Neuromyelitis Optica Spectrum Disorder in Central America and the Caribbean: A Multinational Clinical Characterization Study.

Here, a study of NMOSD in Central America and the Caribbean with a multinational collaborative, multicentric and descriptive approach involving 25 institutions from 9 countries is presented. Demographics, clinical manifestations, expanded disability scale status (EDSS), brain and spinal cord MRI, serological anti-AQP4-IgG and anti-MOG-IgG antibodies, and cerebrospinal fluid (CSF) oligoclonal bands were included. A central serological repository utilized the cell-based assay. The specimens outside of this network employed diverse methodologies. Data were collected at the Gorgas Commemorative Institute of Health Studies (ICGES), Panama, and included 186 subjects, of which 84% were females (sex ratio of 5.6:1). Mestizos constituted 72% of the study group. The median age was 42.5 years (IQR: 32.0-52.0). Associated autoimmune diseases (8.1%) were myasthenia gravis, Sjögren's syndrome and systemic lupus erythematosus. The most common manifestation was optic neuritis-transverse myelitis (42.5%). A relapsing course was described in 72.3% of cases. EDSS scores of 0-3.5 were reported in 57.2% of cases and higher than 7.0 in 14.5%. Positive anti-AQP4-IgG antibody occurred in 59.8% and anti-MOG-IgG antibody in 11.5% of individuals. Antibody testing was lacking for 13.4% of patients. The estimated crude prevalence of NMOSD from Panama and the Dominican Republic was 1.62/100,000 (incidence of 0.08-0.41) and 0.73/100,000 (incidence 0.02-0.14), respectively. This multinational study contributes additional insights and data on the understanding of NMOSD in this Latin American region.

Reduction in rate of epilepsy from neurocysticercosis by community interventions: the Salamá, Honduras study.

PURPOSE: Epilepsy is highly prevalent in developing countries like Honduras, with few studies evaluating this finding. This population-based study evaluated the impact of an 8-year public health and educational intervention program in reducing symptomatic epilepsies in rural Salamá, Honduras. METHODS: We used the capture and recapture method including review of charts, previous databases, key informants from the community, and a second house-to-house survey for epilepsy. Epilepsy incidence and prevalence day after the interventions was May 5, 2005. Residents with active epilepsy with onset after May 1997 were offered neurologic evaluation, electroencephalography, and brain tomography. New data over 8 years were compared to preintervention data from the initial baseline 1997 study utilizing prevalence ratios and confidence intervals. Other calculations utilized chi square or Fisher's exact tests. KEY FINDINGS: Thirty-three of 36 patients with onset of active epilepsy after 1997 accepted evaluations to determine etiology. Symptomatic etiology was found in 58.3%. Neurocysticercosis (NCC) was again the most frequent cause (13.9%), followed by perinatal insults (11.1%). Epilepsy secondary to NCC was significantly reduced from 36.9% in 1997 (p = 0.02). The incidence (35.7/100,000) and prevalence (11.8/1,000) of active epilepsy were not significantly reduced when compared to the incidence (92.7/100,000) and prevalence (15.4/1,000) of active epilepsy in 1997. SIGNIFICANCE: Our cohort appears to indicate that health and educational community interventions can reduce preventable epilepsy from NCC in a hyperendemic population in a low-resource, developing country. Plans are underway for the Honduran Government to institute this rural model countrywide.

Adherence and complementary and alternative medicine use among Honduran people with epilepsy.

Adherence to antiepileptic drugs (AEDs) and use of complementary and alternative medicine (CAM) among Hondurans with epilepsy were evaluated. Our epilepsy cohort of 274 outpatients was surveyed to determine demographics, epilepsy treatment history, adherence, and use of CAM. Nonadherence to epilepsy therapy was reported by 121, with unavailability of AEDs (48%) the most common reason. CAM was reportedly used by 141, with prayer, herbs, and potions being common. Forty-nine rural Miskito Hondurans without epilepsy were also interviewed to gain an understanding of their beliefs and longstanding practices regarding epilepsy. Seventeen (34.7%) attributed epilepsy to the supernatural; only three knew of an AED. Widespread nonadherence to evidence-based epilepsy treatments in Honduras can be attributed to inadequate education, AED unavailability, insufficient resources, cultural beliefs, and wide use of CAM. A comprehensive epilepsy education program and improved access to evidence-based AEDs represent initial priorities to improve the Honduran epilepsy treatment gap.

Evolución de pacientes con enfermedad cerebrovascular isquémica aguda. Hospital Mario Catarino Rivas, Honduras 2019 ­ 2020 / Clinical evolution of patients with Acute Ischemic Stroke. Hospital Mario Catarino Rivas, Honduras 2019 -2020

En nuestro país, la enfermedad cerebrovascular representa una situación alarmante, manifestándose en 3.6 y 5.7 por cada 1,000 habitantes en comunidades rurales y urbanas, respectivamente. Objetivo: Conocer la evolución de pacientes con Enfermedad Cerebrovascular Isquémica Aguda (ECVIA) según datos epidemiológicos y clínicos utilizando la Escala Modificada de Rankin y NIHSS (Escala de Enfermedad Cerebrovascular de los Institutos Nacionales de Salud) en pacientes atendidos en la emergencia de medicina interna del Hospital Mario Catarino Rivas de marzo de 2019 a marzo de 2020. Metodología: Estudio de diseño no experimental, enfoque cuantitativo, alcance descriptivo-correlacional, corte longitudinal. Universo de 86 pacientes y muestra de 68 pacientes con ECVIA. Previo consentimiento al familiar para evaluar al paciente y recopilar datos y 90 días después del primer contacto se realizó una segunda evaluación vía telefónica. Resultados: Mujeres y pacientes de tercera edad fueron los más afectados. El 85.29% (58) de los pacientes presentó Hipertensión Arterial, 39.71% (27) Diabetes Mellitus, 29.41% (20) Enfermedad Cerebrovascu- lar previa. Fallecieron 38 (55.88%) pacientes y 15 (22.06%) presentaron dependencia 90 días después del inicio de la patología. Pacientes con puntuación NIHSS mayor o igual a 16 tienen mayor riesgo relativo (R.R.) de mortalidad (R.R.: 1.91) y discapacidad (R.R.:2.74) que los pacientes que presentaron puntuación NIHSS inferior a 16. Conclusiones: Entre mayor sea el déficit neurológico al inicio de la patología, mayor es la probabilidad de fallecer o quedar con grado de discapacidad elevado...(AU)

Findlay Implantable Two-Stage Centrifugal Pump.

The Findlay centrifugal pump is unique in its two-stage pumping mechanisms and in its complementary interrelationship of the stages to each other and to the exit system, and it forms an extremely efficient unit. The first stage is a lift force pump as an inlet. The second and major stage is a shear force pump. Twenty-six prototypes, many multiply modified, have been hand fabricated, and most have had classic pump function analyses. Six pumps have demonstrated minimal hemolysis (3.5-5 h). At modest rotation speeds, it pumps water up to 10 L/min. Forty-four acute studies in normal dogs have been performed with the Findlay pump in a ventricular assist system. Blood flows through the pump ranged from 1.2 to 4.5 L/min. The conclusion is that the Findlay pump has the ability to operate with low blood damage, performs at acceptable rotational speed with reasonable hydraulic and mechanical efficiency, and is small and implantable.

Adult convulsive status epilepticus in the developing country of Honduras.

Epidemiologic data on convulsive status epilepticus (CSE) is needed to develop preventative strategies. Epilepsy is one of the known risk factors for CSE. A systematic review of epidemiologic studies on status epilepticus (SE) completed in the United States and Europe reports that people with epilepsy account for less than 50% of cases of SE in all age groups. Less is known about the epidemiology of SE in developing countries including those in Central America. A high incidence of epilepsy, widespread non-adherence to anti-epileptic drugs (AED), and common use of complementary and alternative medicines have been shown in all ages in the developing country of Honduras, Central America. In 2003, an epidemiologic study of CSE in Honduran children demonstrated it is common and exhibits a long duration until onset of treatment. The etiologies, treatment, and outcomes of CSE in Honduran adults have not been thoroughly studied. This study is a consecutive case series of 31 adult patients presenting with CSE to the adult medicine emergency department of the tertiary care "Hospital Escuela" in the capital city Tegucigalpa, Honduras. The majority (77.4%) of patients had a prior history of epilepsy. Non-adherence to AED was the most common etiology of CSE (75.0%). The mortality rate in this pilot CSE study was 14.8%, which is similar to studies from industrialized countries where mortality from status epilepticus ranged from 7.6 to 22% for all age groups. However, this rate is concerning given that CSE from epilepsy and AED non-adherence generally carries a good prognosis. Improving AED adherence in this population appears to be the most effective approach in decreasing the rate, and possibly the mortality of Honduran adult CSE.