The Glasgow Coma Scale: 50-year anniversary.

In 1974, Sir Graham Teasdale and Bryan Jennett wrote the "Assessment of coma and impaired consciousness, A practical scale," which has become one of the most influential papers in the history of traumatic brain injury, with more than 10,000 citations as of January 2024. Today, it is one of the most widely used tools in emergency departments, providing a reliable general overview of the patient's consciousness status.

Evaluation of Sputtering Processes in Strontium Iridate Thin Films.

The growth of epitaxial thin films from the Ruddlesden-Popper series of strontium iridates by magnetron sputtering is analyzed. It was found that, even using a non-stoichiometric target, the films formed under various conditions were consistently of the perovskite-like n = ∞ SrIrO3 phase, with no evidence of other RP series phases. A detailed inspection of the temperature-oxygen phase diagram underscored that kinetics mechanisms prevail over thermodynamics considerations. The analysis of the angular distribution of sputtered iridium and strontium species indicated clearly different spatial distribution patterns. Additionally, significant backsputtering was detected at elevated temperatures. Thus, it is assumed that the interplay between these two kinetic phenomena is at the origin of the preferential nucleation of the SrIrO3 phase. In addition, strategies for controlling cation stoichiometry off-axis have also been explored. Finally, the long-term stability of the films has been demonstrated.

Stroke in Tuberculous Meningitis.

A 17-year-old male presented with a 20-day history of vomiting, abdominal pain, weight loss, headache and fever progressing to dysarthria, somnolence, urinary incontinence, slurred speech, weakness, and inability to walk. Neurological examination revealed diminished visual acuity and diplopia. A head computed tomography (CT) showed acute hydrocephalus (Figure 1). Cerebrospinal fluid (CSF) analysis revealed pleocytosis (lymphocyte predominant), hypoglycorrhachia (8 mg/dL), and hyperproteinorrachia (156 mg/dL). The brain magnetic resonance imaging (MRI) revealed leptomeningitis, basal ganglia infarcts and basal meningeal enhancement highly suggestive of tuberculous meningitis (TBM) (Figure 2). We calculated a positive Thwaites score (-5) for TBM. The patient responded well to antituberculous treatment and dexamethasone. At 2 year follow-up the patient remains symptom-free. Stroke is a frequent complication of TBM and might contribute to long-term disability. Brain imaging findings, such as basal meningeal enhancement and basal exudates, hydrocephalus, and infarctions (TBM triad) are useful tools to rapidly identify probable TBM(3,4). Brain infarcts in TBM are located mostly in the arterial territory of distal branching arterires(5). Other less frequent imaging findings are tuberculomas and vasospasm. Key message: Hydrocephalus, basal meningeal enhancement, and basal ganglia infarcts should raise suspicion of tuberculosis, especially in endemic regions.

Cerebral Venous Thrombosis Presenting as Simultaneous Intracerebral Hemorrhage.

A 37-year-old pregnant woman presented to the emergency department with central facial palsy, ipsilateral right hemiparesis, and seizures. Brain Computed Tomogram (CT) showed intracerebral hemorrhage (ICH) and bilateral frontal edema. Magnetic resonance imaging (MRI) revealed multifocal hemorrhages consistent with a diagnosis of multiple simultaneous ICH (MSICH) (Figure 1). We suspected cerebral venous thrombosis (CVT) and performed a MR angiogram confirming this diagnosis (Figure 2). Upon admission, the patient was treated with low-molecular-weight heparin and transitioned to direct oral anticoagulation at discharge. Non traumatic MSICH is a rare imaging finding with high mortality, usually arterial in origin (1). However, since treatment options vary, cerebral venous thrombosis should always be considered in the differential diagnosis, especially in young female patients with known risk factors, such as pregnancy and puerperium (2-4). MRI modalities (Echo-GRE) are valuable tools in identifying ICH when CT is inconclusive (5).

Valoración de la cicatriz postquirúrgica de pacientes operados por quiste pilonidal según técnicas abiertas versus cerradas

Introducción: El quiste pilonidal puede ser abordado según técnicas quirúrgicas abiertas y cerradas, con distintos resultados estéticos. La cicatriz es un factor importante y representa un indicador de satisfacción. Una herramienta para valorar cicatrices es el cuestionario POSAS 2.0, adaptado transculturalmente para Chile. Objetivo: Conocer la valoración subjetiva de los pacientes operados de quiste pilonidal respecto a su cicatriz, según la técnica quirúrgica. Material y Método: Estudio es de carácter retrospectivo, observacional, transversal, analítico y de cohorte. Se aplica la escala de evaluación por el paciente del cuestionario POSAS 2.0, con una calificación desde 1 a 10, con puntaje total entre 7 y 70. Se recolectaron variables clínico-demográficas. Se aplicó estadística analítica, se compararon los resultados obtenidos entre técnicas abiertas y cerradas. Resultados. Se encuestaron 101 pacientes operados de quiste pilonidal entre 2013 y 2019, de los cuales 59 (59,4%) fueron de sexo masculino. La edad promedio fue de 23 años (DS 7,2). Del total, 22 (21,8%) de los pacientes fueron manejados con técnicas cerradas y 79 con técnicas abiertas (78,2%). El promedio del puntaje total de la escala fue 20 (DS 11,4), 22 en técnicas cerradas y 19,6 en técnicas abiertas. No se encontraron diferencias estadísticamente significativas. Conclusión: La cicatriz postoperatoria es valorada positivamente, con un puntaje que denota características similares a la piel normal. No existen diferencias significativas de la percepción de los pacientes respecto a su cicatriz. Esta es la primera comunicación chilena que evalúa la valoración subjetiva de pacientes sobre la cicatriz postoperatoria de quiste pilonidal.

Introduction: The pilonidal cyst can be approached according to open and closed surgical techniques, with different aesthetic results. The scar is an important factor and represents an indicator of satisfaction. A tool to assess scars is the POSAS 2.0 questionnaire, adapted cross-culturally for Chile. Objective: To know the subjective assessment of patients operated on for pilonidal cyst with respect to their scar, according to the surgical technique. Material and Method: This is a retrospective, observational, cross-sectional, analytical, and cohort study. The patient evaluation scale of the POSAS 2.0 questionnaire is applied, with a score from 1 to 10, with a total score between 7 and 70. Clinical-demographic variables were collected. Analytical statistics were applied, the results obtained between open and closed techniques were compared. Results: We surveyed 101 patients operated on for pilonidal cyst between 2013 and 2019, of which 59 (59.4%) were male. The mean age was 23 years (SD 7.2). Of the total, 22 (21.8%) of the patients were managed with closed techniques and 79 with open techniques (78.2%). The mean total score of the scale was 20 (SD 11.4), 22 in closed techniques and 19.6 in open techniques. No statistically significant differences were found. Conclusion: The postoperative scar is positively valued, with a score that denotes similar characteristics to the normal skin. There are no significant differences in patient's perception of their scar. This is the first chilean communication that evaluates the subjective assessment of patients on the postoperative scar of pilonidal cyst.

Matrix metalloproteinase 10 is linked to the risk of progression to dementia of the Alzheimer's type.

Alzheimer's disease has a long asymptomatic phase that offers a substantial time window for intervention. Using this window of opportunity will require early diagnostic and prognostic biomarkers to detect Alzheimer's disease pathology at predementia stages, thus allowing identification of patients who will most probably progress to dementia of the Alzheimer's type and benefit from specific disease-modifying therapies. Consequently, we searched for CSF proteins associated with disease progression along with the clinical disease staging. We measured the levels of 184 proteins in CSF samples from 556 subjective cognitive decline and mild cognitive impairment patients from three independent memory clinic longitudinal studies (Spanish ACE, n = 410; German DCN, n = 93; German Mannheim, n = 53). We evaluated the association between protein levels and clinical stage, and the effect of protein levels on the progression from mild cognitive impairment to dementia of the Alzheimer's type. Mild cognitive impairment subjects with increased CSF level of matrix metalloproteinase 10 (MMP-10) showed a higher probability of progressing to dementia of the Alzheimer's type and a faster cognitive decline. CSF MMP-10 increased the prediction accuracy of CSF amyloid-ß 42 (Aß42), phospho-tau 181 (P-tau181) and total tau (T-tau) for conversion to dementia of the Alzheimer's type. Including MMP-10 to the [A/T/(N)] scheme improved considerably the prognostic value in mild cognitive impairment patients with abnormal Aß42, but normal P-tau181 and T-tau, and in mild cognitive impairment patients with abnormal Aß42, P-tau181 and T-tau. MMP-10 was correlated with age in subjects with normal Aß42, P-tau181 and T-tau levels. Our findings support the use of CSF MMP-10 as a prognostic marker for dementia of the Alzheimer's type and its inclusion in the [A/T/(N)] scheme to incorporate pathologic aspects beyond amyloid and tau. CSF level of MMP-10 may reflect ageing and neuroinflammation.

Formation of Nickel Oxide Nanocuboids in Ferromagnetic La2Ni1-xMn1+xO6.

The control of the spontaneous formation of nanostructures at the surface of thin films is of strong interest in many different fields, from catalysts to microelectronics, because surface and interfacial properties may be substantially enhanced. Here, we analyze the formation of nickel oxide nanocuboids on top of La2Ni1-xMn1+xO6 double perovskite ferromagnetic thin films, epitaxially grown on SrTiO3 (001) substrates by radio-frequency (RF) magnetron sputtering. We show that, by annealing the films at high temperature under high oxygen partial pressure, the spontaneous segregation of nanocuboids is enhanced. The evolution of the structural and magnetic properties of the films is studied as a function of the annealing treatments at different temperatures. It is shown that the formation of NiOx nanocuboids leads to a nanostructured film surface with regions of locally different electrical transport characteristics.

Lumbociatalgia como presentación de un liposarcoma del psoas iliaco: Reporte de caso / Lumbociatalgia as presentation of a liposarcoma from psoas iliaco muscle: Case report

Introducción. Los sarcomas retroperitoneales son tumores raros, con una presentación clínica dada por síntomas compresivos poco específicos. Reporte de Caso: Reportamos un caso de un varón de 69 años con historia de lumbociatalgia e incremento en el volumen del miembro inferior izquierdo hasta llegar a la incapacidad para deambular, se le realizó una Tomografía Abdominal Con Contraste donde se halló una gran tumoración dependiente del músculo psoas iliaco izquierdo que se extendía hasta la pelvis, la cual fue sometida a biopsia encontrándose un Liposarcoma de psoas de alta celularidad. Conclusiones: Los sarcomas son tumores raros originados del tejido mesequenquimal, la gran mayoría de estos tienen síntomas y signos inespecíficos siendo diagnosticados de forma tardía y a pesar del manejo quirúrgico el pronóstico es pobre.

Introduction. Retroperitoneal sarcomas are rare tumors, with a clinical presentation given by poorly specific compression symptoms. Case Report: We report a case of a 69-year-old man with a history of lumbociatalgia and an increase in the volume of the left lower limb until he was unable to wander, he underwent a Contrast Abdominal Tomography where a large tumor dependent on the left iliac psoas muscle was found, that extended to the pelvis, which was biopsied, finding a highly cellular psoas Liposarcoma. Conclusions: Sarcomas are rare tumors originating from the mesequenchymal tissue, the vast majority of them have nonspecific symptoms and signs, being diagnosed late and despite the surgical management of the prognosis is poor.

Search for asymptomatic carriers of SARS-CoV-2 in healthcare workers during the pandemic: a Spanish experience.

BACKGROUND: Asymptomatic carriers of SARS-CoV-2 can be a vehicle for transmission of the infection. This fact is of particular importance in the case of healthcare workers (HCWs). DESIGN: Cross-sectional study in HCWs in a medium size hospital in the South of Spain. METHODS: between April 15 and 25, 2020, naso and oropharyngeal PCR determination was performed together with IgG and IgM antibody determination by immunochromatography to the HCWs of the Costa del Sol Hospital in Marbella of the units involved in patient care with CoVID-19: Emergencies, Intensive Care and Anesthesia, Internal Medicine and Pneumology. Other units not directly involved in the care of these patients were offered to participate. On the day of sampling, a health questionnaire was answered, reporting symptoms on the same day and in the previous fourteen days. RESULTS: 498 HCWs were studied. Two individuals were detected with PCR for SARS-CoV-2 positive. Both were asymptomatic on the day of sampling, but one of them had had a CoVID-19 compatible picture in the previous two weeks and had positive IgG and IgM; therefore, only one subject was truly asymptomatic carrier (0.2%). 9 workers with positive IgG (1.8%) were detected. CONCLUSIONS: the prevalence of asymptomatic carriers among health workers of the services directly involved in the care of patients with CoVID-19 was very low in our center. This type of strategy can be one more tool in controlling the pandemic.

Spontaneous in-flight assembly of magnetic nanoparticles into macroscopic chains.

Knowing the interactions controlling aggregation processes in magnetic nanoparticles is of strong interest in preventing or promoting nanoparticles' aggregation at wish for different applications. Dipolar magnetic interactions, proportional to the particle volume, are identified as the key driving force behind the formation of macroscopic aggregates for particle sizes above about 20 nm. However, aggregates' shape and size are also strongly influenced by topological ordering. 1-D macroscopic chains of several micrometer lengths are obtained with cube-shaped magnetic nanoparticles prepared by the gas-aggregation technique. Using an analytical model and molecular dynamics simulations, the energy landscape of interacting cube-shaped magnetic nanoparticles is analysed revealing unintuitive dependence of the force acting on particles with the displacement and explaining pathways leading to their assembly into long linear chains. The mechanical behaviour and magnetic structure of the chains are studied by a combination of atomic and magnetic force measurements, and computer simulation. The results demonstrate that [111] magnetic anisotropy of the cube-shaped nanoparticles strongly influences chain assembly features.

[Effect of Sacha Inchi oil (Plukenetiavolubilis L.) on 1,2-dimethylhydrazine-induced colon carcinogenesis in Holtzman rats]. / Efecto del aceite de Sacha Inchi (Plukenetiavolubilis L.) en la carcinogénesis de colon inducida por 1,2­dimetilhidrazina en ratas Holtzman.

OBJECTIVES: To evaluate the preventive effect of Sacha Inchi oil (SIO) on 1,2-dimethylhydrazine (DMH)-induced colon carcinogenesis (CC) in Holtzman rats. MATERIALS AND METHODS: Experimental study with 28 Holtzman male albino rats randomly distributed into 4 groups: a positive control group exposed to DMH (C1), a negative control group exposed to SIO at 150 uL/kg/day (C2), and two experimental groups exposed to DMH with SIO at 150 uL/kg/day (E1) and SIO at 300 uL/kg/day (E2). The DMH was applied for 8 weeks and the total induction time was 22 weeks. Pathological examination was performed by identifying cancerous tumor lesions in the guts. The preventive effect was evaluated based on proportions of lack of lesion in the groups exposed to DMH. RESULTS: Cancerous tumor lesions were identified in: two specimens of group C1, one specimen of group E1 and two specimens of group E2. No intestinal lesions were identified in group C2. The proportions of lack of lesion were: in group C1 of 75%, in group E1 of 87.5% and group E2 of 75%. No significant differences were found (p>0.05). CONCLUSIONS: It was not found a significant protective effect of SIO on DMH-induced CC in Holtzman rats, compared to control group.

Efecto del aceite de Sacha Inchi (Plukenetia volubilis L.) en la carcinogénesis de colon inducida por 1,2–dimetilhidrazina en ratas Holtzman / Effect of Sacha Inchi oil (Plukenetia volubilis L.) on 1,2–dimethylhydrazine-induced colon carcinogenesis in Holtzman rats

Objetivos: Evaluar el efecto protector del aceite de Sacha Inchi (ASI) sobre el desarrollo de cáncer de colon (CC) inducido con 1,2–dimetilhidrazina (DMH) en ratas Holtzman. Materiales y métodos: Estudio experimental con 28 ratas albinas machos de la cepa Holtzman distribuidas al azar en 4 grupos: un grupo control positivo expuesto a DMH (C1), un grupo control negativo expuesto a ASI a 150 μL/kg/día (C2), y dos grupos experimentales expuestos a DMH con ASI a 150 μL/kg/día (E1) y ASI a 300 μL/kg/día (E2). La DMH se aplicó por 8 semanas y con un tiempo total de inducción de 22 semanas. Luego se realizó el análisis patológico mediante la identificación de lesiones tumorales cancerosas en los intestinos. El efecto protector se evaluó en base a las proporciones de ausencia de lesión en los grupos expuestos a DMH. Resultados: Se identificaron lesiones tumorales cancerosas en: dos especímenes del grupo C1, un espécimen del grupo E1 y dos especímenes del grupo E2. No se identificaron lesiones intestinales en el grupo C2. Las proporciones de ausencia de lesión fueron: en el grupo C1 de 75%, en el grupo E1 de 87,5% y en el grupo E2 de 75%. No se encontraron diferencias significativas (p>0,05). Conclusiones: No se evidenció un efecto protector significativo del ASI sobre el desarrollo de CC inducido con DMH en ratas Holtzman, respecto al grupo control.

Objectives: To evaluate the preventive effect of Sacha Inchi oil (SIO) on 1,2–dimethylhydrazine (DMH)-induced colon carcinogenesis (CC) in Holtzman rats. Materials and methods: Experimental study with 28 Holtzman male albino rats randomly distributed into 4 groups: a positive control group exposed to DMH (C1), a negative control group exposed to SIO at 150 uL/kg/ day (C2), and two experimental groups exposed to DMH with SIO at 150 uL/kg/day (E1) and SIO at 300 uL/kg/day (E2). The DMH was applied for 8 weeks and the total induction time was 22 weeks. Pathological examination was performed by identifying cancerous tumor lesions in the guts. The preventive effect was evaluated based on proportions of lack of lesion in the groups exposed to DMH. Results: Cancerous tumor lesions were identified in: two specimens of group C1, one specimen of group E1 and two specimens of group E2. No intestinal lesions were identified in group C2. The proportions of lack of lesion were: in group C1 of 75%, in group E1 of 87.5% and group E2 of 75%. No significant differences were found (p>0.05). Conclusions: It was not found a significant protective effect of SIO on DMH-induced CC in Holtzman rats, compared to control group.

Splice variants of zinc finger protein 695 mRNA associated to ovarian cancer.

BACKGROUND: Studies of alternative mRNA splicing (AS) in health and disease have yet to yield the complete picture of protein diversity and its role in physiology and pathology. Some forms of cancer appear to be associated to certain alternative mRNA splice variants, but their role in the cancer development and outcome is unclear. METHODS: We examined AS profiles by means of whole genome exon expression microarrays (Affymetrix GeneChip 1.0) in ovarian tumors and ovarian cancer-derived cell lines, compared to healthy ovarian tissue. Alternatively spliced genes expressed predominantly in ovarian tumors and cell lines were confirmed by RT-PCR. RESULTS: Among several significantly overexpressed AS genes in malignant ovarian tumors and ovarian cancer cell lines, the most significant one was that of the zinc finger protein ZNF695, with two previously unknown mRNA splice variants identified in ovarian tumors and cell lines. The identity of ZNF695 AS variants was confirmed by cloning and sequencing of the amplicons obtained from ovarian cancer tissue and cell lines. CONCLUSIONS: Alternative ZNF695 mRNA splicing could be a marker of ovarian cancer with possible implications on its pathogenesis.

El estudio intraoperatorio: experiencia inicial en el Instituto Regional de Enfermedades Neoplásicas - Norte / The intraoperative study: initial experience in the Instituto Regional de Enfermedades Neoplásicas - North

El estudio intraoperatorio tiene un papel fundamental en el manejo transoperatorio de una neoplasia cuando hay duda si es benigna o maligna, dándole al cirujano las pautas necesarias para la toma inmediata de decisiones terapéuticas. Presentamos la experiencia inicial del Instituto Regional de Enfermedades Neoplásicas Norte (IREN Norte). Objetivo: Determinar la sensibilidad y especificidad del estudio intraoperatorio de las piezas quirúrgicas en los pacientes del IREN Norte. Materiales y métodos: Estudio prospectivo, descriptivo, de validación de prueba; en el que se incluyó las biopsias intraoperatorias de 46 pacientes, a los que se les realizó corte por congelación y/o citología intraoperatoria durante el período comprendido entre agosto del 2009 y septiembre del 2010. El estudio histológico fue el "estandar de oro". Los datos se procesaron a través de pruebas estadísticas para determinar sensibilidad y especificidad. Resultados: De 46 pacientes 84,78% fueron de sexo femenino y 15,22% de sexo masculino, con una edad promedio de 48 años. Se encontraron 11 casos (23.9%) positivos para neoplasia maligna. La sensibilidad y especificidad de la biopsia por congelación fue de 92% y 100% respectivamente (n=33). En relación con la citología intraoperatoria de 43 casos la sensibilidad y especificidad fue de 96% y 100%. La combinación de ambas técnicas dio una sensibilidad de 97% y una especificidad de 100%. Conclusiones: Aunque nuestra experiencia inicial es corta, la sensibilidad y especificidad de la técnica coincide con lo reportado en la literatura, y es vital para la toma de decisiones durante el acto quirúrgico.

The intraoperative study has a key role in the perioperative management of a tumor when there is doubt whether it is benign or malignant, giving the surgeon the necessary guidelines for making immediate treatment decisions. We report the initial experience of the IREN Norte. Objective: To determine the sensitivity and specificity of intraoperative study of surgical specimens in patients in the IREN Norte. Materials and methods: Prospective, descriptive, validation test, which included intraoperative biopsies of 46 patients, who underwent frozen section and / or intraoperative cytology during the period between August 2009 and September 2010. The histological study was the gold standard. The data were processed by statistical tests to determine sensitivity and specificity. Results: Of 46 patients 84.78% were female and 15.22% male, mean age 48 years. 11 cases (23.9%) positive for malignancy The sensitivity and specificity only in the frozen biopsy was 92% and 100% respectively (n = 33). Regarding the 43 cases of intraoperative cytology sensitivity and specificity was 96% and 100%. The combination of both techniques gave a sensitivity of 97% and a specificity of 100%. Conclusions: Although our initial experience is short, the sensitivity and specificity of the technique consistent with that reported in the literature, and is vital for decision making during surgery.