BTLA+CD200+ B cells dictate the divergent immune landscape and immunotherapeutic resistance in metastatic vs. primary pancreatic cancer.

Response to cancer immunotherapy in primary versus metastatic disease has not been well-studied. We found primary pancreatic ductal adenocarcinoma (PDA) is responsive to diverse immunotherapies whereas liver metastases are resistant. We discovered divergent immune landscapes in each compartment. Compared to primary tumor, liver metastases in both mice and humans are infiltrated by highly anergic T cells and MHCIIloIL10+ macrophages that are unable to present tumor-antigen. Moreover, a distinctive population of CD24+CD44-CD40- B cells dominate liver metastases. These B cells are recruited to the metastatic milieu by Muc1hiIL18hi tumor cells, which are enriched >10-fold in liver metastases. Recruited B cells drive macrophage-mediated adaptive immune-tolerance via CD200 and BTLA. Depleting B cells or targeting CD200/BTLA enhanced macrophage and T-cell immunogenicity and enabled immunotherapeutic efficacy of liver metastases. Our data detail the mechanistic underpinnings for compartment-specific immunotherapy-responsiveness and suggest that primary PDA models are poor surrogates for evaluating immunity in advanced disease.

Efficacy and Safety of Sarilumab in patients with COVID19 Pneumonia: A Randomized, Phase III Clinical Trial (SARTRE Study).

INTRODUCTION: SARS-CoV-2 pneumonia is often associated with hyper-inflammation. The cytokine-storm-like is one of the targets of current therapies for coronavirus disease 2019 (COVID-19). High Interleukin-6 (IL6) blood levels have been identified in severe COVID-19 disease, but there are still uncertainties regarding the actual role of anti-IL6 antagonists in COVID-19 management. Our hypothesis was that the use of sarilumab plus corticosteroids at an early stage of the hyper-inflammatory syndrome would be beneficial and prevent progression to acute respiratory distress syndrome (ARDS). METHODS: We randomly assigned (in a 1:1 ratio) COVID-19 pneumonia hospitalized patients under standard oxygen therapy and laboratory evidence of hyper-inflammation to receive sarilumab plus usual care (experimental group) or usual care alone (control group). Corticosteroids were given to all patients at a 1 mg/kg/day of methylprednisolone for at least 3 days. The primary outcome was the proportion of patients progressing to severe respiratory failure (defined as a score in the Brescia-COVID19 scale ≥ 3) up to day 15. RESULTS: A total of 201 patients underwent randomization: 99 patients in the sarilumab group and 102 patients in the control group. The rate of patients progressing to severe respiratory failure (Brescia-COVID scale score ≥ 3) up to day 15 was 16.16% in the Sarilumab group versus 15.69% in the control group (RR 1.03; 95% CI 0.48-2.20). No relevant safety issues were identified. CONCLUSIONS: In hospitalized patients with Covid-19 pneumonia, who were under standard oxygen therapy and who presented analytical inflammatory parameters, an early therapeutic intervention with sarilumab plus standard of care (including corticosteroids) was not shown to be more effective than current standard of care alone. The study was registered at EudraCT with number: 2020-002037-15.

A Retrospective Controlled Cohort Study of the Impact of Glucocorticoid Treatment in SARS-CoV-2 Infection Mortality.

Evidence to support the use of steroids in coronavirus disease 2019 (COVID-19) pneumonia is lacking. We aim to determine the impact of steroid use for COVID-19 pneumonia on hospital mortality. We performed a single-center retrospective cohort study in a university hospital in Madrid, Spain, during March of 2020. To determine the role of steroids in in-hospital mortality, patients admitted with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia and treated with steroids were compared to patients not treated with steroids, and we adjusted with a propensity score for patients on steroid treatment. Survival times were compared using the log rank test. Different steroid regimens were compared and adjusted with a second propensity score. During the study period, 463 out of 848 hospitalized patients with COVID-19 pneumonia fulfilled inclusion criteria. Among them, 396 (46.7%) patients were treated with steroids and 67 patients were not. Global mortality was 15.1%. The median time to steroid treatment from symptom onset was 10 days (interquartile range [IQR], 8 to 13 days). In-hospital mortality was lower in patients treated with steroids than in controls (13.9% [55/396] versus 23.9% [16/67]; hazard ratio [HR], 0.51 [95% confidence interval, 0.27 to 0.96]; P = 0.044). Steroid treatment reduced mortality by 41.8% relative to the mortality with no steroid treatment (relative risk reduction, 0.42 [95% confidence interval, 0.048 to 0.65]). Initial treatment with 1 mg/kg of body weight/day of methylprednisolone versus steroid pulses was not associated with in-hospital mortality (13.5% [42/310] versus 15.1% [13/86]; odds ratio [OR], 0.880 [95% confidence interval, 0.449 to 1.726]; P = 0.710). Our results show that the survival of patients with SARS-CoV-2 pneumonia is higher in patients treated with glucocorticoids than in those not treated. Rates of in-hospital mortality were not different between initial regimens of 1 mg/kg/day of methylprednisolone and glucocorticoid pulses.

Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study.

BACKGROUND: Concerns have been raised about the possibility that inhibitors of the renin-angiotensin-aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19. METHODS: In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437. FINDINGS: We collected data for 1139 cases and 11 390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62-2·41) and risk factors (1·46, 1·23-1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77-1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64-1·00) or angiotensin-receptor blockers (1·10, 0·88-1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34-0·80). The adjusted ORs were similar across severity degrees of COVID-19. INTERPRETATION: RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19. FUNDING: Instituto de Salud Carlos III.

Prevalence and Risk Factors of Prolonged Corrected QT Interval Among Children and Adolescents Treated With Antipsychotic Medications: A Long-Term Follow-Up in a Real-World Population.

PURPOSE: This study aimed to describe the prevalence of corrected QT (QTc) interval disorders and the possible predisposing factors in children and adolescents treated with antipsychotic (AP) medications in a real-world population with a long-term follow-up. METHODS: Data were obtained from the SafEty of NeurolepTics in Infancy and Adolescence (SENTIA) registry (https://sentia.es). The SENTIA includes patients younger than 18 years who are currently taking or initiating treatment with AP medications and have agreed to participate in the registry. The SENTIA's follow-up includes an electrocardiogram (ECG) assessment before starting treatment and at 1, 3, and 6 months after treatment initiation or after any changes in the patient's AP medication treatment. Thereafter, all participants undergo an ECG every 6 months. A QTc interval more than 450 milliseconds, increases in QTc interval of 60 milliseconds or more, or QTc dispersion more than 100 milliseconds were considered abnormal. RESULTS: Since January 1, 2011, 101 patients have been enrolled in SENTIA and have had at least 1 ECG assessment. The mean age at inclusion was 11.5 years; 75% of the patients were men. The mean follow-up time was 20.0 ± 15.1 months. The most frequently prescribed AP medications were risperidone (52.2%) and aripiprazole (45.5%). Seven patients (6.9%) had abnormal changes in QTc. No patient had a QTc interval more than 500 milliseconds. All patients were asymptomatic. The QTc changes were observed at different times of exposure, with a range of 1 to 39 months after beginning AP treatment. Concomitant use of attention deficit and hyperactivity disorder drugs seemed a possible factor associated with QTc disorders. CONCLUSIONS: Patients should undergo a baseline ECG assessment before starting AP medication treatment, particularly patients with concomitant use of attention deficit and hyperactivity disorder drugs or a family/personal history of heart disease.

Sinusitis and oroantral fistula in patients with bisphosphonate-associated necrosis of the maxilla.

BACKGROUND: The management of bisphosphonate related necrosis of the jaw has become clinical routine. While approximately two thirds of the lesions are in the mandible, one third is located in the maxilla. In 40-50 % of maxillary necrosis the maxillary sinus is involved, leading to maxillary sinusitis and oro-antral communications. METHODS: This retrospective single center study includes all patients with diagnosis of BP-ONJ of the maxilla and concomitant maxillary sinusitis. The information collected includes age, gender, primary disease, bisphosphonate intake, involving type of bisphosphonate, route of administration and duration of BP treatment previous to surgical treatment and treatment outcome. RESULTS: A total of 12 patients fulfill the criteria of the diagnosis of maxillary sinusitis associated to maxillary necrosis, of which 6 Patients showed purulent sinusitis. All patients underwent surgical treatment with complete resection of the affected bone and a multilayer wound closure. A recurrence appeared in one patient with open bone and no sign of sinusitis and was treated conservatively. CONCLUSIONS: Purulent maxillary Sinusitis is a common complication of bisphosphonate-related necrosis of the maxilla. The surgical technique described can be suggested for the treatment of these patients.

Unusual redo mitral valve replacement for bleeding in Glanzmann thrombasthenia.

We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology.

Dose increase needed in most cystic fibrosis lung transplantation patients when changing from twice- to once-daily tacrolimus oral administration.

AIM: The aim of this pharmacokinetic (PK) study was to evaluate tacrolimus (TAC) exposure in stable cystic fibrosis (CF) lung transplant (LT) recipients, converted from TAC twice daily to TAC once daily in an open-label, prospective, single-centre study. METHODS: Eligible patients were post-transplant CF patients (18-65 years) with stable lung function, on stable doses of TAC twice daily and who were candidates to switch to TAC once daily. Twelve consecutive patients were included in the study. Patients had their first PK analysis on day 1, still under the stable TAC twice-daily regimen, and were converted to TAC once daily from day 2 onwards. The doses were adjusted according to clinical judgement to achieve target levels, and a second 24-h PK period profile was obtained once the patient was on a stable dosage on the therapeutic range. RESULTS: The mean total (SD) daily dose of TAC twice daily at baseline upon enrolment was 0.17 (0.10) mg/kg/day. The mean (SD) daily dose of TAC once daily after adjustments was 0.22 (0.12) mg/kg/day. In order to achieve target C min levels with a similar AUC0-24, 82% of subjects who were converted to TAC once daily required an increase of dose, in a range of 0-66.7%, with a mean dose increase of 28%. CONCLUSIONS: Our study results indicate that the switch for conversion from TAC twice daily to TAC once daily in patients with CF may need dose adjustment in order to reach levels within the therapeutic target.

SENTIA: a systematic online monitoring registry for children and adolescents treated with antipsychotics.

INTRODUCTION: Despite drastic increases in antipsychotic prescribing in youth, data are still limited regarding their safety in this vulnerable population, necessitating additional tools for capturing long-term, real world data. METHODS: We present SENTIA (SafEty of NeurolepTics in Infancy and Adolescence; https://SENTIA.es), an online registry created in 2010 to track antipsychotic adverse effects in Spanish youth <18 years old currently taking or initiating with any antipsychotic treatment. SENTIA collects information on sociodemographic, diagnostic and treatment characteristics, past personal medical/psychiatric history, healthy lifestyle habits and treatment adherence. Additionally, efficacy and adverse effect data are recorded including the Children's Global Assessment Scale; Clinical Global Impressions scale for Severity and Improvement, the Safety Monitoring Uniform Report Form, Simpson-Angus Scale, Abnormal Involuntary Movement Scale, vital signs, blood pressure, and EKG. Finally, fasting blood is drawn for hematology, electrolytes, renal, liver and thyroid function, glucose, insulin, lipid, prolactin and sex hormone levels. Initially, a diagnostic interview and several psychopathology scales were also included. Patients are assessed regularly and followed even beyond stopping antipsychotics. RESULTS: Since 01/17/2011, 85 youth (11.5 ± 2.9 (range = 4-17) years old, 70.6% male) have been included at one inaugural center. After a mean duration of 17 ± 11 (range = 1-34) months, 78.8% are still actively followed. For feasibility reasons, the diagnostic interview and detailed psychopathology scales were dropped. The remaining data can be entered in <30 minutes. Several additional centers are currently being added to SENTIA. CONCLUSIONS: Implementation of a systematic online pharmacovigilance system for antipsychotic adverse effects in youth is feasible and promises to generate important information.

Alterations in episodic memory in patients with systemic lupus erythematosus.

The purpose of this paper was to examine memory performance in patients with SLE by studying the overall deterioration in memory, analyzing the differences and frequency of impairment in the variables from the visual and verbal memory tests, and studying the alterations in the memory. This study included 59 patients with a diagnosis of systemic lupus erythematosus (SLE) and 18 with a diagnosis of chronic discoid lupus (CDL), who were administered the Spanish complutense verbal learning test (TAVEC) and the Rey complex figure test (RCFT). Statistically significant differences were detected between the two groups on the immediate visual recall and delayed visual recall variables, with the mean of the SLE group being lower than that of the CDL group. The difference between the frequency of verbal and visual impairment could be explained by various factors, one of which would be a lateralization of memory impairment.

Time course of endocrine changes in the hypophysis-gonad axis induced by hypobaric hypoxia in male rats.

Chronic hypobaric hypoxia (CHH) induces a decrease in sperm output and spermatogenesis in male rats. The mechanisms that underlie these changes in testicular function are unknown and could involve changes in the hypophysis-gonad axis. We have tested the hypothesis that changes take place in the endocrine status (FSH, follicle stimulating hormone; LH, luteinizing hormone; testosterone) of rats subjected to CHH. Male Wistar rats were maintained under normobaric or hypobaric conditions (428 torr, 4,600 m). On days 0, 5, 15 and 30 post-exposure, 12 rats were anesthetized, their body weights were measured and blood samples were collected. The testicles were fixed in 4% formaldehyde and processed for histological analysis. In this time course, the FSH levels rose by day 5 post-exposure. On subsequent days, the FSH levels decreased in rats subjected to CHH with a tendency to remain higher than the normoxic group. The LH plasma levels decreased in rats exposed to CHH. Consistent with the decrease in LH levels, the plasma testosterone level decreased significantly after 30 days of CHH exposure. Integrated analysis of hormonal changes in rats subjected to CHH and the body dehydration that occurs in HH allows us to conclude that the effects of CHH on spermatogenesis may be partially related to changes in the hypophysis-gonad hormonal axis.

Seroprevalencia y factores de riesgo de cisticercosis en trabajadores de granjas porcinas y criadores de cerdos artesanales del municipio Mara estado Zulia Venezuela / Seroprevalence and risk factors of cysticercosis in pig farm workers and artisan/traditional pig breeders in the municipality of Mara state of Zulia Venezuela

Determinar la seroprevalencia y los factores de riesgo para cisticercosis en trabajadores de granjas porcinas y criadores artesanales de cerdos en el municipio Mara del estado Zulia. Se estudió el suero de 59 individuos de uno u otro sexo (33 masculinos y 26 femeninos) con edades de 1 a 60 años; 18 trabajadores de granjas porcinas y 41 trabajadores artesanales. Se les determinó los niveles de anticuerpos IgG anticisticercos a través de ELISA, utilizando antígenos de Taenia crassiceps y se realizó una encuesta epidemiológica. La seroprevalencia general fue del 15,25 por ciento. El grupo etario de mayor riesgo fue el de mayores de 40 años. El consumo de carne cruda o poco cocida de cerdo y realizar actividades relacionadas con los cerdos fueron factores de riesgo de importancia. La seroprevalencia en esta población de alto riesgo es elevada comparada con otras investigaciones similares. El grupo etario (> 40 años), el consumo de carne de cerdo cruda o poco cocida concuerda con lo reportado en otros estudios realizados dentro y fuera del país. Realizar actividades frecuentes relacionadas con los cerdos demostró ser un factor de riesgo. Con un modelo de regresión líneal múltiple, se demostró que la concurrencia de estos tres factores, aumenta el riesgo de serología positiva. La alta seroprevalencia demostradaen esta población, sugiere realizar una vigilancia epidemiológica de cisticercosis.

Sustained acclimatization in Chilean mine workers subjected to chronic intermittent hypoxia.

Farias, Jorge G., Jorge Osorio, Gustavo Soto, Julio Brito, Patricia Siques, and Juan G. Reyes. Sustained acclimatization in Chilean mine workers subjected to chronic intermittent hypoxia. High Alt. Med. Biol. 7:302-306, 2006--We wanted to know if sea-level mine workers exposed previously to chronic intermittent hypoxia reached a steady acclimatization at 36 months under hypobaric hypoxia. An intermittently exposed group of mine workers (IE, n = 25) were subjected to submaximal exercise (100 W) at 4500 m. Their systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and hemoglobin oxygen saturation (HbSatO(2)) were monitored. Two comparison groups of unacclimatized sea-level workers (n = 17) were studied. A nonexposed group (NE) performed 5 min of submaximal exercise at sea level. Some kind of exercise was performed both by an acutely exposed group (AE) and IE group at 4500 m. No statistical differences were found for HR, SBP, and DBP (p > 0.05) during exercise between IE and AE groups. Resting HbSatO(2) of IE (87 +/- 6%) was lower than NE (97 +/- 3%) (p < 0.05), but was higher than AE (82 +/- 4%) (p < 0.05). In the exercise condition, HbSatO(2) of IE (85 +/- 5%) was lower than NE (95 +/- 3%) (p < 0.05), but was higher than AE (76 +/- 2%) (p < 0.05). These responses were maintained through the 6 months of the study period. Thus, mine workers subjected to intermittent hypobaric condition for 3 years showed a good degree of acclimatization that was maintained through time.

Cirugía citorreductora posterior a quimioterapia neoadyuvante: en cancer epitelial de ovario avanzado / Later cytoreductive surgery to neoadjuvant chemotherapy in advanced epithelial ovarian cancer

Determinar la capacidad de la quimioterapia neoadyuvante para lograr citorreducción óptima en cáncer epitelial de ovario avanzado y relacionarla con la sobrevida global y libre de enfermedad. 22 pacientes con cáncer epitelial avanzado de ovario fueron elegidas en base a los criterios de Vergote: enfermedad voluminosa, implantes multiples, enfermedad metastásica parenquimatosa; se administró 3 ó 4 ciclos de quimioterapia con carboplatino-taxanos, y posterior cirugía. Todas las pacientes fueron catalogadas como estadio III-C o IV según la clasificación de la FIGO. El tipo histológico predominante fue el adenocarcinoma sin especificación con el 45,5 por ciento. El 63,6 por ciento eran tumores poco diferenciados. Todas las pacientes respondieron a la quimioterapia neoadyuvante, incluso en 5 pacientes se reportó respuesta patológica total. Se logró cirugía citoreductora óptima en 81,8 por ciento de los pacientes. Para un seguimiento promedio de 18 meses: 20 pacientes están vivas (90,9 por ciento), 14 libres de enfermedad. En 4 se produjo recidiva, 4 presentaron persistencia y fallecieron 2 de ellas. La morbilidad perioperatoria fue mínima. La sobrevida libre de enfermedad registró una media de 11,45 meses. El unico factor relacionado con sobrevida libre de enfermedad fue la capacidad de realizar cirugía óptima (P=0,006). L cirugía citorreductora primaria sigue siendo la primera opción en cáncer de ovario epitelial avanzado, la quimioterapia neoadyuvante seguida de cirugía de intervalo es una opción válida en un subgrupo de pacientes con factores de riesgo adversos

Pseudotumor inflamatorio del hígado: en pacientes con adenoma tubulo velloso del colon / Inflammatory pseudotumor of the liver: in patient with tubulovillous adenoma of the colon

El pseudotumor inflamatorio del hígado es un tumor benigno de origen desconocido. En este trabajo se reporta el caso de un paciente masculino de 68 años de edad con malestar general, fiebre y dolor torácico. Se identificó un tumor hepático mediante estudios ecosonográficos y tomográficos. Asimismo se detectó un adenoma tubulo velloso en el colon

Uso de la gliricidia sepium en la suplementación de mautas mestizas y su efecto sobre el crecimiento y la aparición de la pubertad / Use of gliricidia sepium in feed supplementation of crossbred heifers and its effect on growth and the onset of puberty

Con el objetivo de determinar el efecto del uso de la leguminosa forrajera Gliricidia sepium (GS) en la suplementación de mautas mestizas sobre el crecimiento e inicio de la pubertad, se realizó un ensayo durante 10 meses, en una finca comercial ubicada en el sector "Río Grande", Municipio Panamericano, Estado Táchira, Venezuela. Treinta mautas mestizas con peso y edad promedio de 176,9 ± 24,6 kg y 17,22 ± 2,23 meses respectivamente, alimentadas a base de pastoreo en potreros de tanner (Brachiaria arrecta), fueron distribuidas aleatoriamente dentro de 3 grupos de suplementación: (T1) sin suplementación, (T2) alimento balanceado comercial y (T3) 50 por ciento de harina de maíz, 30 por ciento de harina de hojas de GS y 20 por ciento de melaza. Se registraron los pesos corporales cada 15 días y se tomaron muestras semanales de sangre para la determinación de progesterona en suero a través de radioinmunoanálisis. Los datos fueron analizados mediante un análisis de varianza-covarianza del sistema de análisis estadístico (SAS). Las variables evaluadas fueron peso corporal a la pubertad (PP), ganancia diaria de peso corporal (GDP) y edad a la pubertad (EP). Los resultados muestran que la suplementación en los grupos T2 y T3 hace que duperen significativamente (P<0,05) al grupo T1 en cuanto a la GDP (570 y 556 vs 457 g/día) y EP (670 y 720 vs 783 días). El PP no arrojó diferencias significativas. la suplementción con los tratamientos 2 y 3 logra reducir la edad de la aparición de la pubertad en hembras mestizas a pastoreo en condiciones tropicales; por lo tanto, la suplementación con GS mejora el rendimiento animal

Tratamiento neuroquirúrgico del hematoma extradural en el Hospital Clínico Regional de Antofagasta / Neurosurgical treatment of extradural hematoma in the Regional Hospital Clinic of Antofagasta, Chile

An analysis was made on processes of emergency attention, diagnosis, and neurosurgical treatment of patients with encephalocranial trauma complicated by extradural hematoma of patients entering the Neurosurgical and Neurological Service of the Regional Hospital Clinic of Antofagasta between 1999 and 2002. The causes of this injury included falls (four cases), traffic accidents (four cases) and head impacts (four cases). Of 12 patients submitted to surgery, all were male with ages between 15 and 47 years of age. Most of the injuries were frontal or temporal. Among the signs and symptoms the most frequent was impaired consciousness. A total of 83 percent of the patients required attention outside of normal working hours, and thus the wait between emergency treatment and neurosurgery was 7.34 hours. Computed axial tomography (CAT) was indicated as the diagnostic method of choice for this injury. There were no sequelae in 75 percent of the cases, while anosmia (17 percent) was the most relevant sequela. Mortality occurred in only case, and evolutional complications presented in three cases of the group studied. Recommendations are made for the optimization of the process of attention to these patients in a regional assistence network.

Se analizan los procesos de atención de urgencia, diagnóstico y tratamiento neuroquirúrgico de pacientes portadores de un traumatismo encefalocraneano complicado por un hematoma extradural que ingresaron al Servicio de Neurocirugía y Neurología del Hospital Clínico Regional de Antofagasta entre 1999 y 2002. Las causas del TEC fueron caídas (4 casos), accidente del tránsito (4 casos) e impacto craneano (4 casos). De 12 pacientes sometidos a cirugía, todos eran del sexo masculino, con edades entre 15 y 47 años. La mayoría de los HED fueron de localización frontal o temporal. Entre los signos y síntomas, el de mayor frecuencia fue el compromiso de conciencia. En el 83 por ciento de los pacientes la atención se realizó en horario no hábil, en tanto que el tiempo promedio de espera entre la hora de atención de urgencia y la intervención neuroquirúrgica fue de 7,34 horas. Se señala la tomografía axial computarizada (TAC) como el procedimiento diagnóstico de elección en el HED. El 75 por ciento de los casos no presentó secuelas, mientras que la anosmia (17 por ciento) fue la secuela más relevante. La mortalidad fue de un sólo caso y complicaciones evolutivas se observaron en 3 de los casos de esta serie. Se hacen recomendaciones a fin de optimizar el proceso de atención de este tipo de pacientes a nivel de la red asistencial regional.