Search

The objectives of the present study were to comprehensively evaluate all the published cases on compound odontoma associated with calcifying odontogenic cyst (COaCOC) in the English literature and to describe the clinical, imaging and therapeutic variables for this condition. In August 2020, an electronic search of the PubMed / MEDLINE, Web of Science, ScienceDirect, Springer, and Scopus databases was carried out. The eligibility criteria included publications with enough information to confirm the diagnosis. Furthermore, we present a clinical case of a 16-year-old male patient with OCCaC, who was treated with enucleation, obtaining favorable and functional results. A total of 32 cases reported in the literature that met the inclusion and exclusion criteria, including ours, were analyzed and discussed. The mayority of the patients were women (n = 17) with an average age of 14.4 years, the maxilla was the most affected bone (n = 22) and the maxillary anterior region was the area with the highest number of cases (n = 18), the main clinical presentations were the volume increase (n = 14) and asymptomatic (n = 14). The choice treatment was enucleation (n = 26) and, in most cases, no recurrence was reported (n = 20). This study allows to update the characteristics of the OCCaC, giving an effective vision of how to treat this rare pathological association made up of two conditions that are completely different from each other.

espanolPara identificar una patologia cada vez mas comun, conocida como mieloma multiple, es necesario hacer alusion de los factores especificos que la caracterizan. Para ello existen los clasicos criterios conocidos como CRAB (hipercalcemia, insufi- ciencia renal, anemia y lesiones liticas), siendo la insuficiencia renal una de sus complicaciones mas frecuentes. Reciente- mente se han descrito tres biomarcadores indiscutibles para el apoyo diagnostico del mieloma multiple, que son: mas del 10% de celulas plasmaticas clonales en medula osea o biopsia que corrobora la presencia de un plasmocitoma, relacion de cade- nas ligeras ≥ 100 mg/dl y mas de una lesion focal en resonancia magnetica. Se debe tomar siempre en cuenta el diagnostico diferencial con leucemia de celulas plasmaticas, plasmocitoma oseo solitario y plasmocitoma extramedular. Al ser una enfer- medad incurable, se ha investigado mucho en cuanto al manejo terapeutico, el cual tiene como objetivo principal la desapa- ricion de las celulas plasmaticas y la mejoria clinica del paciente. El primer farmaco que demostro algun beneficio fue el melfalan en el ano 1958 y posteriormente al adicionar un esteroide como segundo farmaco se logro mejorar las tasas de respuesta. Despues se fueron estudiando diferentes moleculas, con las que se han realizado multiples combinaciones, alcan- zando mejores tasas de supervivencia global y supervivencia libre de progresion. Anos mas tarde, con la llegada de los inhi- bidores de proteosoma como el bortezomib, asi como de los agentes inmunomoduladores como la talidomida y la lenalido- mida, se presenta un giro importante en la enfermedad, ya que se logran respuestas mas profundas, periodo de remisiones mas prolongadas y mejoria en la calidad de vida de los pacientes. Este consenso tiene la finalidad de integrar a un grupo de especialistas mexicanos y promover la actualizacion de esta patologia. EnglishTo identify this increasingly common pathology, known as Multiple Myeloma, it is necessary to refer to the specific factors that characterize it; to this end, the classic criteria known as CRAB (hypercalcemia, renal failure, anemia and lytic lesions) are available, in which renal failure is one of the most frequent complications. Recently, 3 indisputable biomarkers have been described for the diagnostic support for Multiple Myeloma, which are: more than 10% of clonal plasma cells in BM or, a biop- sy that corroborates the presence of a plasmacytoma, light chain ratio ≥100 mg/dL and more than one focal lesion on mag- netic resonance imaging (MRI). A differential diagnosis for plasma cell leukemia, solitary bone plasmacytoma, and extramed- ullary plasmacytoma should always be considered. Being this an incurable disease, a lot of research has been done regarding its therapeutic management, whose main objective is the disappearance of plasma cells and the patient clinical improvement. Melphalan was the first drug that showed a benefit in 1958 and afterwards, with the addition of a steroid as a second drug, it was possible to improve response rates. Subsequently, different molecules were studied, forming multiple combinations, and achieving better rates of Overall Survival and Progression-Free Survival. Years later, with the arrival of proteasome inhibitors such as bortezomib, and immunomodulators such as thalidomide and lenalidomide, an important turnaround in the disease has been seen, as deeper responses, more prolonged remissions, and improvement in the quality of life of patients have been achieved. This consensus has the purpose of integrating a group of Mexican specialists and promoting the updating of this pathology.

To identify this increasingly common pathology, known as multiple myeloma (MM), it is necessary to refer to the specific factors that characterize it; to this end, the classic criteria known as CRAB (hyperkalemia, renal failure, anemia, and lytic lesions) are available, in which renal failure is one of the most frequent complications. Recently, three indisputable biomarkers have been described for the diagnostic support for MM, which are: more than 10% of clonal plasma cells in bone marrow or, a biopsy that corroborates the presence of a plasmacytoma, light chain ratio ≥ 100 mg/dL and more than one focal lesion on magnetic resonance imaging. A differential diagnosis for plasma cell leukemia, solitary bone plasmacytoma, and extramedullary plasmacytoma should always be considered. Being this an incurable disease, a lot of research has been done regarding its therapeutic management, whose main objective is the disappearance of plasma cells and the patient clinical improvement. Melphalan was the first drug that showed a benefit in 1958 and afterward, with the addition of a steroid as a second drug, it was possible to improve response rates. Subsequently, different molecules were studied, forming multiple combinations, and achieving better rates of overall survival and progression-free survival. Years later, with the arrival of proteasome inhibitors such as bortezomib, and immunomodulators such as thalidomide and lenalidomide, an important turnaround in the disease has been seen, as deeper responses, more prolonged remissions, and improvement in the quality of life of patients have been achieved. This consensus has the purpose of integrating a group of Mexican specialists and promoting the updating of this pathology.

Background: The optimal imaging paradigm for endovascular thrombectomy (EVT) patient selection in early time window (0–6 hours) treated acute ischemic stroke patients remains uncertain. We aimed to compare post-EVT outcomes between patients who underwent prerandomization basic (noncontrast computed tomography [CT], CT angiography only) versus additional advanced imaging (computed tomography perfusion [CTP] imaging) and to determine the association of performance of prerandomization CTP imaging with clinical outcomes. Methods: The HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) pooled patient-level data from randomized controlled trials comparing EVT with usual care for acute ischemic stroke due to anterior circulation large vessel occlusion. Good functional outcome, defined as modified Rankin Scale score 0 to 2 at 90 days, was compared between randomized patients with and without CTP baseline imaging. Univariable and multivariable binary logistic regression analysis was performed to determine the association of baseline CTP imaging and good functional outcome. Results: We analyzed 1348 patients 610 (45.3%) of whom underwent CTP prerandomization. The benefit of EVT compared with best medical management was maintained irrespective of the baseline imaging paradigm (90-day modified Rankin Scale score 0–2 in EVT versus control patients: with CTP: 46.0% (137/298) versus 28.9% (88/305), without CTP: 44.1% (162/367) versus 27.3% (100/366). Performance of CTP baseline imaging compared with baseline noncontrast CT and CT angiography only yielded similar rates of good outcome (odds ratio, 1.05 [95% CI, 0.82–1.33], adjusted odds ratio, 1.04, [95% CI, 0.80–1.35]). Conclusions: Rates of good functional outcome were similar among patients in whom CTP was or was not performed, and EVT treatment effect in the 0- to 6-hour time window was similar in patients with and without baseline CTP imaging.

INTRODUCTION Ischaemic stroke is the most common neurological complication of cardiac catheterisation. This study aims to analyse the clinical and prognostic differences between post-catheterisation stroke code (SC) and all other in-hospital and prehospital SC. METHODS We prospectively recorded SC activation at our centre between March 2011 and April 2016. Patients were grouped according to whether SC was activated post-catheterisation, in-hospital but not post-catheterisation, or before arrival at hospital; groups were compared in terms of clinical and radiological characteristics, therapeutic approach, functional status, and three-month mortality. RESULTS The sample included 2224 patients, of whom 31 presented stroke post-catheterisation. Baseline National Institutes of Health Stroke Scale score was lower for post-catheterisation SC than for other in-hospital SC and pre-hospital SC (5, 10, and 7, respectively; P=.02), and SC was activated sooner (50, 100, and 125minutes, respectively; P

Background and Purpose: Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT. Methods: We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry—a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Logistic regression analysis was used to assess the association between prestroke disability and outcomes and to identify a disabled patient profile with favorable outcome after MT. Results: Of 2487 patients included in the study, 409 (17.1%) had prestroke disability (313 modified Rankin Scale score 2 and 96 modified Rankin Scale score 3). After adjustment for covariates, prestroke disability was not associated with a lower chance of achieving favorable outcome at 90 days (24% versus 30%; odds ratio, 0.79 [0.57–1.08]), whereas it was independently associated with a higher risk of symptomatic intracranial hemorrhage (5% versus 3%; odds ratio, 2.04 [1.11–3.72]) and long-term mortality (31% versus 18%; odds ratio, 1.74 [1.27–2.39]) compared with patients without disability. Prestroke disabled patients without diabetes, Alberta Stroke Program Early CT Score >8 and National Institutes of Health Stroke Scale score Conclusions: Despite a higher mortality and risk of symptomatic intracranial hemorrhage, prestroke-disabled patients return as often as independent patients to their prestroke level of function, especially those nondiabetic patients with favorable early ischemic signs profile. These data support a potential benefit of MT in patients with previous mild or moderate disability after large anterior vessel occlusion stroke.

Resumen Introduccion El gen ATXN2 presenta un VNTR (CAG)n con locus en el exon 1, los alelos largos dentro del rango normal (22-29 repeticiones) se asocian con obesidad severa en sujetos del Reino Unido, Indonesia y el Caribe. Objetivo Analizar la influencia del VNTR (CAG)n del gen ATXN2 en el perfil metabolico en adultos con obesidad y preobesidad asi como analizar su asociacion con parametros metabolicos y ambientales de riesgo cardiovascular. Metodos y materiales Se incluyeron 255 adultos de origen etnico amerindio chinanteca a quienes se les realizo evaluacion antropometrica y bioquimica. El VNTR fue amplificado por PCR punto final y electroforesis PAGE al 8%. Resultados Se encontraron diferencias en la circunferencia indice cintura/cadera e indice de masa corporal en los portadores de genotipos diferentes al homocigoto de 22 repeticiones con un valor para la prueba t de Student de 0,0041 y 0,0334 respectivamente. Tambien encontramos asociacion con la historia familiar de enfermedad cronica. Conclusion El VNTR de ATXN2 se asocia al grado de obesidad en adultos mexicanos con ancestria chinanteca.

Background and Purpose: Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. Methods: We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B–3), and follow-up infarct volume (in mL). Results: Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly ( P =0.03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1.2 [95% CI, 1.1–1.3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1.0 [95% CI, 0.9–1.1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7.0–17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0.83 [95% CI, 0.70–0.97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Conclusions: Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.

Supplemental Digital Content is available in the text., Background and Purpose: Benefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice. Methods: We used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic. Results: We included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (

Introduction:Posner - Schlossman Syndrome (PSS) is a rare disease, more prevalent in men between 20 and 50 years old, characterized by recurrent attacks of anterior uveitis and ocular hypertension.Clinical case:We report the case of a 42-year-old patient with a single eye. He came to the consultation presenting decreased visual acuity, photobobia, halos around the lights, and intense pain in his left eye. The ophthalmological examination revealed inflammatory signs in the anterior segment, elevated intraocular pressure and damage to the optic nerve. Medical treatment was started with corticosteroids and topical antiglaucoma drugs, oral acetazolamide and intravenous mannitol, obtaining no response and it was decided to perform a surgical intervention (Ahmed valve implantation) in the left eye, subsequently achieving a good clinical evolution and resolution of the case.Conclusion:This report highlights that the episodic and recurrent nature of SPS requires strict monitoring. Introducción:El Sindrome de Posner - Schlossman (SPS) es una enfermedad infrecuente, de mayor prevalencia en hombres de entre 20 a 50 años, que se caracteriza por presentar ataques recurrentes de uveítis anterior e hipertensión ocular.Caso clínico:Reportamos el caso de un paciente de 42 años, con ojo único. Acudió a consulta presentando disminución de la agudeza visual, fotobobia, halos alrededor de las luces y dolor intenso en su ojo izquierdo. Al examen oftalmológico se evidenciaron signos inflamatorios en segmento anterior, presión intraocular elevada y daño en el nervio óptico. Se inició tratamiento médico con corticosteroides y antiglaucomatosos tópicos, acetazolamida oral y manitol endovenoso, no obteniendo respuesta y se optó por realizar una intervención quirúrgica (implante de válvula de Ahmed) en el ojo izquierdo, logrando posteriormente una buena evolución clínica y resolución del caso.Conclusión:Este reporte resalta que la naturaleza episódica y recurrente del SPS requiere un seguimiento estricto.

Introducción: a nivel internacional hay una búsqueda de donadores debido a una demanda creciente mientras que éstos son pocos. Dentro de la cultura de la donación existen los factores sociales y psicológicos que influyen directamente en la decisión de la familia de un potencial donador por muerte encefálica. Objetivo: identificar cuáles son las experiencias de la familia ante la condición potencial de donación de órganos en pacientes con muerte encefálica en una institución de tercer nivel. Material y métodos: estudio mixto cuanti-cualitativo retrospectivo, transversal realizado en una institución de tercer nivel, por medio de una familia (el responsable) con un integrante donador por muerte encefálica. Análisis: estadística descriptiva con valores porcentuales, en Spss 23 previo, diseño de base de datos con variables sociodemográficas y de actitud. Resultados: el 51.8 % de la población tuvo el diagnóstico de hemorragia subaracnoidea; seguida del 18.4 % con diagnóstico de tumor cerebral. Y un 9.6% diagnosticados con evento vascular cerebral. Destaca un 1.8 % con diagnóstico de criptocosis cerebral. La investigación revela que el 53.5 % de la población es femenina y el 46.5 % masculina, en la relación con el índice de donación el 43.3 % de los hombres aceptan la donación a diferencia del 23 % de las mujeres que se convierten en donadoras. Conclusiones: las experiencias de los familiares de donadores por muerte encefálica reflejan disposición para donar. Sin embargo, es evidente que se requiere una evaluación de las condiciones emocionales del familiar, en el momento de sugerirle la posibilidad de autorizar la donación.

Background Frailty is defined as decreased physiologic reserve and resistance to stressors that predisposes patients towards poor health results. Its prevalence in chronic kidney disease (CKD) patients who are kidney transplant (KT) candidates is high. Frailty is associated with a higher rate of complications and mortality after transplant. It is unknown whether frailty phenotype differs depending on sex in this population. Methods This was a prospective longitudinal study of 455 KT candidates evaluated for frailty by physical frailty phenotype at the time of inclusion on the KT waiting list. Pre-frailty was defined as the presence of two criteria and frailty as three or more criteria. Univariate and multivariate analyses searched for associations of frailty status, frailty components and gender differences. Results Thirty percent of the total cohort resulted to be pre-frail (20%) or frail (10.3%), but disparities were observed between sexes, with 22.5% of men and 47.2% of women falling into one of these categories. Among frailty criteria, women presented with a higher percentage of exhaustion (39.6% versus 17%) and slowness (22.2% versus 9.6%) compared with men. Comorbidity burden was higher among frail men, whereas social factors were poorer between frail women. Disability was common among those patients who were frail, both men and women. Conclusions Frailty is twice as frequent in advanced CKD women as men. Frailty criteria distribution and phenotype seem to differ among sexes, which might have implications in terms of specific and individualized interventions to improve their status before transplantation., GRAPHICAL ABSTRACT Graphical Abstract

ObjectiveTo test the hypothesis that IV thrombolysis (IVT) treatment before endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the Safe Implementation of Treatment in Stroke–International Stroke Thrombectomy Register (SITS-ISTR).MethodsWe identified centers recording ≥10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014 to 2019. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery, and first segment of anterior cerebral artery. Main outcomes were functional independence (mRS score 0–2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS–Monitoring Study. We performed propensity score–matched (PSM) and multivariable logistic regression analyses.ResultsOf 6,350 patients from 42 centers, 3,944 (62.1%) received IVT. IVT + EVT–treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure, and prestroke disability. PSM analysis showed that IVT + EVT–treated patients had a higher rate of functional independence than patients treated with EVT alone (46.4% vs 40.3%,p< 0.001) and a lower rate of death at 3 months (20.3% vs 23.3%,p= 0.035). SICH rates (3.5% vs 3.0%,p= 0.42) were similar in both groups. Multivariate adjustment yielded results consistent with PSM.ConclusionPretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS-ISTR. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding, and possible residual confounding by indication.Classification of EvidenceThis study provides Class II evidence that IVT before EVT increases the probability of functional independence at 3 months compared to EVT alone.

Objective In small for gestational age (SGA) children, catch-up growth could be influenced by methylation of several genes involved in metabolism. Epigenetics may influence the development of metabolic diseases in adulthood. To compare the methylation of leptin (LEP), glucagon-like peptide-2 receptor (GLP2R), insulin receptor substrate-2 (IRS2) in SGA patients with and without catch-up growth. Methods Observational prospective study of SGA children. Demographical and clinical variables were collected from clinical records and parents’ questionnaire. Methylation status of LEP, IRS2, and GLP2R promoters was evaluated in DNA extracted from patient and one parent saliva samples. Results Forty-eight SGA patients were included. Twenty-six (54.2%) had catch-up growth phenotype and 22 (45.8%) did not. The median age was 5.2 years [RIC 4.1-6.8] without difference between groups (p=0.306). The catch-up group had increased appetite (42.3% vs 9.1%, p=0.008), family history of dyslipidemia (42.3% vs 27.3%) and diabetes (34.6% vs 22.7%) compared to non-catch-up group. Catch-up patients had significantly larger waist circumference compared to non-catch-up group (median 55 cm [RIC 52-58] versus median 49.5 cm [RIC46-52]; p

Duchenne muscular dystrophy (DMD) is a neuromuscular disease that leads to progressive and fatal physical deterioration. The progression of this disease requires frequent or permanent care that implies high levels of demand for the caregivers of children who have developed DMD. Certainly, this disease affects diagnosed children and their caregivers as well. The support from the health system is scarce for both, which translates into an intense burden for the mothers and women of the family who care the person diagnosed with DMD during their lifetime. This qualitative study with phenomenological approach aimed to analyze the meaning of the experience of being a caregiver for boys and young men living with DMD in Colombia. After obtaining their informed consent, caregivers were interviewed and a thematic analysis of their narratives was performed to determine three key topics that endow their experiences with meaning: (1) finding out about the disease, (2) living according to the needs of boys and young men, and (3) providing a new meaning to life. The results show that the meaning of DMD is strongly associated with intense suffering and psychological stress, with a high negative burden, especially during the initial years after diagnosis. The study suggests that it is important to assimilate and process these experiences and findings to learn how to live with DMD and identify the certainty of a child’s premature death.

espanolObjetivo: Determinar la relacion entre la presencia de comorbilidades y la presentacion de complicaciones en las coberturas de las ulceras de presion pelvicas. Material y Metodos: Investigacion descriptiva, retrospectiva, transversal de tipo correlacional, que fue realizado en el Servicio de Cirugia Plastica del Hospital Regional Docente de Cajamarca en Peru, desde Junio de 2010 a Junio 2020. La muestra fue de 35 pacientes con un total de 54 ulceras por presion en Estadios III y IV. Resultados: Encontramos que el sexo masculino fue el mas representativo (77,1%), en su mayoria fueron adultos (60%) con un media de 38,2 ± 13,7. Ademas, el 37.1% estaba expuesto a una comorbilidad, el 42.1% presentaba diabetes mellitus y el 26.3% tuvo obesidad. La etiologia de la ulcera fue por paraplejia (74,1%) y el encamamiento prolongado (11.1%). La ubicacion de la lesion mas frecuente fue la Zona sacra (48,1%), seguido de la region trocanterica derecha (18,5%). El 72,2% de los casos presentaron ulceraciones menores de 10 cm de diametro y el 59,3% tenian una ulcera con profundidad del tipo IV. El tipo de reconstruccion que mas se uso fue el colgajo local de tipo axial en el 59,3% de los casos. El diseno que mas se empleo en la reconstruccion fue el colgajo fasciocutaneo gluteo mayor en V-Y bilateral (29,6%) seguido de colgajos de Tensor de Fascia Lata. Hubo complicaciones en 25,9%, siendo la mas frecuente la necrosis parcial (35,3%). Se encontro como factores de riesgo a las comorbilidades y el tamano de lesion. Conclusiones: Los pacientes con Ulceras de Presion de tipo quirurgica que presentaron comorbilidades y con mayores tamano de lesion presentaron mayor frecuencia de complicaciones con diferencia estadisticamente significativa. EnglishObjective: To determine the relationship between the presence of comorbidities and the presentation of complications in the coverage of pelvic pressure ulcers. Material and Methods: Descriptive, retrospective, cross-sectional research of correlational type, which was carried out in the Plastic Surgery Service of the Regional Teaching Hospital of Cajamarca in Peru, from June 2010 to June 2020. The sample consisted of 35 patients with a total of 54 pressure ulcers in Stages III and IV. Results: We found that the male sex was the most representative (77.1%), the majority were adults (60%) with a mean of 38.2 ± 13.7. In addition, 37.1% were exposed to comorbidity, 42.1% had diabetes mellitus, and 26.3% had obesity. The etiology of the ulcer was paraplegia (74.1%) and prolonged bedwetting (11.1%). The most frequent location of the lesion was the sacral area (48.1%), followed by the right trochanteric region (18.5%). 72.2% of the cases presented ulcerations smaller than 10 cm in diameter and 59.3% had a type IV deep ulcer. The type of reconstruction that was most used was the local axial flap in 59.3% of the cases. The design most used in the reconstruction was the bilateral V-Y gluteal fasciocutaneous flap (29.6%) followed by Tensor Fascia Lata flaps. There were complications in 25.9%, the most frequent being partial necrosis (35.3%). Comorbidities and lesion size found were as risk factors. Conclusions: Patients with surgical pressure ulcers who presented comorbidities and with larger lesions presented a higher frequency of complications with a statistically significant difference. Keywords: Pressure ulcer, complications

Background and Purpose: Improving prehospital triage of large vessel occlusion (LVO) would reduce time to reperfusion therapies. We aimed to study early predictors of LVO in acute ischemic stroke to identify candidates for endovascular treatment. Methods: The Stroke-Chip was a prospective observational study conducted at 6 Stroke Centers in Catalonia. Blood samples were obtained in the first 6 hours from symptom onset of consecutive patients. Stroke severity was evaluated with National Institutes of Health Stroke Scale (NIHSS) and LVO was assessed. Independent association of multiple blood biomarkers with LVO was evaluated using logistic regression models adjusted by covariates. Sensitivity, specificity, and predictive values were assessed for NIHSS and the combination of NIHSS and selected serum biomarkers levels. Results: One thousand three hundred eight suspected strokes were enrolled for a 17-month period. LVO was not assessed in 131 patients. One thousand one hundred seventy-seven patients were selected for analysis (mean age 69.3 years, 56% men, median baseline NIHSS of 6, and median time to blood collection 2.5 hours). LVO was detected in 262 patients. LVO patients were older, had higher baseline NIHSS, history of atrial fibrillation, and lower time from stroke onset to admission. After logistic regression analysis, D-dimer remained an independent predictor of LVO (odds ratio, 1.59 [1.31–1.92]). Specificity and positive predictive value to exclude or detect LVO were higher when using combined D-dimer levels and NIHSS score assessment rather than NIHSS alone. Conclusions: Early D-dimer levels are an independent predictor of LVO and may be useful to better optimize prehospital patient transport to the appropriate stroke center.

Fernandez-Sanjurjo, M, Diaz-Martinez, AE, Diez-Robles, S, Gonzalez-Gonzalez, F, de Gonzalo-Calvo, D, Rabadan, M, Davalos, A, Fernandez-Garcia, B, and Iglesias-Gutierrez, E. Circulating microRNA profiling reveals specific subsignatures in response to a maximal incremental exercise test. J Strength Cond Res XX(X): 000-000, 2020-Circulating microRNAs (c-miRNAs) have been described as emergent regulators and biomarkers of exercise. The aim of this study was to analyze the c-miRNA response to a maximal incremental exercise test (MIET) and its relationship with markers of exercise response and adaptation. Two blood samples were collected from 9 male amateur runners (31-50 years), before (Pre) and after (Post) a MIET. The maximal oxygen uptake (V[Combining Dot Above]O2max), maximum heart rate (HRmax), and maximal aerobic speed (MAS) were recorded. Lactate and creatine kinase (CK) plasma concentrations were measured. A panel of 752 miRNAs was analyzed using standardized protocols and relative quantification to Pre. A total of 13 miRNAs were found significantly upregulated at Post. By focusing on the exercise markers that correlate with the expression of these miRNAs, they were clustered into different functional groups or subsignatures. Thus, miR-21-5p, miR-29b-3p, and miR-183-5p showed a strong correlation with HRmax and a validated target signature related to fatty acid metabolism. Furthermore, let-7c-5p, miR-340-5p, miR-425-3p, and miR-629-5p were significantly correlated with CK, and the most significantly enriched pathways for these subsignatures were the Hippo signaling pathway and signaling pathways regulating pluripotency of stem cells. Finally, Pre miR-106b-5p expression showed an inverse association with MAS and Post lactate concentration, which highlights its relevance as biomarker of training status and its predictive value for performance. No significant correlations were observed with V[Combining Dot Above]O2max. Our results define for the first time specific functional c-miRNA subsignatures, adding novel evidence about their potential regulatory role in exercise response.

Those caring for someone diagnosed with a neurodevelopmental disorder are at risk of experiencing depression and anxiety. However, limited research has examined risk and predictive factors associated with internalizing symptomatology in caregivers from ethnic and culturally diverse backgrounds. We aimed to identify predictive factors for internalizing symptomatology. Using standardized scales, anxiety and depression levels were measured in a predominantly Latinx sample along with their endorsed levels of familism, perceived social, and support affiliate stigma. Multivariate regression analyses were used to test the hypotheses that familism, perceived social support, and affiliate stigma are associated with self-reported depression and anxiety symptoms, separately. The results indicated a significant effect of perceived social support and affiliate stigma on depression and anxiety symptoms, but no such effect of familism. Findings indicate that higher perceived social support scores predicted lower rates of anxiety and depression in caregivers. Conversely, higher affiliate stigma scores predicted higher rates of anxiety and depression. Results provide important clinical implications when working with Latinx families and caregivers of a family member diagnosed with a neurodevelopmental disorder.

Background: Negative attitudes towards people with mental health disorders have been widely studied and identified in the general population, and even within health care professionals. Moreover, studies focused on service users have also identified mental health professionals, including psychiatrists, as a source of stigma. However, in Mexico and Latin America few studies have been conducted addressing this issue.Aims: To explore mental health service users’ perceptions of stigma by members of the general population and by psychiatrists in MexicoMethods: Service users at a psychiatric hospital in Mexico were invited to participate in either focus groups or individual interviews, which were audio recorded, transcribed and analysed using thematic analysis. Results: A total of 47 service users participated in this study. The results suggested that participants were not only aware of the possible consequences of mental health related stigma, but they have also experienced stigmatisation for having a mental illness. Participants also considered psychiatrists can hold negative attitudes towards people with mental illness, something that can represent a barrier for them to have optimal quality of care. Therefore, participants agreed that these attitudes should be addressed to improve the care they received from these professionals. Conclusions: This study suggests that, like members of the general population, psychiatrists are also considered as a source of stigma by people with mental illness in Mexico. These findings not only add to previous work conducted in Mexico and other countries, they also confirm the importance of addressing negative attitudes in this group of health professionals.

Resumen: Antecedentes: Existe un incremento de reportes sobre casos de COVID-19 que presentan síntomas gastrointestinales (GI). Objetivo: Revisión de estudios que reportaron síntomas GI en COVID-19. Resultados: Quince artículos (2,800 pacientes) fueron identificados. La frecuencia de síntomas GI varió del 3.0 al 39.6%, incluyendo diarrea: 7.5%, náuseas: 4.5%, anorexia: 4.4%, vómitos: 1.3%, dolor abdominal: 0.5%, eructos/reflujo: 0.3%. Estos pueden ser la primera manifestación de COVID-19, pero existe controversia sobre si reflejan mejor o peor pronóstico. Se discute la relación potencial del receptor de la enzima conversora de angiotensina ii en el tracto digestivo como ruta de entrada del virus. Conclusión: Los síntomas GI pueden ser comunes en COVID-19 y en algunos casos ser la primera manifestación incluso antes de fiebre y síntomas respiratorios. Por ello, los clínicos y gastroenterólogos debemos estar alertas a estos casos atípicos durante la actual pandemia y sobre la probable transmisión fecal-oral, y considerar medidas preventivas. Abstract: Background: There is an increasing number of reports on the presentation of gastrointestinal symptoms in cases of COVID-19. Aim: To review the studies reporting gastrointestinal symptoms in COVID-19. Results: Fifteen articles (2,800 patients) were identified. Gastrointestinal symptom frequency varied from 3.0% to 39.6% and included diarrhea (7.5%), náusea (4.5%), anorexia (4.4%), vomiting (1.3%), abdominal pain (0.5%), and belching/reflux (0.3%). Those symptoms can be the first manifestation of COVID-19, but whether they reflect a better or worse prognosis, is controversial. The potential relation of the angiotensin converting enzyme 2 receptor in the digestive tract as an entry route for the virus is discussed. Conclusion: Gastrointestinal symptoms may be common in COVID-19, in some cases appearing as the first manifestation, even before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists must be aware of those atypical cases during the current pandemic, as well as of the fecal-oral route and corresponding preventive measures.

RESUMEN Introducción: la neutropenia es una situación de riesgo de infecciones que puede generar elevada morbimortalidad. La fiebre es un marcador de riesgo de complicaciones. Objetivo: determinar la relación de la fiebre con la morbimortalidad y la duración de la internación en pacientes con neutropenia. Metodología: diseño observacional, retrospectivo, realizado en pacientes adultos con neutropenia internados en el Hospital Nacional (Itauguá, Paraguay) entre 2017 y 2019. Se conformaron dos cohortes: una con neutropénicos con fiebre y otra sin fiebre. La variable independiente fue la fiebre y las dependientes fueron la morbimortalidad, los días de internación y las complicaciones nosocomiales. Todos los pacientes fueron tratados con los protocolos vigentes. El estudio contó con la aprobación del Comité de Ética de la Universidad Nacional de Itapúa. Resultados: ingresaron al estudio 169 sujetos con neutropenia, con edad media 44 ± 20 años, siendo 51,4 % del sexo femenino. La cohorte con fiebre se constituyó con 76 sujetos, tuvo una media de internación de 20 ± 10 días y mortalidad 30,9 %. La cohorte sin fiebre se conformó con 96 sujetos, tuvo una media de internación de 15 ± 10 días y mortalidad 10,7 %. Conclusiones: la fiebre en los pacientes con neutropenia se asocia a mayor mortalidad, complicaciones nosocomiales y estancia hospitalaria. ABSTRACT Introduction: neutropenia is a situation with risk of infections that can generate high morbidity and mortality. Fever is a risk factor for complications. Objective: to determine the relation of fever with morbidity and mortality, and length of hospitalization in patients with neutropenia. Methodology: observational, retrospective design, carried out on adult patients with neutropenia hospitalized at the National Hospital (Itauguá, Paraguay) between 2017 and 2019. Two cohorts were formed: one with neutropenic patients with fever and the other without fever. The independent variable was fever and the dependent variables were morbidity and mortality, hospitalization days, and nosocomial complications. All patients were treated with current protocols. The study had the approval of the Comité de Ética of the Universidad Nacional de Itapúa. Results: 169 subjects with neutropenia entered the study, with a mean age of 44 ± 20 years, being 51,4 % female. The fever cohort was made up of 76 subjects, with a mean hospitalization of 20 ± 10 days and mortality of 30,9 %. The fever-free cohort was made up of 96 subjects, had a mean hospitalization of 15 ± 10 days and mortality of 10,7 %. Conclusions: fever in patients with neutropenia is associated with higher mortality, nosocomial complications and hospital stay.

Objective To describe the morphometric characteristics and thickness of the retinal nerve fibre layer (CFNR) in healthy patients using optical coherence tomography (OCT). Methods A cross-sectional and descriptive study was conducted on a total of 184 eyes of 184 people of mestizo origin enrolled after a complete ophthalmological evaluation at the National Institute of Ophthalmology, Lima-Peru. The morphometric parameters of the optical disc and thickness of the CFNR were measured by OCT ZEISS Cirrus HD Model 5000. Megalopapilla was defined as: area of ​​the optical disc greater than 2.5 mm2 and area greater than the mean plus 2 standard deviations. Results The areas obtained were: optical disc of 2.21 ± 0.43 mm2, neuroretinal ring of 1.37 ± 0.25 mm2, 0.84 ± 0.48 mm2 cup; mean cup/disc ratio of 0.58 ± 0.16, vertical cup/disc ratio of 0.55 ± 0.15, and a CFNR thickness of 100.30 ± 8.54 μm. The prevalence of megalopapilla, being considered as a disc area greater than 2.5 mm2 and 3.07 mm2, was 24% and 4%, respectively. When comparing megalopapilla with normal discs, the area of ​​the ring (P = .08) and thickness of CFNR (P = .73) did not show statistically significant differences. Conclusion The mean disc area was 2.21 ± 0.43 mm2 with a CFNR thickness of 100.30 ± 8.54 μm. The prevalence of megalopapilla was 24% and 4%, considering a disc area greater than 2.5 mm2 and 3.07 mm2, respectively. These results show that the megalopapilla and normal discs are similar in terms of ring area and CFNR thickness.

Objetivo: Comparar el desempeño profesional del personal de los establecimientos de salud con funciones obstétricas-neonatales esenciales I-II entre Lima y Provincias durante el periodo setiembre-octubre del 2015. Materiales y métodos: Es una investigación analítica transversal realizada a 350 establecimientos de salud con funciones obstétricas-neonatales esenciales I-II, basada en las encuestas nacionales realizadas por el Instituto Nacional de Estadística e Informática durante el 2015. Se fusionó 2 bases de datos y se generó nuevas variables para determinar el desempeño laboral y se analizaron los datos con el software estadístico R y el IBM SPSS Statistics 25 usando la prueba chi cuadrado. Resultados: El estudio mostró que el licenciado de obstetricia fue el personal de salud que con más frecuencia atendió partos vaginales, tanto en Lima (62.9%) como en provincias (91.4%). Respecto al partograma, solo un 5% de establecimientos de Lima y un 4% de establecimientos de provincias llenaban de forma completa el partograma. Se encontró diferencia significativa en el desempeño laboral durante el manejo del parto expulsivo (p=0.008) y el alumbramiento (p=0.014). Igualmente, se encontró diferencias significativas en el retraso del clampaje del cordón umbilical (p=0.002) de Lima respecto a provincias. El tiempo promedio del clampaje fue de 2 minutos 30 segundos en ambos casos y sobre el contacto piel a piel, fue de 13 minutos para Lima y 10 minutos para provincias. Conclusiones: Existe una brecha en el desempeño profesional durante la atención del parto vaginal entre los establecimientos FONE I-II de Lima y provincias. Nacionalmente aún existen déficits de cumplimiento de los indicadores para lograr una adecuada atención.

El diagnóstico temprano de la infección por SARS-CoV-2 es muy importante para establecer un tratamiento oportuno. En el presente reporte, en la exploración realizada en otorrinolaringología encontramos un enantema vesicular aperlado en el paladar superior en 954 de 958 pacientes con la cepa clásica, y no se encontró en pacientes con la cepa inglesa. Este hallazgo no se había reportado. Los pacientes fueron tratados a tiempo exitosamente y solo dos pacientes murieron, lo cual se asoció a diabetes mellitus descompensada. Este reporte sugiere que el enantema vesicular encontrado es patognomónico de COVID-19 por cepas clásicas.

Objetivo Evaluar los resultados funcionales y el impacto en la calidad de vida de pacientes con paralisis cordal unilateral en abduccion (PCUA) de etiologia variable, posoperados de tiroplastia de medializacion con tecnica de Netterville en el Instituto Nacional de Rehabilitacion. Metodo En los pacientes candidatos a tiroplastia de medializacion se documentaron el tiempo maximo fonatorio y cuestionarios de funcionalidad (VHI-30) y calidad de vida (VRQoL) prequirurgicos y 3 a 6 meses posquirurgicos. Se utilizaron pruebas de comparacion de medias para analizar los resultados. Resultados Se realizo tiroplastia de medializacion en 27 pacientes con PCUA de 2013 a 2019. Todos tuvieron mejoria estadistica y clinicamente significativa por el tiempo maximo fonatorio (media de 4.07 a 11.07 segundos), el VHI-30 (media de 81 a 29 puntos) y la VRQoL (media de 33 a 15 puntos). No se documento ninguna complicacion mayor. Conclusiones La tiroplastia de medializacion es un tratamiento seguro que mejora de manera significativa la calidad de vida y la funcionalidad de los pacientes con PCUA. Objective To evaluate functional and quality of life results in patients with unilateral vocal fold paralysis (UVFAP) of different etiology, who underwent medialization thyroplasty, using Netterville’s technique. Method In patients eligible for medialization thyroplasty, maximum phonatory time was measured, quality of life (VRQoL) and functionality (VHI-30) questionnaires were applied before surgery and posteriorly at 3 and 6 months after surgery. Means comparison tests were used to analyze the results. Results Medialization thyroplasty was carried out in 27 patients presenting with UVFAP from 2013 to 2019. All had a statistically significant and clinically significant improvement. This was measure with maximum phonatory time (medium of 4.07 to 11.07 seconds), VHI-30 (medium of 81 to 29 points), and VRQoL (medium of 33 to 15 points). No mayor complications were documented. Conclusions Medialization thyroplasty is a safe procedure that significantly improves functionality and quality of life in patients with UVFAP.

RESUMEN Introducción: la enfermedad por el nuevo coronavirus 2019 (COVID-19) es actualmente la causa de una pandemia. Los profesionales de la salud deben tener información confiable y fidedigna sobre el COVID-19. Objetivos: determinar los conocimientos, la percepción de riesgo y prácticas del personal de salud del Hospital Nacional de Itauguá y Hospital Regional de Caacupé acerca de la enfermedad COVID-19. Materiales y métodos: estudio observacional, transversal, realizado en ambos hospitales. Se solicitó al personal médico y de enfermería de dichos hospitales su participación respondiendo el cuestionario anónimo online. El estudio contó con la aprobación del Comité de Ética de la Universidad Nacional de Itapúa. Resultados: participaron del estudio 384 sujetos, de los cuales 334 (86,98%) refirieron haber recibido capacitación sobre COVID-19, 245 (63,8%) participantes fueron del sexo femenino, la edad promedio fue 32,6 ± 8 años, 315 (82%) procedían del área urbana, 214 (55,7%) pertenecen al Hospital Nacional de Itauguá y 170 (44,3%) al Hospital Regional de Caacupé. Respecto a su profesión, 274 (71,3%) son médicos, 89 (23,2%) licenciados en enfermería y 21 (5,5%) técnicos en enfermería. El promedio del porcentaje de respuestas correctas fue 84,70% ± 14,02%. Un total de 319 (83,07%) participantes presentó un alto nivel de conocimientos (≥75% de respuestas correctas). La percepción de riesgo más frecuente (96%) fue que la falta de información dificulta la preparación del personal de salud. La práctica preventiva predominante (95%) fue el autorreporte de los síntomas. Conclusión: el nivel de conocimientos del personal sanitario sobre COVID-9 fue elevado, la mayoría percibe los factores de riesgo de infección y demuestra prácticas preventivas contra esta enfermedad. ABSTRACT Introduction: The new coronavirus disease 2019 (COVID-19) is currently the cause of a pandemic. Health professionals must have reliable and trustworthy information about COVID-19. Objectives: To determine the knowledge, risk perception and practices of the health personnel of the National Hospital of Itauguá and the Regional Hospital of Caacupé about the COVID-19 disease. Materials and methods: We carried out an observational, cross-sectional study in both hospitals. The medical and nursing staff of these hospitals were asked to participate by answering an anonymous online questionnaire. The study was approved by the Ethics Committee of the National University of Itapúa. Results: 384 subjects participated in the study, of which 334 (86.98%) reported having received training on COVID-19, 245 (63.8%) participants were female, the average age was 32.6 ± 8 years, 315 (82%) came from the urban area, 214 (55.7%) belong to the National Hospital of Itauguá and 170 (44.3%) to the Regional Hospital of Caacupé. Regarding their profession, 274 (71.3%) are doctors, 89 (23.2%) are nursing graduates and 21 (5.5%) are nursing technicians. The mean percentage of correct answers was 84.70% ± 14.02%. A total of 319 (83.07%) participants presented a high level of knowledge (≥75% correct answers). The most frequent risk perception (96%) was that the lack of information makes it difficult for health personnel to prepare. The predominant preventive practice (95%) was the self-report of symptoms. Conclusion: The level of knowledge of health personnel about COVID-9 was high, most perceive the risk factors for infection and demonstrate preventive practices against this disease.

To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru.We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records.A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively.We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.Describir las características clínicas y evaluar los factores asociados con la mortalidad de los pacientes adultos con la nueva enfermedad causada por coronavirus 2019 (COVID-19) ingresados a un hospital de referencia nacional de Perú.Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnóstico de infección por coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2). Se excluyó a quienes ingresaron con prueba rápida serológica positiva al ingreso, sin clínica sugestiva ni imágenes compatibles. Los datos se recolectaron a partir de la historia clínica.Se incluyó un total de 813 adultos, 544 (66,9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61,2 años (desviación estándar: 15) y 575 (70,5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34,1%) y obesidad (25,9%). Los síntomas más frecuentes al ingreso fueron disnea (82,2%) y tos (53,9%). Un total de 114 (14%) pacientes recibieron ventilación mecánica, 38 (4,7%) ingresaron a unidad de cuidados intensivos y 377 (46,4%) fallecieron. Se asociaron a la mortalidad el requerimiento de soporte ventilatorio, el mayor compromiso pulmonar y los marcadores inflamatorios. Encontramos que por cada 10 años que aumentó la edad, el riesgo de morir se incrementó en 32% (riesgo relativo: 1,32; intervalo de confianza 95%: 1,25 a 1,38). Aquellos pacientes que requirieron ingreso a unidad de cuidados intensivos y ventilación mecánica tuvieron 1,39 (intervalo de confianza 95%: 1,13 a 1,69) y 1,97 (intervalo de confianza 95%: 1,69 a 2,29) veces el riesgo de morir, respectivamente.La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad, marcadores inflamatorios y compromiso respiratorio.

The implementation of prevention strategies can reduce the risk of having a stroke. This prospective, longitudinal, multicenter observational study of 82 patients describes health habits, quality of life, coping strategies, and physical and neurological status at 3 months and 1 year after stroke. The EuroQoL-5D quality of life scale (EQ-5D) and the coping strategy measurement scale (COPE-28) were used to assess pain and discomfort, and behavioral and lifestyle changes. Significant differences were observed in the pain or discomfort levels of those patients with behavioral and lifestyle changes. Correlation was also found between pain or discomfort and the coping strategies associated with active emotional support at 1 year after stroke. The results of the pain or discomfort dimension were not, however, associated with better adherence to treatment. Pain and discomfort could have a predictive value in changes in lifestyles and behaviors but not for treatment adherence in patients who have had a stroke, which is significant at 1 year. In addition to important active coping strategies such as social support, these changes in behavior and lifestyle following a stroke are long-term and should therefore be assessed during the initial examination.

Background The long-term outcomes following arthroscopic Bankart repair have been rarely reported. Because of its relative novelty, little is known about recurrent instability, postoperative arthritis, and patient satisfaction, particularly for well-established modern procedures. The purpose of the study was to evaluate the long-term outcomes following arthroscopic Bankart repair. Methods Patients who underwent isolated arthroscopic Bankart repair from 2003 to 2006 were retrospectively reviewed. Recurrent instability, radiographic, and clinical scores (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Rowe scores) were evaluated. Patient factors (ie, age, gender, side, number of instability episodes, contact sports, and bone loss) were analyzed to determine the correlation with outcome measures. Results Among the 98 patients (102 shoulders), we were able to contact 50 patients (51 shoulders, mean age 27.0 years, mean follow-up 121.2 months). Significant bone loss in glenoid and humerus was arthroscopically observed in 16 (31.4%) and 28 (54.9%) shoulders, respectively. Sixteen shoulders (31.4%) experienced recurrent instability. Recent radiographs were obtained for 38 shoulders, 14 (36.8%) of which showed moderate to severe arthritis. Clinical outcomes at follow-up were 89.3, 10.8, and 76.0 for ASES, SST, and Rowe scores, respectively. Neither recurrent instability nor arthritis was correlated with any patient factors. Conclusion When isolated arthroscopic Bankart repair was used in all patients with shoulder instability regardless of bony defect, postoperative recurrent instability and arthritis rates were unacceptably high. Additional procedures should be chosen after careful consideration of multiple patient factors.

Summary Background Nutritional disorders are frequent in patients with chronic pulmonary obstructive disease (COPD) and have negative health impacts. This study aimed to explore the value of the European Society of Clinical Nutrition and Metabolism (ESPEN) definition of malnutrition (and/or its individual components) to predict hospitalizations and mortality at 2 years, and to determine the prevalence of malnutrition in COPD patients referred to pulmonary rehabilitation. Methods The study was a prospective analysis of 118 patients with COPD free of exacerbations and/or hospital admissions in the previous two months. Main outcome variables were mortality, hospital admissions, and length of stay at 2-year follow-up; main covariates were malnutrition assessment according to the ESPEN definition and its components: unintentional weight loss, body mass index, and fat-free mass index (FFMI). Body composition was assessed by bioimpedance analysis. Kaplan-Meier survival curves and linear regression analyses were performed, adjusting for age and airflow obstruction as potential confounders. Results The observed prevalence of malnutrition was 24.6%. Malnutrition was associated with increased mortality risk (HR = 3.9 [95% CI: 1.4–10.62]). FFMI was independently associated with increased mortality (HR = 17.0 [95% CI: 2.24–129.8]), which persisted after adjustment for age and lung function (adjusted HR = 13.0 [95% CI: 1.67–101.7]). Low age-related body mass index was associated with increased risk of hospital admissions. Conclusions Malnutrition according to ESPEN criteria, highly prevalent in patients with stable COPD referred to pulmonary rehabilitation, was associated with 4 times greater mortality risk after 2 years. Low FFMI was associated with a 17-fold increase in mortality risk, suggesting independent predictive value.

Background and Purpose— Previous studies have reported less favorable outcome and less effect of endovascular treatment (EVT) after ischemic stroke in women than in men. Our aim was to study the influence of sex on outcome and on the effect of EVT for ischemic stroke in recent randomized trials on EVT. Methods— We used data from 7 randomized controlled trials on EVT within the HERMES collaboration. The primary outcome was 90-day functional outcome (modified Rankin Scale). We compared baseline characteristics and outcomes between men and women. With ordinal logistic regression, we evaluated the association between EVT and 90-day functional outcome for men and women separately, adjusted for potential confounders. We tested for interaction between sex and EVT. Results— We included 1762 patients in the analyses, of whom 833 (47%) were women. Women were older (median, 70 versus 66 years; P P P P for interaction of 0.926. Conclusions— Sex does not influence clinical outcome after EVT and does not modify treatment effect of EVT. Therefore, sex should not be a consideration in the selection of patients for EVT.

Purpose: We present a case of a patient with progressive open angle glaucoma who presented changes suggestive of improvement in the Heidelberg retinal tomography 3 (HRT3) analysis after a cardiac catheterization. Observation: A 69-year-old woman presented with progressive open angle glaucoma despite maximum tolerable antiglaucomatous topical treatment. A filtering surgery (trabeculectomy) was performed and successfully achieved intraocular pressure (IOP) levels of 10 mm Hg on average. Despite this, changes were evidenced in the HRT3 protocols (trend analysis and topographic change analysis) suggesting marked progression. Brimonidine 0.2% twice a day was initiated, and a cardiovascular examination was requested. A cardiac catheterism was performed in the following weeks, and afterward, all structural parameters improved until the last control. Medication was not discontinued, and no signs of apparent progression on the HRT3 parameters have been evidenced up until the time of writing this case report. Conclusions and Importance: There was a marked improvement in the HRT3 parameters (trend and topographic change analysis), suggesting that the progression stopped after a cardiac catheterism in a patient with progressive glaucoma despite having the IOP controlled. To our knowledge, this is the first case of a patient with progressive glaucoma that was medically and surgically managed, and despite achieving low IOP levels, the progression detected by the HRT3 analysis could not be stopped until a cardiac catheterization was performed.

The revised European consensus on sarcopenia definition and diagnosis (EWGSOP2) includes the SARC-F questionnaire, the most valid and consistent sarcopenia screening tool, as the mandatory first step. Our aim was the translation, cross-cultural adaptation, and validation of the SARC-F questionnaire as a culturally-responsive Spanish-language version for the European population. Cross-sectional descriptive study, applying the two-step WHO methodology for translation and cross-cultural adaptation of health questionnaires, and harmonization with the Mexican-Spanish version. European Union Geriatric Medicine Society recommendations for SARC-F validation in European languages were considered. Outpatient clinics of a university hospital. Inclusion criteria: stable, ambulatory (including aids), community-dwelling population ≥65 years old. The self-reported 5-item SARC-F questionnaire was administered; scores ≥4 indicated sarcopenia. Sensitivity, specificity, accuracy-likelihood ratios, predictive values, and kappa statistics were calculated and consecutively compared with European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2 criteria. This Spanish version, administered in an average 70s, has adequate internal consistency (Cronbach alpha=0.779). For the validation study, 90 (43.3%) of 208 potentially eligible subjects (81.4 ± 5.9 years old, 75.6% women) were included. SARC-F identified 51 (56.7%) subjects with sarcopenia and 39 (43.3%) without the disease. Prevalence was 17.8% per EWGSOP and 25.6% per EWGSOP2 (58% accuracy and fair agreement: sensitivity, 783%; specificity, 50.8%). SARC-F is a feasible tool, suitable for bedside assessment in community-dwelling older patients. Wide diffusion of this culturally-responsible SARC-F Spanish version is expected as EWGSOP2 is adopted and sarcopenia assessment is broadly implemented in Spain.

Background and aims Symptomatic intracranial atherosclerosis (ICAS) is associated with a high risk of stroke recurrence and occurrence of other vascular events. However, ICAS has been poorly studied from its asymptomatic stage. The objective of our study was to determine if subclinical intracranial atherosclerosis is associated with long-term incident vascular events in Caucasians. Methods The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) Study is a population-based study that enrolled 933 subjects with a moderate-high vascular risk and without history of stroke or coronary disease, and determined the prevalence of asymptomatic ICAS and associated risk factors. At baseline visit, carotid atherosclerosis and ICAS were screened by color-coded duplex ultrasound, and moderate-severe stenosis was confirmed by magnetic resonance angiography. At baseline, 8.9% of subjects had asymptomatic ICAS, of whom 3.3% were moderate-severe. In the longitudinal phase, subjects were prospectively followed-up to assess the incidence of a combined primary endpoint of vascular events (stroke, acute coronary syndrome and/or vascular death). Results After 7.17 years of follow-up, there were 51 incident cerebrovascular events (16 transient ischemic attacks, 27 ischemic, 8 hemorrhagic strokes), 63 incident coronary events and 23 vascular deaths. After multivariate Cox regression analyses adjusted by age, sex, vascular risk and presence of carotid plaques, ICAS was an independent predictor for overall vascular events (HR 1.83 [1.10–3.03], p = 0.020), and moderate-severe intracranial stenosis was also an independent predictor for cerebrovascular events (HR 2.66 [1.02–6.94], p = 0.046). Conclusions Asymptomatic ICAS is independently associated with the incidence of future vascular events in our population. These findings might have implications for the development of primary prevention strategies.

Background Polypharmacy increases the risk of pharmacological interactions, prevalence of secondary effects and with this the lack of adherence to treatment. It is estimated that between 10 and 40% of patients hospitalized in psychiatric institutions are prescribed more than one antipsychotic. The objective of the present study was to identify the prevalence of polypharmacy, evaluate adverse effects associated to the use of psych drugs and to estimate the risk in specific groups. Methods We carried out a longitudinal, retrospective study that included the analysis of all discharged patients (n = 140) in the first trimester of the year in a psychiatric hospital in Mexico. The information was classified into 7 sections: sociodemographic, diagnosis, clinical follow-up information, prescribed drugs, adverse reactions, substance abuse, laboratory and complementary results. Risk estimation was obtained with Odds Ratios, to correlate continuous variables Pearson’s correlation was used. Student’s T and Mann Whitney’s U were used to compare 2 independent samples; multiple and linear regressions were carried out. Results The mean number of drugs used during hospitalization was 7.8 drugs per patient. The mean prescribed psych drugs was 4.07. The mean antipsychotic dose was the risperidone equivalent of 5.08 mg. 29.2% of patients had at least one secondary effect associated to the use of drugs, 17.8% presented extrapyramidal symptoms. 81.4% of patients were prescribed 6 or more drugs (polypharmacy) and were 5 times more likely to suffer a secondary effects (OR 6.24). 14.2% had polypharmacy while receiving antipsychotics and had more than twice the risk of presenting extrapyramidal symptoms (OR 3.05). For each added psych drug, hospital stay increased by 6.56 days. Conclusions Despite international guideline recommendations where reasoned and conciliatory prescription of psych drugs is advised, there is still a high prevalence of polypharmacy in patients hospitalized in psychiatric institutions. In the present study 4 out of 5 patients received polypharmacy decreasing tolerability, treatment adherence and increasing the risk and costs secondary to an increased hospital stay.

International audience; Importance: The positive treatment effect of endovascular therapy (EVT) is assumed to be caused by the preservation of brain tissue. It remains unclear to what extent the treatment-related reduction in follow-up infarct volume (FIV) explains the improved functional outcome after EVT in patients with acute ischemic stroke.Objective: To study whether FIV mediates the relationship between EVT and functional outcome in patients with acute ischemic stroke.Design, setting, and participants: Patient data from 7 randomized multicenter trials were pooled. These trials were conducted between December 2010 and April 2015 and included 1764 patients randomly assigned to receive either EVT or standard care (control). Follow-up infarct volume was assessed on computed tomography or magnetic resonance imaging after stroke onset. Mediation analysis was performed to examine the potential causal chain in which FIV may mediate the relationship between EVT and functional outcome. A total of 1690 patients met the inclusion criteria. Twenty-five additional patients were excluded, resulting in a total of 1665 patients, including 821 (49.3%) in the EVT group and 844 (50.7%) in the control group. Data were analyzed from January to June 2017.Main outcome and measure: The 90-day functional outcome via the modified Rankin Scale (mRS).Results: Among 1665 patients, the median (interquartile range [IQR]) age was 68 (57-76) years, and 781 (46.9%) were female. The median (IQR) time to FIV measurement was 30 (24-237) hours. The median (IQR) FIV was 41 (14-120) mL. Patients in the EVT group had significantly smaller FIVs compared with patients in the control group (median [IQR] FIV, 33 [11-99] vs 51 [18-134] mL; P = .007) and lower mRS scores at 90 days (median [IQR] score, 3 [1-4] vs 4 [2-5]). Follow-up infarct volume was a predictor of functional outcome (adjusted common odds ratio, 0.46; 95% CI, 0.39-0.54; P < .001). Follow-up infarct volume partially mediated the relationship between treatment type with mRS score, as EVT was still significantly associated with functional outcome after adjustment for FIV (adjusted common odds ratio, 2.22; 95% CI, 1.52-3.21; P < .001). Treatment-reduced FIV explained 12% (95% CI, 1-19) of the relationship between EVT and functional outcome.Conclusions and relevance: In this analysis, follow-up infarct volume predicted functional outcome; however, a reduced infarct volume after treatment with EVT only explained 12% of the treatment benefit. Follow-up infarct volume as measured on computed tomography and magnetic resonance imaging is not a valid proxy for estimating treatment effect in phase II and III trials of acute ischemic stroke.

Rationale: Ischemic stroke is among the leading causes of adult disability. Part of the variability in functional outcome after stroke has been attributed to genetic factors but no locus has been consistently associated with stroke outcome. Objective: Our aim was to identify genetic loci influencing the recovery process using accurate phenotyping to produce the largest GWAS (genome-wide association study) in ischemic stroke recovery to date. Methods and Results: A 12-cohort, 2-phase (discovery-replication and joint) meta-analysis of GWAS included anterior-territory and previously independent ischemic stroke cases. Functional outcome was recorded using 3-month modified Rankin Scale. Analyses were adjusted for confounders such as discharge National Institutes of Health Stroke Scale. A gene-based burden test was performed. The discovery phase (n=1225) was followed by open (n=2482) and stringent joint-analyses (n=1791). Those cohorts with modified Rankin Scale recorded at time points other than 3-month or incomplete data on previous functional status were excluded in the stringent analyses. Novel variants in PATJ (Pals1-associated tight junction) gene were associated with worse functional outcome at 3-month after stroke. The top variant was rs76221407 (G allele, β=0.40, P =1.70×10 −9 ). Conclusions: Our results identify a set of common variants in PATJ gene associated with 3-month functional outcome at genome-wide significance level. Future studies should examine the role of PATJ in stroke recovery and consider stringent phenotyping to enrich the information captured to unveil additional stroke outcome loci.

Background: In-hospital stroke death rate is an important sanitary issue. Despite advances in the acute phase management of stroke patients, mortality and disability rates remain high. In aging populations and with different mortality between the sexes in general, the study of sex- and age-related differences becomes increasingly relevant for optimization of post-acute clinical care of stroke patients. Methods: We designed a cohort follow-up study with 13,932 consecutive ischemic stroke (IS) patients from 19 Spanish hospitals. Data was obtained from the Spanish Stroke Registry; transient ischemic attacks and ages Results: The median (percentiles 2.5 and 97.5%) age was 78 (41–92) years old for women and 71 (41–92) for men. IS women were more likely to be older, to exhibit cardio-embolic aetiology, and less likely to have been admitted to a stroke unit or to have had a stroke code activated. Both pre-stroke modified Rankin Scale and National Institute of Health Stroke Scale (NIHSS) scores at admission increased significantly with age and were higher in women than those in men. Differences in distributions of common risk factors for IS and of in-hospital outcomes between women and men actually changed with patient’s age. It is to be noted here that although there were no statistically significant differences (p > 0.05) between the sexes within any age group, in-hospital mortality appeared significantly higher in women than that in men when analysed overall, due to confounding. Death was more closely related to stroke in women than in men and occurred earlier. Although there were some age-specific sex differences between the predictors for in-hospital mortality, stroke severity measured by NIHSS was the main predictor of in-hospital mortality for both sexes. Topographic classifications – partial anterior circulatory infarct and total anterior circulatory infarct – were significant prognostic factors for men aged Conclusion: Although most of our findings were consistent with previous studies, it is important to take into account and highlight differences in in-hospital mortality between the sex and age group. Not to account for age-related differences between the sexes can give false results that may mislead management decisions. As most deaths in women were related to stroke, it is important to improve their early management, stroke code activation, access to stroke units and/or revascularisation therapies, especially in the older age groups.

Previous studies suggested that erythropoietin (EPO) may protect against severe COVID-19-induced injuries, ultimately preventing mortality. This hypothesis is based on the fact that, in addition to promoting the increase in red blood cells, EPO is an anti-inflammatory, anti-apoptotic and protective factor in several non-erythropoietic tissues. Furthermore, EPO promotes nitric oxide production in the hypoxic lung and stimulates ventilation by interacting with the respiratory centers of the brainstem. Given that EPO in the blood is increased at high-altitude, we evaluated the serum levels of EPO in critical patients with COVID-19 at "Hospital Agramont" in the city of El Alto (4150 masl) in Bolivia. A total of 16 patients, 15 men, one woman, with a mean age of 55.8 ± 8.49 years, admitted to the Intensive Care Unit were studied. All patients were permanent residents of El Alto, with no travel history below 3000 masl for at least one year. Blood samples were collected upon admission to the ICU. Serum EPO concentration was assessed using an ELISA kit, and a standard technique determined hemoglobin concentration. Only half of the observed patients survived the disease. Remarkably, fatal cases showed 2.5 times lower serum EPO than survivors (2.78 ± 0.8643 mU/mL vs 7.06 ± 2.713 mU/mL; p = 0.0096), and 1.24 times lower hemoglobin levels (13.96 ± 2.56 g/dL vs 17.41 ± 1.61 g/dL; p = 0.0159). While the number of cases evaluated in this work is low, our findings strongly warrant further investigation of EPO levels in COVID-19 patients at high and low altitudes. Our results also support the hypothesis that exogenous EPO administration could help critically ill COVID-19 patients overcome the disease.

Biomarkers; Stroke; Stroke‐associated infection Biomarcadors; Ictus; Infecció associada a un ictus Biomarcadores; Ictus; Infección asociada a un ictus Background Acute decompensated heart failure (ADHF) and respiratory tract infections (RTIs) are potentially life‐threatening complications in patients experiencing stroke during hospitalization. We aimed to test whether blood biomarker panels might predict these complications early after admission. Methods and Results Nine hundred thirty‐eight patients experiencing ischemic stroke were prospectively recruited in the Stroke‐Chip study. Post‐stroke complications during hospitalization were retrospectively evaluated. Blood samples were drawn within 6 hours after stroke onset, and 14 biomarkers were analyzed by immunoassays. Biomarker values were normalized using log‐transformation and Z score. PanelomiX algorithm was used to select panels with the best accuracy for predicting ADHF and RTI. Logistic regression models were constructed with the clinical variables and the biomarker panels. The additional predictive value of the panels compared with the clinical model alone was evaluated by receiver operating characteristic curves. An internal validation through a 10‐fold cross‐validation with 3 repeats was performed. ADHF and RTI occurred in 19 (2%) and 86 (9.1%) cases, respectively. Three‐biomarker panels were developed as predictors: vascular adhesion protein‐1 >5.67, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) >4.98 and d‐dimer >5.38 (sensitivity, 89.5%; specificity, 71.7%) for ADHF; and interleukin‐6 >3.97, von Willebrand factor >3.67, and d‐dimer >4.58 (sensitivity, 82.6%; specificity, 59.8%) for RTI. Both panels independently predicted stroke complications (panel for ADHF: odds ratio [OR] [95% CI], 10.1 [3–52.2]; panel for RTI: OR, 3.73 [1.95–7.14]) after adjustment by clinical confounders. The addition of the panel to clinical predictors significantly improved areas under the curve of the receiver operating characteristic curves in both cases. Conclusions Blood biomarkers could be useful for the early prediction of ADHF and RTI. Future studies should assess the usefulness of these panels in front of patients experiencing stroke with respiratory symptoms such as dyspnea. This project received funding from Instituto de Salud Carlos III (ISCIII) [DTS14/00004, PI17/02130], co‐financed by the European Regional Development Fund (FEDER), and from Fundació La Marató de TV3 [201706] and the European Union's Horizon 2020 research and innovation program [754517]. Neurovascular Research Laboratory takes part into the Spanish stroke research network INVICTUS+ (RD16/0019/0021). The funders had no role in the study design and conduction.

[Background and objective] We aimed to evaluate the safety and outcomes of thrombectomy in anterior circulation acute ischaemic stroke recorded in the SITS–International Stroke Thrombectomy Register (SITS-ISTR) and compare them with pooled randomized controlled trials (RCTs) and two national registry studies., [Methods] We identified centres recording ≥10 consecutive patients in the SITS-ISTR with at least 70% of available modified Rankin Scale (mRS) at 3 months during 2014–2019. We defined large artery occlusion as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Outcome measures were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial haemorrhage (SICH) per modified SITS-MOST., [Results] Results are presented in the following order: SITS-ISTR, RCTs, MR CLEAN Registry and German Stroke Registry (GSR). Median age was 73, 68, 71 and 75 years; baseline NIHSS score was 16, 17, 16 and 15; prior intravenous thrombolysis was 62%, 83%, 78% and 56%; onset to reperfusion time was 289, 285, 267 and 249 min; successful recanalization (mTICI score 2b or 3) was 86%, 71%, 59% and 83%; functional independence at 3 months was 45.5% (95% CI: 44–47), 46.0% (42–50), 38% (35–41) and 37% (35–41), respectively; death was 19.2% (19–21), 15.3% (12.7–18.4), 29.2% (27–32) and 28.6% (27–31); and SICH was 3.6% (3–4), 4.4% (3.0–6.4), 5.8% (4.7–7.1) and not available., [Conclusion] Thrombectomy in routine clinical use registered in the SITS-ISTR showed safety and outcomes comparable to RCTs, and better functional outcomes and lower mortality than previous national registry studies., SITS (Safe Implementation of Treatment in Stroke) is financed directly and indirectly by grants from Karolinska Institutet, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institutet and private donors, as well as from an unrestricted sponsorship from Boehringer Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority, Ferrer International and EVER Pharma. SITS is currently conducting studies supported by Boehringer Ingelheim and Biogen, as well as in collaboration with Karolinska Institutet, supported by Stryker, Covidien and Phenox. N Ahmed is supported by grants provided by the Stockholm County Council and the Swedish Heart-Lung Foundation. S Holmin is supported by grants provided by the Söderberg Foundations, the Stockholm County Council, the Erling Persson Foundation, VINNOVA and HMT. Irene Escudero-Martínez has received a grant from ‘Fundación Progreso y Salud, Junta de Andalucía’ (grant EF-0437-2018). RM has been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR). RH has been supported by the grants no. DRO–UHHK 00179906 from the Ministry of Health of the Czech Republic and no. PROGRES Q40 from Charles University, Czech Republic.

[enter Abstract Body]The impact of the COVID-19 outbreak on mental health among HIV high-risk populations is not known. We assess the prevalence of depressive symptoms (DS) and explore the association with characteristics related to the COVID-19 pandemic. We conducted an online survey among 881 men who have sex with men (MSM) and transgender women (TGW) assessing the presence of DS using the Center for Epidemiological Studies Depression Scale (CESD-10); results were compared with previously self-reported DS and national data. We applied latent class analysis (LCA) to identify classes of participants with similar COVID-19 related characteristics. The overall prevalence of significant DS was 53.3%. By LCA posterior probabilities we identified three classes: (1) minimal impact of COVID-19 (54.1%), (2) objective risk for COVID-19 (41.5%), and (3) anxiety and economic stress caused by COVID-19 (4.4%). Multivariate logistic regression showed that compared with those in class one, the odds to have significant DS were almost five times higher for those in class three. Our findings suggest high levels of depression among MSM and TGW in Mexico during the COVID-19 pandemic and highlight the need for the provision of targeted psychological interventions to minimize the impacts of COVID-19 on the mental health.

Background and Purpose: Whether reperfusion into infarcted tissue exacerbates cerebral edema has treatment implications in patients presenting with extensive irreversible injury. We investigated the effects of endovascular thrombectomy and reperfusion on cerebral edema in patients presenting with radiological evidence of large hemispheric infarction at baseline. Methods: In a systematic review and individual patient-level meta-analysis of 7 randomized controlled trials comparing thrombectomy versus medical therapy in anterior circulation ischemic stroke published between January 1, 2010, and May 31, 2017 (Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration), we analyzed the association between thrombectomy and reperfusion with maximal midline shift (MLS) on follow-up imaging as a measure of the space-occupying effect of cerebral edema in patients with large hemispheric infarction on pretreatment imaging, defined as diffusion-magnetic resonance imaging or computed tomography (CT)-perfusion ischemic core 80 to 300 mL or noncontrast CT-Alberta Stroke Program Early CT Score ≤5. Risk of bias was assessed using the Cochrane tool. Results: Among 1764 patients, 177 presented with large hemispheric infarction. Thrombectomy and reperfusion were associated with functional improvement (thrombectomy common odds ratio =2.30 [95% CI, 1.32–4.00]; reperfusion common odds ratio =4.73 [95% CI, 1.66–13.52]) but not MLS (thrombectomy β=−0.27 [95% CI, −1.52 to 0.98]; reperfusion β=−0.78 [95% CI, −3.07 to 1.50]) when adjusting for age, National Institutes of Health Stroke Score, glucose, and time-to-follow-up imaging. In an exploratory analysis of patients presenting with core volume >130 mL or CT-Alberta Stroke Program Early CT Score ≤3 (n=76), thrombectomy was associated with greater MLS after adjusting for age and National Institutes of Health Stroke Score (β=2.76 [95% CI, 0.33–5.20]) but not functional improvement (odds ratio, 1.71 [95% CI, 0.24–12.08]). Conclusions: In patients presenting with large hemispheric infarction, thrombectomy and reperfusion were not associated with MLS, except in the subgroup with very large core volume (>130 mL) in whom thrombectomy was associated with increased MLS due to space-occupying ischemic edema. Mitigating cerebral edema-mediated secondary injury in patients with very large infarcts may further improve outcomes after reperfusion therapies.

Background and Purpose: Large-scale observational studies of acute ischemic stroke (AIS) promise to reveal mechanisms underlying cerebral ischemia. However, meaningful quantitative phenotypes attainable in large patient populations are needed. We characterize a dynamic metric of AIS instability, defined by change in National Institutes of Health Stroke Scale score (NIHSS) from baseline to 24 hours baseline to 24 hours (NIHSS baseline – NIHSS 24hours = ΔNIHSS 6-24h ), to examine its relevance to AIS mechanisms and long-term outcomes. Methods: Patients with NIHSS prospectively recorded within 6 hours after onset and then 24 hours later were enrolled in the GENISIS study (Genetics of Early Neurological Instability After Ischemic Stroke). Stepwise linear regression determined variables that independently influenced ΔNIHSS 6 –24h . In a subcohort of tPA (alteplase)-treated patients with large vessel occlusion, the influence of early sustained recanalization and hemorrhagic transformation on ΔNIHSS 6–24h was examined. Finally, the association of ΔNIHSS 6 –24h with 90-day favorable outcomes (modified Rankin Scale score 0–2) was assessed. Independent analysis was performed using data from the 2 NINDS-tPA stroke trials (National Institute of Neurological Disorders and Stroke rt-PA). Results: For 2555 patients with AIS, median baseline NIHSS was 9 (interquartile range, 4–16), and median ΔNIHSS 6 –24h was 2 (interquartile range, 0–5). In a multivariable model, baseline NIHSS, tPA-treatment, age, glucose, site, and systolic blood pressure independently predicted ΔNIHSS 6 –24h (R 2 =0.15). In the large vessel occlusion subcohort, early sustained recanalization and hemorrhagic transformation increased the explained variance (R 2 =0.27), but much of the variance remained unexplained. ΔNIHSS 6 –24h had a significant and independent association with 90-day favorable outcome. For the subjects in the 2 NINDS-tPA trials, ΔNIHSS 3 –24h was similarly associated with 90-day outcomes. Conclusions: The dynamic phenotype, ΔNIHSS 6–24h , captures both explained and unexplained mechanisms involved in AIS and is significantly and independently associated with long-term outcomes. Thus, ΔNIHSS 6 –24h promises to be an easily obtainable and meaningful quantitative phenotype for large-scale genomic studies of AIS.

Los tumores de celulas germinales son una variante de los tumores ovaricos, siendo el teratoma el mas frecuente. Del total de los tumores ovaricos diagnosticados, el 12% se encontraran en pacientes en edad fertil. Se presenta el caso de una paciente de 22 anos que acude a consulta con un diagnostico presuntivo de teratoma bilateral en busqueda de alternativas terapeuticas, ya que se le planteo originalmente ooforectomia bilateral. Tras un abordaje completo se corroboro el diagnostico y se procedio a la reseccion tumoral, logrando la enucleacion completa de ambos teratomas y preservando el tejido ovarico, su funcionalidad y su fertilidad. Germ cell tumors are a variant of ovarian tumors, with teratoma being the most frequent. Of the total number of diagnosed ovarian tumors, 12% are found in patients of childbearing age. In this case, we present a 22-year-old patient who comes to a consultation with a presumptive diagnosis of bilateral teratoma in search of therapeutic alternatives, since she was originally presented with a bilateral oophorectomy. After a complete approach, the diagnosis was corroborated and tumor resection was carried out, achieving complete enucleation of both teratomas, preserving the ovarian tissue, thus its functionality and fertility.

The role of miRNAs in intestinal lipid metabolism is poorly described. The small intestine is constantly exposed to high amounts of dietary lipids, and it is under conditions of stress that the functions of miRNAs become especially pronounced. Approaches consisting in either a chronic exposure to cholesterol and triglyceride rich diets (for several days or weeks) or an acute lipid challenge were employed in the search for intestinal miRNAs with a potential role in lipid metabolism regulation. According to our results, changes in miRNA expression in response to fat ingestion are dependent on factors such as time upon exposure, gender and small intestine section. Classic and recent intestinal in vitro models (i.e. differentiated Caco-2 cells and murine organoids) partially mirror miRNA modulation in response to lipid challenges in vivo. Moreover, intestinal miRNAs might play a role in triglyceride absorption and produce changes in lipid accumulation in intestinal tissues as seen in a generated intestinal Dicer1-deletion murine model. Overall, despite some variability between the different experimental cohorts and in vitro models, results show that some miRNAs analysed here are modulated in response to dietary lipids, hence likely to participate in the regulation of lipid metabolism, and call for further research.

Background Achondrogenesis is a skeletal dysplasia characterized primarily by short stature, severe micromelia, short and narrow chest, prematurity, polyhydramnios, fetal hydrops, and in utero or neonatal death. Based on the radiological and histopathological findings, there are three types of achondrogenesis: type 1A (Houston-Harris), type 1B (Fraccaro) and type 2 (Langer-Saldino). Clinical case A premature female product was studied whose clinical, radiological and histopathological characteristics were compatible with achondrogenesis Type 1A. The family information allowed us to conclude that the 4 products of the 6 previous pregnancies were affected. Statistical analysis in at least 4 families previously described, including this family case showed significant differences between expected and observed number of members, being incongruent with an autosomal recessive mode of inheritance previously reported. Conclusions therefore, it could be considered a new subtype of achondrogenesis type 1A due to the presence of a preferential germline mutation.