Frontal sulcotomy through 3D printed illuminated endoport for minimally invasive evacuation of a deep-seated intracerebral hematoma - A case report.

Spontaneous intracerebral hemorrhage carries high mortality and disability rates and usually affects deep brain structures. We have implemented a self-designed low-cost 3D-printed illuminated endoport for the surgical drainage of a deep spontaneous intracerebral hemorrhage in a patient who arrived with right hemiparesis and a GCS score of 10. A minimally invasive approach was made and our patient had a favorable functional outcome after surgery. Carrying out this approach with a low-cost 3D-printed endoport makes it possible to offer a safe and efficient treatment option to a low-income country population.

Extrasynaptic Communication.

Streams of action potentials or long depolarizations evoke a massive exocytosis of transmitters and peptides from the surface of dendrites, axons and cell bodies of different neuron types. Such mode of exocytosis is known as extrasynaptic for occurring without utilization of synaptic structures. Most transmitters and all peptides can be released extrasynaptically. Neurons may discharge their contents with relative independence from the axon, soma and dendrites. Extrasynaptic exocytosis takes fractions of a second in varicosities or minutes in the soma or dendrites, but its effects last from seconds to hours. Unlike synaptic exocytosis, which is well localized, extrasynaptic exocytosis is diffuse and affects neuronal circuits, glia and blood vessels. Molecules that are liberated may reach extrasynaptic receptors microns away. The coupling between excitation and exocytosis follows a multistep mechanism, different from that at synapses, but similar to that for the release of hormones. The steps from excitation to exocytosis have been studied step by step for the vital transmitter serotonin in leech Retzius neurons. The events leading to serotonin exocytosis occur similarly for the release of other transmitters and peptides in central and peripheral neurons. Extrasynaptic exocytosis occurs commonly onto glial cells, which react by releasing the same or other transmitters. In the last section, we discuss how illumination of the retina evokes extrasynaptic release of dopamine and ATP. Dopamine contributes to light-adaptation; ATP activates glia, which mediates an increase in blood flow and oxygenation. A proper understanding of the workings of the nervous system requires the understanding of extrasynaptic communication.

The Golden Hour: Sustainability and Clinical Outcomes of Adequate Time to Antibiotic Administration in Children with Cancer and Febrile Neutropenia in Northwestern Mexico.

PURPOSE: Time to antibiotic administration (TTA) is a commonly used standard of care in pediatric cancer settings in high-income countries. Effective interventions to improve outcomes in cancer patients with febrile neutropenia (FN) often address timely and appropriate antibiotic administration. We assessed the effectiveness of a locally adapted multimodal strategy in decreasing TTA in a resource-constrained pediatric cancer center in Mexico. METHODS: We conducted a prospective observational study between January 2014 and April 2019. A three-phase (phase I: execution, phase II: consolidation, phase III: sustainability) multimodal improvement strategy that combined system change, FN guideline development, education, auditing and monitoring, mentoring, and dissemination was implemented to decrease TTA in inpatient and ambulatory areas. Sustainability factors were measured by using a validated tool during phases I and III. RESULTS: Our population included 105 children with cancer with 204 FN events. The baseline assessment revealed that only 50% of patients received antibiotics within 60 minutes of prescription (median time: inpatient, 75 minutes; ambulatory, 65 minutes). After implementing our improvement strategy, the percentage of patients receiving antibiotics within 60 minutes of prescription increased to 88%. We significantly decreased median TTA in both clinical areas during the three phases of the study. In phase III (sustainability), the median TTA was 40 minutes (P = .023) in the inpatient area and 30 minutes (P = .012) in the ambulatory area. The proportion of patients with sepsis decreased from 30% (baseline) to 5% (phase III) (P = .001). CONCLUSION: Our results demonstrate that locally adapted multimodal interventions can reduce TTA in resource-constrained settings. Mentoring and dissemination were novel components of the multimodal strategy to improve FN-associated clinical outcomes. Improving local infrastructure, ongoing monitoring systems, and leadership engagement have been key factors to achieving sustainability during the 5-year period.

Trombosis en el recién nacido / Thrombosis in the newborn

La trombosis en recién nacidos (RN) es una patología infrecuente que se asocia principalmente a catéter venoso central. Su presentación clínica puede ser la de un RN asintomático o con sintomatología variable, según la ubicación y tamaño de la trombosis. El diagnóstico generalmente se realiza con ecografía doppler y exámenes específicos según sea la presentación clínica. Con respecto al manejo, actualmente no existe mucha evidencia en RN, pero se suele utilizar trombolíticos/fibrinolíticos extrapolando las investigaciones de adultos. En esta revisión se detalla sobre epidemiología, fisiopatología, factores de riesgo, presentaciones clínicas, diagnóstico y tratamiento. Existe falta de estudios sobre epidemiología nacional y tratamiento en RN, se plantea la necesidad de estos.

Thrombosis in newborns is an infrequent pathology which is mainly associated with a central venous catheter. Its clinical presentation may be that of an asymptomatic newborn or with variable symptoms, depending on the location and size of the thrombosis. The diagnosis is generally made with Doppler ultrasound and specific examinations depending on the clinical presentation. Regarding management, currently there is not much evidence in newborns, but thrombolytics / fibrinolytics are usually used extrapolating from adult investigations. This review details epidemiology, pathophysiology, risk factors, clinical presentations, diagnosis and treatment. There is a lack of studies on national epidemiology and treatment in newborns, the need for these arises.

Embarazo espontáneo en una paciente con agenesia de cuello uterino / Spontaneous pregnancy in patient with cervical agenesis

Resumen ANTECEDENTES: La incidencia de agenesia cervical con endometrio funcional se desconoce, aunque se calcula menor a 0.1% en la población general. El pronóstico reproductivo de pacientes con malformaciones müllerianas es limitado y requiere múltiples intervenciones quirúrgicas. CASO CLÍNICO: Paciente primigesta de 21 años, con antecedente de agenesia de cuello uterino y dos tercios superiores de la vagina. Acudió a consulta a las 38.1 semanas de embarazo establecido conforme a la fecha de la última menstruación. Refirió haber concebido de forma espontánea y negó complicaciones durante el embarazo. Se programó para finalizar el embarazo mediante cesárea. El periodo trans y posquirúrgico transcurrió sin complicaciones maternas ni fetales. CONCLUSIÓN: El embarazo espontáneo en pacientes con malformaciones müllerianas debe tratarse a tiempo para asegurar que no surjan complicaciones que pongan en riesgo la vida de la madre y su hijo.

Abstract BACKGROUND: The incidence of cervical agenesis with functional endometrium is unknown, but it's estimated to be less than 0.1% in the general population. The reproductive prognosis in Müllerian malformations is limited and, in most cases, requires multiple surgical interventions to be improved. CASE REPORT: A 21-year-old primiparous patient with a history of agenesis of the cervix and two upper thirds of the vagina. Attended a first-time obstetric appointment at 38.1 weeks of gestation. She refers that the pregnancy was conceived spontaneously and denied complications during pregnancy. A cesarean section was scheduled to end the pregnancy, which had no trans or post-operative maternal-fetal morbidity. CONCLUSIONS: Spontaneous pregnancy in patients with congenital agenesis of the cervix should be addressed in time to ensure a favorable obstetric outcome.

The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country.

BACKGROUND: The US National Healthcare Safety Network has provided a definition of mucosal barrier injury-associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its influence in pediatric oncology centers in low- to middle-income countries. OBJECTIVES: To determine the influence of the definition on the rate of central line-associated bloodstream infection (CLABSI) and compare the clinical characteristics of MBI versus non-MBI LCBI cases. METHODS: We retrospectively applied the National Healthcare Safety Network definition to all CLABSIs recorded at a pediatric oncology center in Tijuana, Mexico, from January 2011 through December 2014. CLABSI events were reclassified according to the MBI-LCBI definition. Clinical characteristics and outcomes of MBI and non-MBI CLABSIs were compared. RESULTS: Of 55 CLABSI events, 44% (24 out of 55) qualified as MBI-LCBIs; all were MBI-LCBI subcategory 1 (intestinal flora pathogens). After the number of MBI-LCBI cases was removed from the numerator, the CLABSI rate during the study period decreased from 5.72-3.22 infections per 1,000 central line days. Patients with MBI-LCBI were significantly younger than non-MBI-LCBI patients (P = .029) and had a significantly greater frequency of neutropenia (100% vs 39%; P = .001) and chemotherapy exposure (87% vs 58%; P = .020) and significantly longer median hospitalization (34 vs 23 days; P = .008). CONCLUSION: A substantial proportion of CLABSI events at our pediatric cancer center met the MBI-LCBI criteria. Our results support separate monitoring and reporting of MBI and non-MBI-LCBIs in low- to middle-income countries to allow accurate detection and tracking of preventable (non-MBI) bloodstream infections.