEDLINE and Google Scholar, regardless of language, from the year 2000 to April 2021. The most recommended disinfectants for the disinfection of orthodontic pliers and the considerations in their use were established. In addition, risks of corrosion and recommendations to avoid them were determined. It is important to have up-to-date information that can be used to develop an optimal asepsis program, especially in the present context of a pandemic.

Natural incorporation of mercury in bone.

Mercury (Hg) is a highly toxic element that causes bone defects and malformations. Structure and surface analyses using quantitative x-ray diffraction using the Rietveld method, High-Resolution Transmission Electron Microscopy and nanodiffraction analyses, and Fourier-Transformed Infrared spectroscopy showed that bone enriched naturally with Hg (≤ 2.3 %) contained Hg3PO4 [(Hg2)3(PO4)2] and HgO. Bone [mostly as apatite, verified as carboxyapatite Ca10(PO4)4(CO3)3(OH)2(s)] and cinnabar (HgS) dissolved releasing Hg+ (existing as dimer Hg22+) and PO43-, both of which became immobilized as (Hg2)3(PO4)2. Besides, released Hg2+ became oxidized to form HgO. The outcome of this work is novel, provided that only a handful of stable compounds of Hg22+ are found in nature.

Estado epiléptico en adultos: caracterización de pacientes monitorizados por videoelectroencefalograma / Status epilecticus in adults: patient characterization by video-electroencephalogram monitoringby video-electroencephalogram monitoring

Introducción: el estado epiléptico (EE) es una afección potencialmente mortal con una morbilidad significativa en quienes sobreviven a esta entidad. Pacientes y métodos: estudio transversal descriptivo de corte analítico con el objetivo de describir la prevalencia y la relación con variables sociodemográficas, electroencefalográficas, imagenológicas y desenlaces clínicos en los pacientes hospitalizados que fueron monitorizado por videoelectroencefalograma (VEEG), en el Hospital de San José de Bogotá, Colombia, entre agosto 2017 y agosto 2019. Resultados: de los 135 pacientes monitorizados por VEEG, 27,47% cumplieron con los criterios para EE. La edad promedio fue 48 (DE: 19,56) años, 54,05% (n=20) de sexo masculino y 75,67% (n=28) sin antecedentes de epilepsia. Predominaron las manifestaciones motoras (70,27%, n=26), en 59,46% en el puntaje STESS fue desfavorable, 64,86% (n=24) requirió inducción a coma y monitorización en la unidad de cuidados intensivos(UCI) y 37,84% (n=14) fallecieron durante su estancia intrahospitalaria. Se encontró una relación entre EE, requerimiento de UCI y muerte intrahospitalaria. Conclusiones: la prevalencia del EE en pacientes hospitalizados monitorizados por VEEG fue cercana a 28%, lo que sugiere una relación entre EE, requerimiento de UCI y muerte intrahospitalaria.

Introduction: status epilepticus (SE) is a life-threatening disorder associated with high morbidity in SE survivors. Patients and methods: descriptive and analytical cross-sectional study with the aim to characterize the prevalence and relation with socio-demographic, electroencephalography and neuro-image variables as well as clinical outcomes of hospitalized patients who received video-electroencephalogram (video-EEG) monitoring, at Hospital de San José in Bogotá, Colombia, between August 2017 and August 2019. Results: of the 135 patients who received video-EEG monitoring, 27.47% met the criteria for SE. The median age was 48 (SD: 19.56) years, 54.05% (n=20) were men and 75.67% (n=28) had no history of epilepsy. There was a predominance of motor manifestations (70.27%, n=26), 59.46% had an unfavorable STESS score, while 64.86% (n=24) required induced coma and monitoring in the intensive care unit (ICU) and 37.84 % (n=14) died during their hospital stay. A relationship was found between SE, requiring admission to the ICU and in-hospital death. Conclusions: the prevalence of SE in hospitalized patients monitored by video-EEG was close to 28%, and a relationship between SE, requiring ICU admission and in-hospital death is suggested.

Allelic diversity and patterns of selection at the major histocompatibility complex class I and II loci in a threatened shorebird, the Snowy Plover (Charadrius nivosus).

BACKGROUND: Understanding the structure and variability of adaptive loci such as the major histocompatibility complex (MHC) genes is a primary research goal for evolutionary and conservation genetics. Typically, classical MHC genes show high polymorphism and are under strong balancing selection, as their products trigger the adaptive immune response in vertebrates. Here, we assess the allelic diversity and patterns of selection for MHC class I and class II loci in a threatened shorebird with highly flexible mating and parental care behaviour, the Snowy Plover (Charadrius nivosus) across its broad geographic range. RESULTS: We determined the allelic and nucleotide diversity for MHC class I and class II genes using samples of 250 individuals from eight breeding population of Snowy Plovers. We found 40 alleles at MHC class I and six alleles at MHC class II, with individuals carrying two to seven different alleles (mean 3.70) at MHC class I and up to two alleles (mean 1.45) at MHC class II. Diversity was higher in the peptide-binding region, which suggests balancing selection. The MHC class I locus showed stronger signatures of both positive and negative selection than the MHC class II locus. Most alleles were present in more than one population. If present, private alleles generally occurred at very low frequencies in each population, except for the private alleles of MHC class I in one island population (Puerto Rico, lineage tenuirostris). CONCLUSION: Snowy Plovers exhibited an intermediate level of diversity at the MHC, similar to that reported in other Charadriiformes. The differences found in the patterns of selection between the class I and II loci are consistent with the hypothesis that different mechanisms shape the sequence evolution of MHC class I and class II genes. The rarity of private alleles across populations is consistent with high natal and breeding dispersal and the low genetic structure previously observed at neutral genetic markers in this species.

CKD Care and Research in Guatemala: Overview and Meeting Report.

On October 14-15, 2019, the 1st Symposium to Promote Chronic Kidney Disease (CKD) Research in Guatemala was held in Guatemala City, Guatemala. The Symposium hosted more than 50 attendees, including health care professionals, policy makers, researchers, and leaders of nongovernmental organizations. The meeting's objectives were to (1) share clinical and health delivery experiences, (2) disseminate local research, and (3) establish consensus priorities for future research. In this report, we review the state of CKD nephrology in Guatemala, summarize experiences shared during the meeting from representatives of the clinical settings in Guatemala where CKD care is provided, and describe consensus priorities for future research.

Evaluating a multicomponent program to improve hypertension control in Guatemala: study protocol for an effectiveness-implementation cluster randomized trial.

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease (CVD). Despite advances in hypertension prevention and treatment, the proportion of patients who are aware, treated and controlled is low, particularly in low-income and middle-income countries (LMICs). We will evaluate an adapted version of a multilevel and multicomponent hypertension control program in Guatemala, previously proven effective and feasible in Argentina. The program components are: protocol-based hypertension treatment using a standardized algorithm; team-based collaborative care; health provider education; health coaching sessions; home blood pressure monitoring; blood pressure audit; and feedback. METHODS: Using a hybrid type 2 effectiveness-implementation design, we will evaluate clinical and implementation outcomes of the multicomponent program in Guatemala over an 18-month period. Through a cluster randomized trial, we will randomly assign 18 health districts to the intervention arm and 18 to enhanced usual care across five departments, enrolling 44 participants per health district and 1584 participants in total. The clinical outcomes are (1) the difference in the proportion of patients with controlled hypertension (< 130/80 mmHg) between the intervention and control groups at 18 months and (2) the net change in systolic and diastolic blood pressure from baseline to 18 months. The context-enhanced Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM)/Practical Robust Implementation and Sustainability Model (PRISM) framework will guide the evaluation of the implementation at the level of the patient, provider, and health system. Using a mixed-methods approach, we will evaluate the following implementation outcomes: acceptability, adoption, feasibility, fidelity, adaptation, reach, sustainability, and cost-effectiveness. DISCUSSION: We will disseminate the study findings, and promote scale up and scale out of the program, if proven effective. This study will generate urgently needed data on effective, adoptable, and sustainable interventions and implementation strategies to improve hypertension control in Guatemala and other LMICs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03504124. Registered on 20 April 2018.

Nutrientes y alimentos en la esclerosis múltiple / Nutrients and foods in multiple sclerosis. Abstract

La alimentación influye en la mejora de la sintomatología de cualquier enfermedad, incluida la esclerosis múltiple (EM),la cual, se caracteriza por un proceso inflamatorio crónico, autoinmune del sistema nervioso central generando situaciones como inflamación, alteraciones; digestivas y mentales, discapacidad, y fatiga. El propósito de la presente revisión fue identificar la evidencia científica sobre los aspectos nutricionales que mejoran la progresión de EM. La metodología consistió en la búsqueda de literatura, en bases de datos electrónicas, referente a nutrición y esclerosis múltiple, principalmente entre los años 2015-2020. Entre los resultados de los aspectos nutricionales que mostraron eficacia en mejorar la progresión de EM, se encuentran el zinc, vitamina D, fibra, probióticos, aceite de pescado y de oliva, cacao, cúrcuma, y salmón. Existen evidencias del papel inmunomodulador del Zn y de la vitamina D en la inhibición de la producción de citocinas proinflamatorias. Niveles bajos de ambos componentes se asocian con mayor riesgo de padecer EM. Otros componentes de interés nutricional son la fibra y probióticos; producen ácidos grasos de cadena corta, con propiedades antiinflamatorias. La primera se conoce por su papel en la motilidad gastrointestinal y los segundos por su acción celular y molecular en procesos inflamatorios, y modulación del microbioma, por mencionar algunos. Los aspectos nutricionales antes mencionados pueden contribuir a modular la inflamación y mejorar la fatiga. Finalmente, este documento genera un panorama importante para continuar con la investigación referente a la influencia de la alimentación en pacientes con EM(AU)

Diet influences the improvement of the symptoms of any disease, including multiple sclerosis (MS), which is characterized by a chronic, autoimmune inflammatory process of the central nervous system generating situations such as inflammation, mental and digestive alterations, disability and fatigue. The aim of this review was to identify the scientific evidence on the nutritional aspects that improve the progression of MS. The methodology consisted of searching literature, in electronic databases, referring to nutrition and multiple sclerosis, mainly between the years 2015-2020. The results of the nutritional aspects that showed effectiveness in improving the progression of MS, are zinc, vitamin D, fiber, probiotics, fish oil and olive oil, cocoa, turmeric and salmon. There is evidence of the immunomodulatory role of Zn and vitamin D in inhibiting the production of proinflammatory citokines. Low levels of both components are associated with an increased risk of MS. Other components of nutritional interest are fiber and probiotics; they produce short chain fatty acids, with anti-inflammatory properties. The first is known for its role in gastrointestinal motility and the second one for its cellular and molecular actions in inflammatory processes and the microbiome modulation, to name a few. The nutrition aspects mentioned above, can contribute to modulate inflammation and improve fatigue. Finally, this paper creates an important perspective to continue the investigation concerning the influence of diet in MS patients(AU)

Secuelas neurológicas del síndrome de Guillain-Barré en pacientes adultos / Neurologic sequelae of Guillain-Barré syndrome in adults

Introducción:el síndrome de Guillain-Barré (SGB) es una polineurorradiculopatía desmielinizante aguda inmunomediada. El síntoma principal es la debilidad muscular. El objetivo del presente estudio es describir las características del episodio agudo, las secuelas neurológicas a largo plazo y cómo estas afectan la situación laboral y las actividades de tiempo libre. Materiales y métodos: estudio realizado en dos fases: primera, descripción retrospectiva de casos; segunda, corte transversal donde se interrogaron las secuelas neurológicas y sus implicaciones. Resultados: se identificaron 63 casos de SGB con edad promedio de 50,79 años (DE 17.8), más frecuente en hombres (61,9%) y cuyo promedio de la escala Hughes en el episodio agudo fue 3,2 (DE ± 10,1). Las principales complicaciones durante la fase aguda fueron neumonía (7,94 %) y úlceras por presión (3,17 %). Se logró contactar vía telefónica a 28 pacientes, 82,1% presentó al menos un síntoma como secuela, 60,7% parestesias, 57,1% fatiga, 50% calambres y 46,4% dolor de características neuropáticas. El 32,1% tuvo cambios o retiro de su trabajo por las secuelas; 21,43% debió modificar sus actividades de tiempo libre. Conclusión: existe alta prevalencia de síntomas residuales discapacitantes después del episodio agudo de SGB con predominio de síntomas sensitivos, coincidiendo con estudios realizados en países desarrollados. Estas alteraciones ocasionan un impacto negativo en la actividad laboral y en la de tiempo libre de los pacientes.

Introduction: Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating polyneuropathy. The main symptom encountered is muscle weakness. This study seeks to describe the characteristics of an acute episode, the long-term neurologic sequelae and how they affect patients ́ work and leisure activities. Materials and Methods: a two-phase study comprising a retrospective case description in the first phase followed by a cross sectional study during the second phase in which patients were asked to describe their neurologic sequelae and how they affected them Results: we identified 63 cases of GBS, mean age was 50.79 years (SD 17.8), there was a male preponderance (61.9%) with a 3.2 (SD ± 10.1) average score on the Hughes scale during the acute episode. Major complications during the acute phase were pneumonia (7.94 %) and pressure sores (3.17 %). Phone contact was achieved with 28 patients, 82.1% presented at least one sequelae 60.7% paresthesia, 57.1% fatigue, 50% cramps and 46.4% neuropathic pain. In 32.1% of cases patients ́ work was adjusted or they were removed from work because of their sequelae; 21.43% had to modify their free-time activities. Conclusion: there is a high prevalence of disabling residual symptoms after a GBS acute episode predominantly sensory signs, which coincide with the results of studies conducted in developed countries. Said alterations negatively impact patients ́ work and leisure activities

Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala's Public Primary Health Care System: Lessons Learned, Challenges, and Opportunities.

BACKGROUND: There is an urgent need to define appropriate intervention strategies to control blood pressure in low- and middle-income countries. In 2018, a program proven effective in Argentina was translated to Guatemala's public primary health care system in rural and primarily indigenous communities. OBJECTIVES: This paper describes the stakeholder engagement process used to adapt the program to the Guatemalan rural context prior to implementing a type II hybrid effectiveness-implementation trial and shares lessons learned. METHODS: We identified key differences in the 2 contexts that are relevant to translating the intervention to the Guatemalan context. Alongside interviews and focus group discussions, we conducted consultation workshops in July and August 2018, applying a participatory translation process involving patients, family members, community members, health care providers, and Ministry of Health officials. The process consisted of multiple meetings in Guatemala City, as well as meetings in each of the 5 departments where the study will be implemented, and 1 district per department. During the workshops, we presented the evidence-based experience from Argentina and then focused on the challenges and recommended solutions that the participants identified for each of the intervention's 6 components. The process concluded with a meeting in which the research team and Ministry of Health officials defined specific details of the intervention. RESULTS: The outcome of the process is an adapted approach appropriate to integrate into Guatemala's public primary health care system in the trial phase. The approach considers the challenges and recommended strategies for each of the 6 intervention components. CONCLUSIONS: We identified lessons learned, challenges, and opportunities during the adaptation process. Findings will inform ongoing stakeholder engagement during the study implementation and future scale-up and efforts to translate evidence-based hypertension control strategies to low- and middle-income countries globally.

Encefalitis autoinmune: experiencia de una serie de casos / Autoinmune encephalitis: a series of cases

La encefalitis límbica autoinmune se define como un desorden inflamatorio severo en el cerebro que genera una encefalopatía rápidamente progresiva por lo regular en menos de 6 semanas. Se han descrito anticuerpos contra epítopes de proteínas sinápticas de superficie o contra proteínas intracelulares. Se reportan seis casos de encefalitis autoinmune con la descripción de cada uno incluyendo las manifestaciones típicas, alteraciones imagenológicas, curso clínico, complicaciones durante la hospitalización y respuesta al tratamiento. En dos de los casos se logró confirmar mediante el aislamiento de los anticuerpos. Uno falleció durante su hospitalización. Nuestra experiencia muestra un alto riesgo de secuelas y refractariedad al tratamiento que dependen del tiempo de inicio de la terapia.

Autoimmune limbic encephalitis is defined as a severe inflammatory neurological disease which causes a rapidly progressive encephalopathy, usually in less than six weeks. An association with autoantibodies to extracellular epitopes or antibodies to intracellular synaptic proteins has been described. Six cases of autoimmune encephalitis are here presented, including typical findings, imaging alterations, clinical features, inpatient stay complications and response to treatment. Two cases were confirmed by autoantibody testing. One patient died during hospitalization. Our experience show, high risk of sequelae and unresponsive states to treatment which depended on how soon the treatment was initiated.

Infarto bitalámico por trombosis venosa cerebral profunda: hallazgos clínicos y radiológicos / Bilateral thalamic infarcts due to deep cerebral venous thrombosis: clinical and radiological findings

La enfermedad cerebrovascular es un problema de salud pública mundial, considerada dentro de las primeras causas de mortalidad. La trombosis venosa cerebral (TVC) es una de sus patologías, que a pesar de ser infrecuente puede llevar a severas complicaciones en el paciente. Es por eso que se presentan dos casos de infartos bitalámicos secundarios a trombosis venosa cerebral profunda, con hallazgos clínicos e imagenológicos inusuales que hicieron aún más difícil su diagnóstico. Debido a las diferentes funciones que posee el tálamo además de la infrecuencia de la trombosis venosa cerebral profunda, la presentación clínica sigue siendo atípica y es usual que se consideren otros diagnósticos al inicio del evento, por lo tanto, consideramos importante proyectar estudios con muestras de mayor tamaño para definir con claridad la clínica y los hallazgos radiológicos de esta patología.

Cerebrovascular disease is a global public health problem and is a major cause of mortality. Cerebral venous thrombosis (CVT) is an uncommon but serious type of cerebrovascular disease. Thus, we report two cases of bilateral thalamic infarcts secondary to deep cerebral venous thrombosis presenting with unusual clinical and radiological features which made diagnosis more difficult. The functional complexity of the thalamus and the uncommon presentation of deep cerebral venous thrombosis lead to atypical clinical manifestations hence various conditions are considered in the differential diagnosis at onset of the event. Therefore, we emphasize the importance of conducting future studies with a larger sample size in order to further elucidate the clinical and radiological characteristics of this condition.

Signos de alarma en neuralgia del trigémino / Alarm signs in trigeminal neuralgia

La neuralgia del trigémino es característica en personas mayores de 50 años, comprometiendo principalmente el territorio V2 y V3 de dicho nervio de manera unilateral y la carbamezepina es el fármaco con mayor efectividad, pero no siempre responden. La presentación atípica y los signos de alarma ponen en consideración el estudio con resonancia magnética cerebral, pues obliga a descartar una causa secundaria, siendo necesario el análisis de neuroimágenes. Debido a esto, presentamos un caso de quiste epidermoide con neuralgia secundaria, que se presenta con signos de alarma y se deben considerar los estudios complementarios.

Classic trigeminal neuralgia (TN) is most common after 50 years of age, predominantly unilateral within the distribution of the V2 and V3 branches of the trigeminal nerve. Carbamazepine is the most effective medication, although not all patients respond to it. In consideration physicians should arrange a brain magnetic resonance imaging study when facing TN patients with atypical presentation and alarm signs, as secondary causes must be ruled out. We present a case of epidermoid cyst with secondary TN which presented with "red flag" signs. Image studies were therefore mandatory.

Antibacterial clay against gram-negative antibiotic resistant bacteria.

Antibiotic resistant bacteria persist throughout the world because they have evolved the ability to express various defense mechanisms to cope with antibiotics and the immune system; thus, low-cost strategies for the treatment of these bacteria are needed, such as the usage of environmental minerals. This paper reports the antimicrobial properties of a clay collected from Brunnenberg, Germany, that is composed of ferroan saponite with admixtures of quartz, feldspar and calcite as well as exposed or hidden (layered at inner regions) nano Fe(0). Based on the growth curves (log phase) of six antibiotic resistant bacteria (4 gram-negative and 2 gram-positive), we concluded that the clay acted as a bacteriostat; however, the clay was only active against the gram-negative bacteria (except for resilient Klebsiella pneumonia). The bacteriostatic mode of action was evidenced by the initial lack of Colony Forming Units on agar plates with growth registered afterward, certainly after 24h, and can be explained because interactions between membrane lipopolysaccharides and the siloxane surfaces of the clay. Labile or bioavailable Fe in the clay (extracted by EDTA or DFO-B) induced the quantitative production of HO as well as oxidative stress, which, nevertheless, did not account for by its bacteriostatic activity.

Guillain-Barré syndrome in patients with a recent history of Zika in Cúcuta, Colombia: A descriptive case series of 19 patients from December 2015 to March 2016.

PURPOSE: Zika virus (ZIKV) infection is an emerging global threat and a public health problem in the Americas. Guillain-Barré syndrome (GBS) has been recently associated to ZIKV. This report presents a case series of GBS possibly associated to ZIKV. METHODS: Clinical and demographic data from patients with GBS treated in 5 intensive care units and with recent history of ZIKV in Cúcuta, Colombia were collected from December 1 2015 to April 30 2016. Electrophysiological examination, lumbar puncture, and reverse transcriptase-polymerase chain reaction for ZIKV were performed in 14, 10, and 1 patients, respectively. RESULTS: Nineteen patients with GBS and a recent history of acute viral syndrome compatible with ZIKV infection were studied (mean age, 44 years; range, 17-78). Neurologic symptoms developed at a median of 10 days after the onset of the viral symptoms. Albuminocytological dissociation was found in 8 cases. Electrophysiological criteria for acute motor axonal neuropathy were found in all patients tested. Five patients met level 1, 8 patients level 2, and 6 patients level 3 of diagnostic certainty for GBS in the Brighton classification. Fifteen patients required respiratory assistance, 16 received intravenous immunoglobulins, and 3 had plasmapheresis. Seventy-nine percent of patients were in Hughes GBS disability scale 4 to 5 at discharge and no patients died during the observation period. Acute ZIKV infection, confirmed by reverse transcriptase-polymerase chain reaction, was observed for 1 patient. CONCLUSIONS: All cases of this GBS outbreak had a recent history ZIKV infection, reinforcing existing evidence for the association between GBS and ZIKV. Future genetic and immunologic studies are warranted to further investigate the cause of the outbreak in detail.

Epilepsia occipital / Occipital lobe epilepsy

Se han hecho innumerables intentos para lograr una definición que incluya toda la semiología y fisiología que envuelve la epilepsia, y tratar de hacerlo ha sido una tarea que ha tomado muchos años. Aunado a ello se ha propuesto una clasificación en diferentes grupos según su inicio y desencadenamiento, como lo son focales y generalizadas. La presente revisión versará acerca de la epilepsia occipital, clasificada antes dentro de las crisis parciales, en las que se han identificado un curso y un pronóstico favorables en el transcurso del tiempo, y que tienen en común un inicio en la edad temprana. Ha sido descrito que algunos de estos trastornos pudieran tener una base genética hereditaria o bien esporádica en otros, lo cual requiere una investigación exhaustiva. Por lo anterior se hace necesaria una revisión completa acerca de la epilepsia occipital, con el fin de dar claridad conceptual, clínica y diagnóstica de este desorden, así como para hacer aportes al conocimiento de la misma en pro de mejorar la calidad de vida y el tratamiento en la práctica clínica de pacientes que se encuentren dentro del espectro de esta enfermedad.

Epilepsy and its overall semiology and physiology have been subject to Innumerable definition attempts which have taken many years of effort. Likewise, a proposal for an epilepsy classification based on onset and precipitating factors was developed dividing seizures into focal and generalized seizures. This article reviews occipital lobe epilepsy which was formerly classified in the partial seizures group characterized by a favorable course and prognosis over time and by onset during early childhood. A possible genetic hereditary origin and that they may be sporadic has been described for some of these problems and still require a thorough investigation. Thus, it is necessary to conduct an extensive review on occipital lobe epilepsy for obtaining conceptual, clinical and diagnostic clarity as well as, to enhance knowledge on this illness for improving quality of life and clinical treatment in patients experiencing this spectrum of disorders.