ABSTRACT
Guatemala implemented wastewater-based poliovirus surveillance in 2018, and three genetically unrelated vaccine-derived polioviruses (VDPVs) were detected in 2019. The Ministry of Health (MoH) response included event investigation through institutional and community retrospective case searches for acute flaccid paralysis (AFP) during 2018-2020 and a bivalent oral polio/measles, mumps, and rubella vaccination campaign in September 2019. This response was reviewed by an international expert team in July 2021. During the campaign, 93% of children 6 months <7 years of age received a polio-containing vaccine dose. No AFP cases were detected in the community search; institutional retrospective searches found 37% of unreported AFP cases in 2018â2020. No additional VDPV was isolated from wastewater. No evidence of circulating VDPV was found; the 3 isolated VDPVs were classified as ambiguous VDPVs by the international team of experts. These detections highlight risk for poliomyelitis reemergence in countries with low polio vaccine coverage.
Subject(s)
Poliomyelitis , Poliovirus , Child , Humans , Poliovirus Vaccine, Oral/adverse effects , Wastewater , Guatemala/epidemiology , Retrospective Studies , Poliomyelitis/epidemiology , Poliomyelitis/prevention & control , Environmental MonitoringABSTRACT
ANTECEDENTES: Los abordajes quirúrgicos de la región selar han sido un reto para los neurocirujanos. Con la introducción de la técnica endoscópica se ha minimizado el trauma quirúrgico, pero esta técnica no se encuentra exenta de complicaciones. OBJETIVO: Describir nuestra experiencia institucional en pacientes sometidos a resección de macroadenomas hipofisarios por vía microquirúrgica endonasal transesfenoidal asistida por endoscopia con énfasis en las complicaciones resultantes. MÉTODO: Revisamos los expedientes electrónicos de 17 pacientes sometidos a dicho procedimiento de manera consecutiva entre 2017 y 2018, y recabamos variables como edad, sexo, clasificación imagenológica, tiempo de diagnóstico al momento de la cirugía, complicaciones posoperatorias y recurrencia. RESULTADOS: La edad promedio de los pacientes fue de 45.23 años y el 70.59% eran mujeres. Radiológicamente predominó el grado 2 Knosp (47.05%). La complicación principal fue diabetes insípida transitoria (23.52%), seguida por la fístula de líquido cefalorraquídeo (11.76%). CONCLUSIONES: El manejo microquirúrgico asistido por endoscopia ha demostrado ser un recurso valioso para tratar macroadenomas hipofisarios, pero presenta grados variables de complicaciones, por lo cual se requiere la adquisición de habilidades para el uso del endoscopio, la planeación preoperatoria adecuada y el manejo conjunto multidisciplinario con el fin de evitarlas. BACKGROUND: Surgical approaches to the sellar region have been a challenge for the neurosurgeon. With the introduction of the endoscopic technique, surgical trauma has been minimized, however it is not free of complications. OBJECTIVE: To describe our institutional experience in patients undergoing resection of pituitary macroadenomas by endoscopic-assisted microsurgical approach, with emphasis on the resulting complications. METHOD: We reviewed the electronic files of 17 patients who underwent this procedure consecutively between 2017 and 2018, collecting variables such as age, sex, imaging classification, time of diagnosis at the time of surgery, postoperative complications and recurrence. RESULTS: The average age of the patients was 45.23 years, with 70.59% women. Radiologically, grade 2 Knosp predominated (47.05%). The main complication was transient diabetes insipidus (23.52%) followed by cerebrospinal fluid fistula (11.76%). CONCLUSIONS: The endoscopic-assisted microsurgical approach has proven to be a valuable resource for treating pituitary macroadenomas, however it presents variable degrees of complications, which requires the acquisition of skills for the use of the endoscope, adequate preoperative planning, and multidisciplinary joint management in order to avoid them.
