ABSTRACT
BACKGROUND: Stenting with flow diverter devices (FDDs) has increasingly emerged as a treatment for intracranial aneurysms. The use of FDDs in the developing world has not been described. METHODS: A retrospective review was performed of a cohort of patients who underwent flow diversion at 4 tertiary-care centers in Lima, Peru between January 2017 and June 2021. Demographics, clinical features, and aneurysm morphology were evaluated. Clinical outcomes were observed 3 months after discharge and occlusion rates were assessed 12 months after treatment. RESULTS: Sixty-nine patients (mean age, 46 ±14.5 years; 17% female) were treated with FDDs; 4% (n = 3) of the treated aneurysms were ruptured. Most aneurysms were saccular (n = 65; 94%), <10 mm in maximum size (n = 60; 87%), and located in the anterior circulation (n = 67; 97%). Minor complications, such as groin hematoma, occurred in 7 cases. No serious complications or deaths occurred. Patients' functional status was excellent (modified Rankin Scale score 0-1) in 99% (n = 66) at discharge and 100% (n = 67) at 3 months. Although some patients were lost to follow-up, complete occlusion was seen in 76% (n = 31) of 41 treated patients at 12 months. CONCLUSIONS: We report the largest multicenter experience of FDDs for cerebral aneurysm treatment in Peru, with reasonable outcomes that are comparable to other settings despite various challenges, suboptimal circumstances, and lack of resources.
Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Humans , Female , Adult , Middle Aged , Male , Intracranial Aneurysm/therapy , Peru/epidemiology , Treatment Outcome , Cerebral Angiography , Retrospective Studies , Stents , Follow-Up StudiesABSTRACT
Microneedle patches are a promising source for transdermal diffusion of macromolecules and are designed to painlessly penetrate the skin. In this study, a biodegradable chitosan microneedle patch to deliver meloxicam for managing pain in cattle was tested. The potential of reuse of the polymeric solution to fabricate the patches, optimization of fabrication, morphological analysis of the microneedle patch and analysis of preservation of the chemical composition after sterilization were evaluated. In-vitro analysis consisted of studying in-vitro penetration mechanical properties, compression testing analysis of microneedle patch, and in-vitro drug release analysis. In-vivo studies were performed to analyze the dissolution capability of the microneedle patch. Results regarding the physical characteristics, chemical composition, and mechanical properties confirmed that rheological properties of the chitosan solution, present significant differences over time, demonstrating that reusing the solution on the fourth day results in failure patches. Morphological characteristics and chemical composition studies revealed that the process of sterilization (ethylene oxide gas) needed for implanting the patches into the skin did not affect the properties of microneedle patches. In-vitro studies showed that approximately 33.02 ± 3.88% of the meloxicam was released over 7 days. A full penetration of the microneedles into the skin can be obtained by applying approximately 3.2 N. In-vivo studies demonstrated that microneedle patches were capable of swelling and dissolving, exhibiting a dissolution percentage of more than 50% of the original height of microneedle after 7 days. No abnormal tissue, swelling, or inflammation was observed in the implanted area. The results of this work show that chitosan biodegradable microneedle patches may be useful to deliver meloxicam to improve pain management of cattle with positive effects for commercial manufacturing.
Subject(s)
Chitosan , Administration, Cutaneous , Animals , Cattle , Chitosan/chemistry , Drug Delivery Systems/methods , Meloxicam/pharmacology , Needles , Pain/drug therapy , Pain/veterinary , Pain Management , Skin , Transdermal PatchABSTRACT
Objetivos: Explorar los factores asociados a mortalidad en pacientes con infarto cerebral que fueron hospitalizados en el Instituto Nacional de Ciencias Neurológicas. Material y Métodos: Se revisaron las historias clínicas de pacientes con diagnóstico de infarto cerebral hospitalizados en el Instituto Nacional de Ciencias Neurológicas, durante Enero del 2008 hasta Diciembre del 2009. Se describen las variables demográficas y clínicas de los pacientes, además se utilizó el modelo de regresión logística para explorar los factores asociados a mortalidad en los pacientes. Resultados: Se analizaron 461 historias clínicas de pacientes con infarto cerebral. El promedio de edad fue de 67 años, el 56% fueron hombres. La mortalidad fue del 7,6%, IC 95% (5,3-10,4); los factores asociados a mortalidad que tuvieron significancia estadística fueron: el déficit sensitivo OR=2,7, cefalea OR=2,75, trastorno de conciencia OR=12, escala NIHSS al ingreso OR=1,25 y el territorio vascular anterior OR=2,65. Conclusiones: en éste estudio exploratorio los factores asociados a mortalidad intrahospitalaria por infarto cerebral fueron la presencia de déficit sensitivo, cefalea, pérdida de conciencia, déficit neurológico severo y territorio vascular de la circulación anterior.
Objectives: To explore associated factors to mortality of patients with cerebral infarction. Methods: We reviewed clinical records of patients with diagnosis of cerebral infarction hospitalized at the Instituto Nacional de Ciencias Neurologicas, January 2008 to December 2010. We describe the demographic and clinical variables. In addition, the logistic regression model was used to determine the factors associated with mortality in these patients. Results: We reviewed clinical records of 461 patients with brain infarction. The median age was 67 years and 56% were men. We calculated a ratio of 7.6% dead, 95% IC (5.3-10.4); the factors significantly associated are the sensitive deficit OR = 2.7, headache OR = 2.75, consciousness disorder OR = 12, NIHSS scale OR = 1.25 and anterior vascular territory OR = 2.65. Conclusions: in this exploratory study factors associated with mortality by cerebral infarction were the presence of sensitive deficit, headache, loss of consciousness, severe neurological deficit and vascular territory of the anterior circulation.