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Introduction: Greater occipital nerve block (GONB) is a minimally invasive procedure frequently used in patients with chronic migraine (CM); however, the quality of the evidence supporting its use is still unknown. Therefore, we aimed to conduct a systematic review, meta-analysis and quality assessment of GONB local anaesthetics combined or not with corticosteroids to prevent CM. Methods: We searched Medline, Scopus and Web of Science up to October 2020. We included randomized control trials (RCT) and observational studies assessing GONB without language restrictions. Two researchers selected the studies, extracted the data and evaluated the risk of bias independently. The primary outcomes measured to assess efficacy were the change from baseline in the intensity and frequency of headache in the intervention group compared to placebo at a onetime point. We performed a meta-analysis with random effect models, and we evaluated random errors with trial sequential analysis (TSA). We assessed the risk of bias (ROB) with the ROB2 tool and the certainty of the evidence with GRADE. Results: We identified 2864 studies in the databases and included three RCTs for quantitative synthesis. Most ROB assessments were ‘high risk’ or ‘some concerns’. GONB reduced the intensity of headaches at the end of the first month (MD: −1.35, 95% CI: −2.12 to −0.59) and the second month (MD: -2.10, CI 95%: −2.94 to −1.26) as well as the frequency of headaches (first month: MD: −4.45 days, 95% CI: −6.56 to −2.34 days; second month: MD: -5.49, 95% CI −8.94 to −2.03 days). Corticosteroids did not show a significant decrease in the frequency of headaches during the first month of treatment (MD: −1.1 days, 95% CI: −4.1 to 1.8, p =.45). Included trials reported similar adverse events between groups. The exploratory TSA showed inconclusive results. Overall, the quality of the evidence was very low because of the substantial risk of bias and imprecision. Conclusion: The limited evidence available shows that GONB with local anaesthetics could reduce headache frequency and intensity compared to placebo, while adding corticosteroids did not show additional benefits. GONB was safe with a similar number of minor adverse events. However, our confidence in these estimates is very low since the evidence is based on a few trials, with a small sample size and a significant risk of bias. In addition, the exploratory TSA was inconclusive, so we need larger and specific trials.

BACKGROUND: New information for potential treatments against SARS-CoV-2 is rapidly increasing. As a result, countries and organizations have begun to release therapeutic guidelines. OBJECTIVE: To provide a synopsis of the recommendations supported in evidence-based guidelines for therapeutic options with potential activity against SARS-CoV-2. METHOD: Rapid systematic review of guidelines and/or protocols that provide interim clinical guidance for COVID-19 disease were extracted from PubMed/Medline, Web of Science, Scopus, Scielo, Google Scholar, and a general Google search. Duplicates were removed and a summary of the proposed interventions was included. A benefit risk analysis was then conducted. RESULTS: Twenty guidelines and/or protocols were selected; the majority of which came from Europe and Latin America. Seventeen interventions were identified and classified into 6 pharmacological groups. Antimalarials, lopinavir/ritonavir and remdesivir were the only agents recommended and supported by clinical trials. The remaining interventions were recommended based on indirect evidence, observational studies, or in vitro studies. CONCLUSIONS: Antimalarials have shown results against COVID-19 with surrogate outcomes and the presence of serious adverse events. We recommend active monitoring of agents with potential efficacy against SARS-CoV-2 and incorporating the results in national guidelines and protocols. Clinical trials should be conducted to show direct benefit with clinically relevant outcomes in various populations. ANTECEDENTES: La nueva información de terapias contra el SARS-CoV-2 crece rápidamente. Como resultado, los países y organizaciones han comenzado a publicar pautas terapéuticas. OBJETIVO: Proporcionar una sinopsis de las recomendaciones soportadas en guías basadas en evidencia de las opciones terapéuticas con actividad potencial contra el SARS-CoV-2. MÉTODO: Revisión sistemática rápida de guías o protocolos que dan orientación clínica provisional para la enfermedad COVID-19 de PubMed/Medline, Web Of Science, Scopus, Scielo, Google Scholar y una búsqueda general en Google. Los duplicados se eliminaron y se incluyó un resumen de las intervenciones propuestas. Luego se realizó un análisis de riesgos y beneficios. RESULTADOS: Veinte guías o protocolos se seleccionaron, la mayor parte provino de Europa y Latinoamérica. Diecisiete intervenciones se identificaron y clasificaron en seis grupos farmacológicos. Los antimaláricos, lopinavir/ritonavir y remdesivir fueron los únicos agentes recomendados y respaldados por ensayos clínicos. Las intervenciones restantes se recomendaron con base en evidencia indirecta, estudios observacionales o estudios in vitro. CONCLUSIONES: Los antimaláricos han mostrado resultados contra COVID-19 con desenlaces sustitutos y eventos adversos graves. Recomendamos la vigilancia activa de agentes con eficacia potencial contra el SARS-CoV-2 incorporando los resultados en las guías y protocolos nacionales. Deben realizarse ensayos clínicos que muestren un beneficio directo con desenlaces clínicamente relevantes en diversas poblaciones.

We aimed to make a scoping review of the clinical practice guidelines (CPG) for endovascular treatment for Acute ischemic stroke (AIS) due to a proximal large vessel occlusion (LVO). We will conduct a scoping review in order to systematically map the CPGs that assess initial management of stroke, as well as to assess their quality and identify any existing contradictions between recommendations. Our protocol was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P). The following databases will be searched from 2018 to June 2020: PubMed, TripDatabase, Scopus and Google Scholar. To assess the quality of CPG we will use the Rigor of Development Domain (domain 3) of the Appraisal of Guidelines Research and Evaluation II (AGREE-II). After that, two independent researchers will assess the quality of the recommendations using some criteria of the AGREE-REX.

Objetivo: Describir la producción científica en educación médica en Latinoamérica en Scopus, en el periodo 2011-2015. Métodos: Estudio transversal bibliométrico. Se realizó una búsqueda de artículos científicos correspondientes al periodo 2011-2015 en Scopus, usando términos relacionados a la educación médica y especificando que al menos un autor tenga filiación de un país latinoamericano. Se revisó cada artículo para seleccionar solo aquellos artículos originales que hayan estudiado temas de educación médica. Finalmente, sus características fueron registradas y analizadas usando Microsoft Excel 2010. Resultados: En el periodo 2011-2015 se publicaron 850 artículos originales de educación médica con autores de Latinoamérica en Scopus, de los cuales el 49,1% tuvo algún autor de Brasil. El número de publicaciones por año fue estacionario. La población de estudio más frecuente fueron los estudiantes de medicina (54,0%). El tema más frecuente fue la evaluación de competencias (30,7%). El 21,1% de los artículos presentaron colaboración internacional, pero pocos (4,1%) presentaron colaboración con autores de otros países de Latinoamérica. Conclusiones: La investigación en educación médica en Latinoamérica en el periodo 2011-2015 es aún deficiente y estacionaria. El tema principal fue la evaluación de competencias, mientras que la población estudiada más frecuente fueron los estudiantes de medicina. La colabora- ción internacional fue baja, y la colaboración entre países de Latinoamérica fue menor a la colaboración con países fuera de Latinoamérica.

La enfermedad de Gaucher, es un trastorno autosómico recesivo de depósito lisosomal que se caracteriza por deficiencia de la beta-glucocerebrosidasa que lleva a la acumulación de glucosilceramida principalmente en células del sistema fagocítico mononuclear causando afectaciones sistémicas. Se presenta paciente varón de 20 años que cursa con dolor crónico en hipocondrio izquierdo con episodios de sangrados desde hace 3 años y sensación de alza térmica, al examen físico se identificó ictericia y esplenomegalia masiva, sin afectación neurológica. Como apoyo al diagnóstico se mostró osteoporosis severa, pancitopenia y como hallazgo inesperado la presencia de trombosis de vena porta con transformación cavernomatosa complicada con biliopatía portal simulando un tumor de klatskin, los estudios de médula y enzimáticos eran compatibles con enfermedad de Gaucher, por lo cual recibió tratamiento con imiglucerasa realizando seguimiento. Es un caso poco frecuente, de gran interés, heterogeneidad en sus manifestaciones clínicas e inéditas por su complicación, constituyendo un desafío llegar a su diagnóstico de esta enfermedad huérfana.

La enfermedad de Gaucher, es un trastorno autosómico recesivo de depósito lisosomal que se caracteriza por deficiencia de la beta-glucocerebrosidasa que lleva a la acumulación de glucosilceramida principalmente en células del sistema fagocítico mononuclear causando afectaciones sistémicas. Se presenta paciente varón de 20 años que cursa con dolor crónico en hipocondrio izquierdo con episodios de sangrados desde hace 3 años y sensación de alza térmica, al examen físico se identificó ictericia y esplenomegalia masiva, sin afectación neurológica. Como apoyo al diagnóstico se mostró osteoporosis severa, pancitopenia y como hallazgo inesperado la presencia de trombosis de vena porta con transformación cavernomatosa complicada con biliopatía portal simulando un tumor de klatskin, los estudios de médula y enzimáticos eran compatibles con enfermedad de Gaucher, por lo cual recibió tratamiento con imiglucerasa realizando seguimiento. Es un caso poco frecuente, de gran interés, heterogeneidad en sus manifestaciones clínicas e inéditas por su complicación, constituyendo un desafío llegar a su diagnóstico de esta enfermedad huérfana. Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.

The diagnosis and treatment of depression in patients with Parkinson’s disease (PD) is inadequate, often contributing to a reduced quality of life, rapid disease progression, higher cognitive impairment, and an increased burden of care for family members of patients with PD. Objective: To determine the factors associated with depression in PD and to examine the frequency of depressive symptoms among patients with PD. Methods: This study was an observational, analytical, multicenter study of a cross-sectional cohort, conducted between July 2016 and May 2017. PD patients were recruited from neurology clinics in Lima, Peru. All statistical analyses were performed using descriptive statistics. Bivariate and multivariate logistic regression analyses were calculated using STATA. Results: Out of 124 patients (average age: 68.7 years; 58% males) included in the study 60.5% (75/124) presented with symptoms of depression; only 20% (25/124) received antidepressants. Factors associated with depression in PD included: unemployment, falls, freezing of gait, involuntary movements micrographia, stooped posture, hyposmia, movement disorders in sleep, rapid disease progression, and the use of MAOIs. Furthermore, statistically significant differences were found in disease duration, UPDRS and MMSE scores, Hoehn and Yahr (HY) stage, and length of time taking L-dopa between PD patients with and without depressive symptoms. Conclusion: Factors associated with depressive symptoms in patients with PD were hyposmia, rapid progression of the disease, the use of L-dopa, and use of MAOIs. The frequency of depressive symptoms in patients with PD is high; early diagnosis and prompt treatment are needed to improve their quality of life and the family environment. Tesis