Global neurosurgery: Reflections on myelomeningocele in the Zanzibar archipelago (Tanzania).

Objective: Our main goal was to describe the general characteristics and demographic data of myelomeningocele (MMC) patients at Mnazi Mmoja Surgical NED Institute (MMSNI) in Zanzibar and to assess the clinical characteristics and medium-term result-impact of the implemented health care measures. Methods: This is a retrospective study on 41 MMC patients treated at the MMSNI in Zanzibar (Tanzania) from September 2016 to September 2018. Patient demographics, prenatal care, clinical and radiographic characteristics, surgical management and nursing care, and clinical outcomes were abstracted. Results: The mean age of the patients was 6.1 ± 4.6 days, and 53.7% were males. A total of 51.2% came from Zanzibar, 39% to Pemba, and 9.8% from mainland Tanzania. Maternal ultrasound checkups revealed hydrocephalus in 18.7% of the cases. 85.4% of the newborns were operated on. Surgical wound infection was the most frequent complication (28.6%). A significantly higher risk of complications was observed in children from Pemba Island (p = 0.046) and those born by vaginal delivery (p = 0.694), particularly infections. During follow-up, 48.57% of the patients presented with infantile hydrocephalus and in the majority of them, a ventriculoperitoneal shunt was inserted. Conclusions: Proper prenatal care with early diagnosis, together with the neurosurgical and nursing standard of care in a specialized institution, are all essential to increase the chances of successful treatment of newborns harboring MMC and is one of the main goals pursued in the MMSNI, as the only referral public health center with locally trained health personnel in Zanzibar archipelago.

The NED foundation experience: A model of global neurosurgery.

Introduction: The Neurosurgery Education and Development (NED) Foundation (NEDF) started the development of local neurosurgical practice in Zanzibar (Tanzania) in 2008. More than a decade later, multiple actions with humanitarian purposes have significantly improved neurosurgical practice and education for physicians and nurses. Research question: To what extent could comprehensive interventions (beyond treating patients) be effective in developing global neurosurgery from the outset in low and middle-income countries? Material and method: A retrospective review of a 14- year period (2008-2022) of NEDF activities highlighting landmarks, projects, and evolving collaborations in Zanzibar was carried out. We propose a particular model, the NEDF model, with interventions in the field of health cooperation that have simultaneously aimed to equip, treat, and educate in a stepwise manner. Results: 138 neurosurgical missions with 248 NED volunteers have been reported. In the NED Institute, between Nov 2014-Nov 2022, 29635 patients were seen in the outpatient clinics and 1985 surgical procedures were performed. During the course of NEDF's projects, we have identified three different levels of complexity (1, 2 and 3) that include the areas of equipment ("equip"), healthcare ("treat") and training ("educate"), facilitating an increase of autonomy throughout the process. Discussion and Conclusion: In the NEDF's model, the interventions required in each action area (ETE) are coherent for each level of development (1, 2 and 3). When applied simultaneously, they have a greater impact. We believe the model can be equally useful for the development of other medical and/or surgical specialties in other low-resource healthcare settings.

Hacia la creación de la especialidad sanitaria de Psicología Clínica de la Infancia y la Adolescencia / Towards the creation of the health qualification of Clinical Child and Adolescent Psychology

En España aún no existe un título oficial de especialista sanitario en Psicología Clínica de la Infancia y la Adolescencia, sin embargo, son muchos los argumentos que evidencian la necesidad de su creación. Entre los principales están la urgente necesidad de mejorar la calidad de la atención a la salud mental de la infancia y la adolescencia; el hecho de que esta especialidad sanitaria ya existe como rama científica diferenciada y consolidada; la necesidad de un programa de formación reglada propio para esta área de la psicología clínica, dada la especificidad y extensión de los conocimientos científicos y competencias profesionales necesarios para su ejercicio; o que la Psicología Clínica de la Infancia y la Adolescencia ya existe de facto como especialidad sanitaria diferenciada en algunos sistemas sanitarios públicos autonómicos. En este artículo se exponen y desarrollan estos y otros argumentos con el objetivo de impulsar la creación de esta nueva especialidad sanitaria en nuestro país. (AU)

There is still no official title of health specialist in Clinical child and adolescent psychology in Spain. However, there are many reasons for creating it: the urgent need to improve the quality of children and adolescents´ mental health care; the fact that this health specialty already exists as a differentiated and consolidated scientific discipline; the need for a proper training program for this clinical psychology area, due to the specificity and extent of the scientific knowledge and professional skills necessary for its exercise; or that Clinical child and adolescent psychology, as a matter of fact (although it is not yet officially or legally recognized), already exists as a differentiated health specialty in some public health systems. This article presents and explains these and other equally relevant reasons in detail, with the aim of promoting the creation of this new health specialty in our country. (AU)

Prevalencia de sobrepeso y obesidad infantil. Estudio de una cohorte en Castilla y León, España / Prevalence of overweight and obesity in child population. A study of a cohort in Castile and Leon, Spain

Introducción: Varios estudios advierten que el sobrepeso y la obesidad se han convertido en una epidemia con graves consecuencias sobre la salud de la población. El objetivo del presente estudio es estimar la prevalencia de sobrepeso y obesidad en Castilla y León en una muestra de niños a los 6, 11 y 14 años de edad, describir su evolución y su asociación con hábitos de vida y antecedentes. Metodología: Estudio observacional, de cohorte retrospectivo, realizado por los pediatras de la Red Centinela Sanitaria, que se enmarca en un proyecto conjunto con el Centro Nacional de Investigación sobre la Evolución Humana de Burgos para conocer el patrón de crecimiento y desarrollo de la población infantil de Castilla y León. En 2012 se realizó un examen de salud y una recogida retrospectiva a partir de la historia clínica en una muestra de 326 niños, de la cohorte de nacidos en 1998. Resultados: Según los criterios de la OMS, a los 14 años había un 25,3% de sobrepeso entre los niños y un 18,5% entre las niñas. En cuanto a la obesidad, esta afectaba al 8,2 y 4,8%, respectivamente. A los 11 años se produce un pico de sobrepeso en las niñas y de obesidad en los niños. El entorno urbano-no urbano, la calidad y duración del sueño, así como el índice de masa corporal (IMC) de los padres han sido algunos de los factores asociados con el peso de los niños. Discusión: En Castilla y León, como en otras poblaciones de nuestro entorno, existe un grave problema de sobrepeso y obesidad infantil. Para su control, es necesario profundizar sobre los estilos de vida y los antecedentes relacionados con el nacimiento, así como el cálculo de la velocidad de crecimiento en la edad pediátrica

Introduction: Several studies warn that overweight and obesity have become an epidemic with severe consequences in the population's health. The objetive of the present study is to estimate the prevalence of overweight and obesity in Castile and Leon in a sample of children at 6, 11 and 14 years of age, to describe its evolution and its association with life habits and antecedents. Material and methods: Observational study, retrospective cohort, performed by the pediatricians of the Health Sentinel Network. The study is part of a joint Project with the National Research Center on Human Evolution (CENIEH) in Burgos to know the pattern of growth and development of the child population of Castile and Leon. In 2012, a health examination and a retrospective collection were carried out based on the clinical history of a simple of 326 children, from the cohort was born in 1998. Results: Following the WHO references, at age 14 there was 25.3% of boys and 18.5% of girls with overweight. Obesity was estimated to affect the 8.2% and 4.8% of them respectively. At 11 years of age there was the maximum of overweight in girls and of obesity in boys. At the urban-non urban environment, quantity and quality of sleep and the parents' BMI have been some of the associated factors to weight level of the children. Discussion: In Castile and Leon, as in other populations of our environment, there is a severe problema of overweight and obesity. For their control it is necesary to deepen understanding of lifestyles and antecedents related to the birth as well as to calculate the growth rate in the pediatric age

Prevalence of overweight and obesity in child population. A study of a cohort in Castile and Leon, Spain. / Prevalencia de sobrepeso y obesidad infantil. Estudio de una cohorte en Castilla y León, España.

INTRODUCTION: Several studies warn that overweight and obesity have become an epidemic with severe consequences in the population's health. The objetive of the present study is to estimate the prevalence of overweight and obesity in Castile and Leon in a sample of children at 6, 11 and 14 years of age, to describe its evolution and its association with life habits and antecedents. MATERIAL AND METHODS: Observational study, retrospective cohort, performed by the pediatricians of the Health Sentinel Network. The study is part of a joint Project with the National Research Center on Human Evolution (CENIEH) in Burgos to know the pattern of growth and development of the child population of Castile and Leon. In 2012, a health examination and a retrospective collection were carried out based on the clinical history of a simple of 326 children, from the cohort was born in 1998. RESULTS: Following the WHO references, at age 14 there was 25.3% of boys and 18.5% of girls with overweight. Obesity was estimated to affect the 8.2% and 4.8% of them respectively. At 11 years of age there was the maximum of overweight in girls and of obesity in boys. At the urban-non urban environment, quantity and quality of sleep and the parents' BMI have been some of the associated factors to weight level of the children. DISCUSSION: In Castile and Leon, as in other populations of our environment, there is a severe problema of overweight and obesity. For their control it is necesary to deepen understanding of lifestyles and antecedents related to the birth as well as to calculate the growth rate in the pediatric age.

Results of Upfront Therapy for Marginal Zone Lymphoma.

BACKGROUND: Marginal zone lymphomas (MZLs) are indolent disorders composed of 3 subtypes: extranodal marginal zone lymphoma (MALT), splenic marginal zone lymphoma (SMZL), and nodal marginal zone lymphoma (NMZL). Early-stage MALT is treated with radiotherapy or antibiotics, and advanced MALT and NMZL are managed with either watch and wait or chemotherapy. SMZLs are treated with splenectomy or rituximab. However, because these approaches have failed to cure patients with SMZL and NMZL, we have systematically used upfront chemotherapy for them, as well as for advanced MALT. We report the outcomes of this approach. PATIENTS AND METHODS: A total of 44 patients with MZL were identified from our database and divided into 2 groups. Group 1 (22 with early-stage MALT) patients received either radiotherapy (n = 17) or antibiotics with or without surgery (n = 5). Group 2 included 9 patients with advanced MALT, 9 with SMZL, and 4 with NMZL. Group 2 was treated with FND-R (fludarabine 25 mg/m2 on days 1 to 3, mitoxantrone 10 mg/m2 on day 1, dexamethasone 20 mg on days 1 to 5, and rituximab 375 mg/m2 on day 1; n = 14) or CHOP-R (cyclophosphamide 750 mg/m2 on day 1, doxorubicin 50 mg/m2 on day 1, vincristine 2 mg intravenous push on day 1, prednisone 100 mg/m2 orally on days 1 to 5, rituximab 375 mg/m2 on day 1; n = 8), followed by maintenance rituximab for 70%. RESULTS: All patients achieved complete remission, and only 2 patients in group 1 had developed a relapse at 70 and 75 months. Both relapses were stage I MALT that had initially been treated with radiotherapy. Both were salvaged with FND-R and remained free of disease at 27 and 39 months after the relapse. At 10 years, the failure-free survival for the 44 patients was 80% and the overall survival was 100%. None of the patients in group 2 developed a relapse. The long-term toxicities have been acceptable. CONCLUSIONS: The excellent responses using upfront chemotherapy for MZL suggests that this disorder is curable. Our results should be confirmed in a prospective trial.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Surgical approach in treatment of translation/rotation injuries of the lower cervical spine in 21 patients.

BACKGROUND: The management of lower cervical spine injuries with a dislocation of one or both facet joints and a displacement of a vertebra over the adjacent stills generates considerable controversy. We describe our experience in surgical approach of these injuries. METHODS: We present 21 cases treated between 2003-2010. Neurological status was evaluated with Frankel scale. Diagnosis was done by radiograph (XR), computed tomography (CT) and/or magnetic resonance image (MRI). Cervical traction was placed in 10 cases before surgery. Posterior and/or anterior approach was used for reduction and stabilization. RESULTS: The 21 cases presented were treated by surgery. Posterior approach was initially used in 17 cases and complete reduction was achieved in 13 of them. The 4 cases where we only got a partial reduction, surgery had to be delayed for different reasons. Anterior approach was initially used in 4 of the 21 cases. In 3 of them, reduction was previously obtained by traction and the fourth case anterior approach was used initially due to an important spinal cord compression. Permanent stabilization was achieved in 19 of the 21 cases. In 1 of the other 2 cases an important deformity was detected after the anterior approach. The other case had a minimal progression after a posterior approach with no increase in successive check-ups. In the first 10 cases, we used traction before surgery but reduction was achieved only in 3 of them. As the number of cases increased we rather used posterior approach in the first place, without even trying a preoperative traction. There was no case of neurological deterioration after surgery. CONCLUSION: Translation/rotation injuries of the lower cervical spine are unstable and surgical treatment must be indicated. It is our impression that posterior approach allows a better reduction and stabilization of this injuries and should be used initially without even trying a preoperative traction.

Surgical approach in treatment of translation/rotation injuries of the lower cervical spine in 21 patients

Antecedentes El tratamiento de las lesiones del raquis cervical inferior con luxación de una o ambas facetas articulares y desplazamiento de una vértebra sobre la adyacente todavía genera una controversia considerable. Describimos nuestra experiencia en el tratamiento quirúrgico de este tipo de lesiones. Métodos Presentamos 21 casos tratados entre 2003-2010. La situación neurológica fue valorada con la escala de Frankel. El diagnóstico se hizo mediante radiografía (XR), tomografía computerizada (CT) y/o resonancia magnética (MRI). La tracción cervical fue utilizada en 10 casos antes de la cirugía. En su estabilización se utilizó un abordaje posterior y/o anterior. Resultados Los 21 casos presentados fueron tratados mediante cirugía. Se realizó inicialmente un abordaje posterior en 17 casos y se consiguió la reducción completa en 13 de ellos. Los 4 casos donde obtuvimos solo una reducción parcial, la cirugía tuvo que retrasarse por diferentes motivos. El abordaje anterior se utilizó inicialmente en 4 de los 21 casos. En 3 de ellos, la reducción se consiguió previamente mediante tracción y en el cuarto caso se utilizó (..) (AU)

The 3' untranslated region of a soybean cytosolic glutamine synthetase (GS1) affects transcript stability and protein accumulation in transgenic alfalfa.

Higher plants assimilate nitrogen in the form of ammonia through the concerted activity of glutamine synthetase (GS) and glutamate synthase (GOGAT). The GS enzyme is either located in the cytoplasm (GS1) or in the chloroplast (GS2). Glutamine synthetase 1 is regulated in different plants at the transcriptional level and there are some reports of regulation at the level of protein stability. Here we present data that clearly establish that GS1 in plants is also regulated at the level of transcript turnover and at the translational level. Using a Glycine max (soybean) GS1 transgene, with and without its 3' untranslated region (UTR), driven by the constitutive CaMV 35S promoter in Medicago sativa (alfalfa) and Nicotiana tabacum (tobacco), we show that the 3' UTR plays a major role in both transcript turnover and translation repression in both the leaves and the nodules. Our data suggest that the 3' UTR mediated turnover of the transcript is regulated by a nitrogen metabolite or carbon/nitrogen ratios. We also show that the 3' UTR of the gene for the soybean GS1 confers post-transcriptional regulation on a reporter gene. Our dissection of post-transcriptional and translational levels of regulation of GS in plants shows that the situation in plants strongly resembles that in other organisms where GS is regulated at almost all levels. Multistep regulation of GS shows the high priority given by organisms to regulating and ensuring optimal control of nitrogen substrates and preventing overproduction of glutamine and drainage of the glutamate pool.