LUMBAR syndrome-OEIS complex overlap: A case series and review.

We present three new and six published infants with overlapping features of LUMBAR syndrome (lower body hemangioma, urogenital anomalies, spinal cord malformations, bony deformities, anorectal/arterial anomalies and renal anomalies) and OEIS complex (omphalocele, exstrophy, imperforate anus, and spinal defects), also known as cloacal exstrophy. OEIS is included under the recently proposed umbrella coined recurrent constellations of embryonic malformations (RCEMs). The RCEMs represent a phenotypically overlapping spectrum of rare disorders of caudal dysgenesis with unknown cause but likely shared pathogenesis. It has recently been proposed that LUMBAR be considered an RCEM. This report of infants with combined features of OEIS and LUMBAR is the first to demonstrate an overlap between LUMBAR and another RCEM, which supports LUMBAR's inclusion within the RCEM spectrum.

[Impact of COVID-19 lockdown on patients with idiopathic intracranial hypertension in Spain]. / Impacto del confinamiento por COVID-19 en pacientes con hipertensión intracraneal idiopática en España.

INTRODUCTION: The nationwide lockdown implemented in Spain in March 2020 in response to the 2019 coronavirus disease pandemic (COVID-19) could have had an effect on the clinical situation, disease management and access to care in patients with idiopathic intracranial hypertension. PATIENTS AND METHODS: A cross-sectional observational study was conducted by means of an online survey. The frequency and impact of headache, visual symptoms, dizziness, cognitive symptoms, diplopia, anxiety and depression on patients' quality of life were recorded. Disease treatment and delays experienced in accessing care were recorded. Participants were grouped according to the time elapsed since diagnosis. RESULTS: A total of 112 patients participated in the study (103 women). The average time since disease onset was 6.25 years. Headache, anxiety and depression were responsible for considerable impact in the period prior to lockdown. The impact of headache was not aggravated during lockdown, but anxiety and depression did become significantly worse. Recently diagnosed participants reported higher rates of anxiety, depression, dizziness and diplopia; chronically diagnosed participants reported a higher frequency of cognitive symptoms. CONCLUSIONS: The clinical situation of the participants deteriorated during lockdown, although the differences were smaller than previously thought. This was probably because the baseline situation was more severe than expected. Further studies are needed to clarify the medium and long-term impact of the COVID-19 pandemic on patients with idiopathic intracranial hypertension.

TITLE: Impacto del confinamiento por COVID-19 en pacientes con hipertensión intracraneal idiopática en España.Introducción. El confinamiento nacional instaurado en España en marzo de 2020 como respuesta a la pandemia por la enfermedad por coronavirus 2019 (COVID-19) pudo tener un efecto en la situación clínica, el manejo de la enfermedad y el acceso a la atención médica en pacientes con hipertensión intracraneal idiopática. Pacientes y métodos. Se realizó un estudio observacional transversal por medio de una encuesta en línea. Se registraron la frecuencia y el impacto en la calidad de vida de la cefalea, los síntomas visuales, el mareo, los síntomas cognitivos, la diplopía, la ansiedad y la depresión. Se registró el tratamiento de la enfermedad y los retrasos experimentados en el acceso a la atención médica. Se agrupó a los participantes según el tiempo de evolución desde el diagnóstico. Resultados. Participaron 112 pacientes (103 mujeres). El tiempo medio de evolución de la enfermedad fue 6,25 años. La cefalea, la ansiedad y la depresión fueron responsables de un impacto considerable en el período previo al confinamiento. El impacto de la cefalea no empeoró durante el confinamiento, pero la ansiedad y la depresión empeoraron significativamente. Los participantes diagnosticados recientemente comunicaron mayores tasas de ansiedad, depresión, mareo y diplopía; los de evolución crónica, mayor frecuencia de síntomas cognitivos. Conclusiones. La situación clínica de los participantes se deterioró durante el confinamiento, aunque las diferencias fueron menores de lo que se pensaba. Esto se debió, probablemente, a que la situación basal era más grave de lo esperado. Son necesarios más estudios para aclarar el impacto a medio y largo plazo de la pandemia por COVID-19 en pacientes con hipertensión intracraneal idiopática.

Impacto del confinamiento por COVID-19 en pacientes con hipertensión intracraneal idiopática en España / Impact of COVID-19 lockdown on patients with idiopathic intracranial hypertension in Spain

Introducción: El confinamiento nacional instaurado en España en marzo de 2020 como respuesta a la pandemia por la enfermedad por coronavirus 2019 (COVID-19) pudo tener un efecto en la situación clínica, el manejo de la enfermedad y el acceso a la atención médica en pacientes con hipertensión intracraneal idiopática. Pacientes y métodos: Se realizó un estudio observacional transversal por medio de una encuesta en línea. Se registraron la frecuencia y el impacto en la calidad de vida de la cefalea, los síntomas visuales, el mareo, los síntomas cognitivos, la diplopía, la ansiedad y la depresión. Se registró el tratamiento de la enfermedad y los retrasos experimentados en el acceso a la atención médica. Se agrupó a los participantes según el tiempo de evolución desde el diagnóstico. Resultados: Participaron 112 pacientes (103 mujeres). El tiempo medio de evolución de la enfermedad fue 6,25 años. La cefalea, la ansiedad y la depresión fueron responsables de un impacto considerable en el período previo al confinamiento. El impacto de la cefalea no empeoró durante el confinamiento, pero la ansiedad y la depresión empeoraron significativamente. Los participantes diagnosticados recientemente comunicaron mayores tasas de ansiedad, depresión, mareo y diplopía; los de evolución crónica, mayor frecuencia de síntomas cognitivos. Conclusiones: La situación clínica de los participantes se deterioró durante el confinamiento, aunque las diferencias fueron menores de lo que se pensaba. Esto se debió, probablemente, a que la situación basal era más grave de lo esperado. Son necesarios más estudios para aclarar el impacto a medio y largo plazo de la pandemia por COVID-19 en pacientes con hipertensión intracraneal idiopática.(AU)

Introduction: The nationwide lockdown implemented in Spain in March 2020 in response to the 2019 coronavirus disease pandemic (COVID-19) could have had an effect on the clinical situation, disease management and access to care in patients with idiopathic intracranial hypertension. Patients and methods: A cross-sectional observational study was conducted by means of an online survey. The frequency and impact of headache, visual symptoms, dizziness, cognitive symptoms, diplopia, anxiety and depression on patients’ quality of life were recorded. Disease treatment and delays experienced in accessing care were recorded. Participants were grouped according to the time elapsed since diagnosis. Results: A total of 112 patients participated in the study (103 women). The average time since disease onset was 6.25 years. Headache, anxiety and depression were responsible for considerable impact in the period prior to lockdown. The impact of headache was not aggravated during lockdown, but anxiety and depression did become significantly worse. Recently diagnosed participants reported higher rates of anxiety, depression, dizziness and diplopia; chronically diagnosed participants reported a higher frequency of cognitive symptoms. Conclusions: The clinical situation of the participants deteriorated during lockdown, although the differences were smaller than previously thought. This was probably because the baseline situation was more severe than expected. Further studies are needed to clarify the medium and long-term impact of the COVID-19 pandemic on patients with idiopathic intracranial hypertension.(AU)

Tiempo puerta-aguja entre neurólogo presencial y localizado en ictus isquémico tratado con alteplasa. Estudio PRISA / Door-to-needle times for patients with ischaemic stroke treated with alteplase by on-site and off-site on-duty neurologists. PRISA study

Introducción: La guardia de neurología es frecuentemente presencial; es decir, con el neurólogo presente en el centro hospitalario; pero en algunos centros, puede ser localizada o mixta. La fibrinólisis intravenosa (FIV) es uno de los principales tratamientos reperfusores en el ictus isquémico agudo (IIA). El objetivo del siguiente trabajo es comparar el tiempo puerta-aguja (TPA) durante la guardia presencial y la guardia localizada. Material y métodos: Estudio prospectivo, observacional, desde el año 2012 hasta el año 2017 en el que se incluyeron pacientes con IIA y FIV. Se recogieron datos como sexo, edad, hora del inicio de los síntomas, hora de llegada al hospital, hora de la tomografía axial computarizada (TAC), hora de inicio de la FIV. Se consideró guardia de «Presencia» desde las 8:00 hasta las 20:00 y «Localizada» desde las 20:00 hasta las 08:00, divido en 3 grupos: guardia «Presencial», guardia «Localizada» y guardia «Localizada con residente». Resultados: N.° = 138; edad media 69,7 años; mujeres 45,7%. Pacientes en guardia de «Presencia» 96, «Localizada» 42, de los cuales 17 con residente. Ambos grupos presentaban características basales similares. Los TPA de los grupos «Presencia» y «Localizada» fueron 59 y 72 min, respectivamente (p = 0,003). Los TPA de grupos «Presencia», «Localizada» y «Localizada con residente», respectivamente 59, 74 y 68 min (p = 0,001), con significación entre «Presencia» y «Localizada». No se observaron diferentes entre el TPA dependiendo de la franja horaria de mañana, tarde y noche ni entre días laborales y días de fin de semana. Conclusión: La presencia o ausencia del neurólogo en el centro hospitalario en el momento del código ictus, influye en la demora de administración del tratamiento fibrinolítico. La presencia del residente de neurología puede acelerar la realización del proceso. (AU)

Background: Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site. Methods: We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present. Results: Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site–resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72 minutes, respectively (P = .003). DNTs were 59, 74, and 68 minutes (P = .001), respectively, for the on-site, off-site, and off-site–resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends. Conclusion: DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT. (AU)

Duct-like Recess in the Infundibular Portion of Third Ventricle Craniopharyngiomas: An MRI Sign Identifying the Papillary Type.

BACKGROUND AND PURPOSE: Papillary craniopharyngiomas (PCPs) are particularly challenging lesions requiring accurate diagnosis to plan the best therapy. Our aim was to define a narrow duct-like recess identified on MR imaging at the base of papillary craniopharyngiomas with a strict third ventricle location. MATERIALS AND METHODS: A duct-like recess at the infundibular portion of craniopharyngiomas was observed on conventional T1WI and T2WI in 3 strict third ventricle papillary craniopharyngiomas in our craniopharyngioma series (n = 125). We systematically investigated this finding on the MR imaging of 2582 craniopharyngiomas and 10 other categories of third ventricle tumors (n = 690) published in the modern era (1986-2020). The diagnostic value and significance of this finding are addressed. RESULTS: The duct-like recess was recognized in 52 papillary craniopharyngiomas, including 3 of our own cases, as a narrow canal-shaped cavity invaginated at the tumor undersurface, just behind the optic chiasm. This structure largely involves papillary craniopharyngiomas with a strict third ventricle topography (96%), follows the same diagonal trajectory as the pituitary stalk, and finishes at a closed end. The duct-like recess sign identifies the papillary craniopharyngioma type with a specificity of 100% and a sensitivity of 38% in the overall craniopharyngioma population. This finding can also establish the strictly intra-third ventricle location of the lesion with a 90% specificity and 33% sensitivity. These recesses appear as hypointense circular spots on axial/coronal T1WI and T2WI. Their content apparently corresponds to CSF freely flowing within the suprasellar cistern. CONCLUSIONS: The presence of a duct-like recess at the infundibular portion of a third ventricle tumor represents a distinctive hallmark of papillary craniopharyngiomas that can be used as a simple MR imaging sign to reliably diagnose these lesions.

Intoxicación por harina de altramuz: nuevas perspectivas a través de un caso clínico / Lupine flour intoxication: new insights through a case report

El altramuz es un fruto de la familia de las leguminosas que se consume ampliamente como un aperitivo en zonas del Mediterráneo, norte de África, Asia y América Latina. Contiene dos alcaloides que aportan un sabor muy amargo al fruto y tienen efecto anticolinérgico: la esparteína y la lupanina; éstos se eliminan del fruto tras someterlo a un proceso de lavado y remojado. Presentamos un caso de intoxicación por consumo de harina de altramuz: mujer de 41 años que consultó en urgencias por un cuadro agudo de malestar general, sequedad de boca, distensión abdominal, náuseas y midriasis bilateral. Los síntomas se iniciaron una hora después de haber consumido un pan casero elaborado con harina de altramuz seco. Tras instaurar tratamiento sintomático e hidratación, los síntomas desaparecieron en las siguientes horas. La intoxicación por altramuz es un cuadro clínico infrecuente y probablemente infradiagnosticado considerando lo extendido de su consumo, en particular la intoxicación por consumo de harina del mismo. Es probable que en el futuro aumente el consumo de altramuz con objeto de beneficiarse de sus propiedades saludables (mayor contenido proteico, en fibras y proteínas, mayor saciedad). Se precisan un alto índice de sospecha clínica para identificar y tratar correctamente el cuadro, y una información completa a la población general sobre la manera correcta de preparación del altramuz, alertando y concienciando de los riesgos que conlleva su consumo en estado no procesado. (AU)

Lupin is a plant member of the Leguminosae family, widely consumed as a snack in Mediterranean countries, north of Africa, Asia and Latin America. Lupine seeds may cause poisoning due to the presence of two alkaloids, sparteine and lupanine, which can cause anticholinergic effects and have a bitter taste. These substances can be eliminated from the plant after a process of washing and rinsing. A clinical case is presented. A female patient aged 41 was admitted to the Emergency Room with general malaise, mouth dryness, abdominal distension, nausea and bilateral mydriasis, all of acute onset. Symptoms started one hour after consuming a homemade bread elaborated with dry lupine seeds. Symptomatic treatment and intravenous hydration were started and the symptoms disappeared within a few hours. Lupine seed intoxication is infrequent and probably underdiagnosed, considering how widely consumed the seeds are. Lupine flour intoxication is a particularly elusive diagnosis. Lupin consumption is likely to rise in the future due to increased interest in achieving its health benefits (high protein and fiber content). A high degree of clinical suspicion is needed to correctly identify and treat the intoxication. General population should be informed about how to correctly prepare lupine seeds, alerting about the potential risks of consumption in its unprocessed state. (AU)

Door-to-needle times in patients treated by on-site and off-site on-call neurologists. PRISA study.

BACKGROUND: Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site. METHODS: We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present. RESULTS: Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site-resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72 minutes, respectively (P =  .003). DNTs were 59, 74, and 68 minutes (P =  .001), respectively, for the on-site, off-site, and off-site-resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends. CONCLUSION: DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT.

Seasonal Dynamics of Fleas (Siphonaptera: Pulicidae, Ceratophyllidae and Leptopsyllidae) on Oryctolagus cuniculus in a Meso-Mediterranean Area of Central Spain.

Flea infestations of wild rabbits were examined monthly in central Spain in a meso-Mediterranean area for 5 yr. A total of 1,180 wild rabbits were trapped and 7,022 fleas were collected from them. Overall, the prevalence was 74.1% with a mean flea index of 5.95 fleas per rabbit. Four flea species were identified: Spilopsyllus cuniculi (Dale, 1878) was the most abundant species (accounting for 74.3% of fleas collected) followed by Xenopsylla cunicularis (Smit, 1957), Odontopsyllus quirosi (Gil Collado, 1934), and Nosopsyllus fasciatus (Bosc, 1800) (18.9, 6.7, and 0.1%, respectively). The highest prevalence was observed in S. cuniculi (48.6%) followed by X. cunicularis, O. quirosi, and N. fasciatus (34.3, 20.0, and 0.6%, respectively). Odontopsyllus quirosi and S. cuniculi were mainly collected from autumn to spring with the peak of infestation in winter, while X. cunicularis was mainly found from spring to autumn with maximum levels of infestation during the summer months. The relevance of these findings is discussed.

[Tumour form of neurocysticercosis in a patient with prostate carcinoma]. / Forma tumoral de neurocisticercosis en un paciente con carcinoma de próstata.

INTRODUCTION: Neurocysticercosis is a parasitic infection of the central nervous system caused by contact with the eggs of the parasite Taenia solium, which subsequently lodge in brain and eye tissue. It manifests itself in the form of cystic lesions scattered throughout the brain parenchyma that are usually small in size and, depending on their stage of development, may appear with associated oedema or with calcifications inside them. CASE REPORT: We report the case of a 63-year-old male visiting due to constitutional symptoms, generalised pain and confusion. A cranial computed axial tomography (CAT) scan showed a right frontoparietal lesion with a cyst-like appearance and surrounding oedema, as well as several smaller lesions with calcifications inside them. Given the pseudotumoural appearance, an extension study was performed and a prostatic adenocarcinoma with universal bone metastases was detected. Treatment with antiparasitic medication and dexamethasone was started, with a good initial response, which later worsened with the onset of left hemiparesis. In the follow-up CAT scan, an increase in the right frontoparietal lesion with increased oedema was observed, related to the inflammatory response to the treatment. After a new course of antiparasitic drugs, the patient maintained a sustained and stable clinical response. CONCLUSIONS: The unusual feature of this case was a rare presentation of neurocysticercosis in the form of a pseudotumoural lesion. Few cases have been reported in the literature, and it is important to maintain a high level of clinical and radiological suspicion, as this type of lesion may be more resistant to the penetration of antiparasitic drugs and require longer treatment and even surgery.

TITLE: Forma tumoral de neurocisticercosis en un paciente con carcinoma de próstata.Introducción. La neurocisticercosis es una infección parasitaria del sistema nervioso central que se produce por contacto con los huevos del parásito Taenia solium, que posteriormente se acantona en el tejido cerebral y ocular. Se manifiesta en forma de lesiones quísticas dispersas por el parénquima cerebral que suelen ser de pequeño tamaño y, dependiendo del estadio evolutivo en el que se presenten, pueden aparecer con edema asociado o con calcificaciones en su interior. Caso clínico. Varón de 63 años que consulta por cuadro constitucional, dolores generalizados y confusión. En la tomografía axial computarizada (TAC) craneal se visualiza una lesión frontoparietal derecha de 4 cm de diámetro, de aspecto quístico y edema circundante, así como varias lesiones de menor tamaño con calcificaciones en su interior. Dado el aspecto pseudotumoral, se realiza un estudio de extensión y se detecta un adenocarcinoma prostático con metástasis óseas universales. Se comienza un tratamiento con antiparasitarios y dexametasona con buena respuesta inicial, y empeora posteriormente con la aparición de una hemiparesia izquierda. En la TAC de control se observa un aumento de la lesión frontoparietal derecha con mayor edema, en relación con la respuesta inflamatoria con el tratamiento. Tras un nuevo ciclo de antiparasitarios, mantiene una respuesta clínica sostenida y estable. Conclusiones. Este caso tiene la peculiaridad de una forma de presentación poco frecuente de neurocisticercosis en forma de lesión pseudotumoral. Existen pocos casos descritos en la bibliografía, y es importante mantener un alto nivel de sospecha clínica y radiológica, ya que este tipo de lesiones puede ser más resistente a la penetración de antiparasitarios y precisar un tratamiento más prolongado e incluso quirúrgico.

[Familial cavernous malformation secondary to a novel genetic mutation]. / Cavernomatosis familiar secundaria a una nueva mutación genética.

TITLE: Cavernomatosis familiar secundaria a una nueva mutación genética.

Comparación de la terapia de ondas de choque extracorpóreas focales y presión radiales en la fascitis plantar / Comparison between extracorporeal shockwave therapy and radial pressure wave therapy in plantar fasciitis

OBJETIVO: La fascitis plantar es una causa frecuente de dolor plantar, de etiología mal definida. Los pacientes presentan dolor a la palpación de la tuberosidad medial del calcáneo. Los tratamientos con ondas de choque extracorpóreas han demostrado resultados positivos. El objetivo de este estudio es comparar la efectividad de tratamientos con ondas de choque focales y ondas de presión radial. PACIENTES Y MÉTODOS: Setenta y nueve pacientes diagnosticados de fascitis plantar fueron incluidos entre enero del 2017 y junio del 2018, de manera no aleatorizada. Se aplicó un tratamiento por ondas de choque focales a los pacientes del Hospital Arnau de Vilanova de Valencia y un tratamiento por ondas de presión radiales a los pacientes de Hospital de Llíria. Las variables de resultado estudiadas fueron: dolor evaluado por escala visual analógica; grosor de la fascia plantar medido por ecografía; dolor, discapacidad, limitación de actividades y calidad de vida autoevaluadas mediante el Foot Function Index, el Euroqol-5D y la escala de Roles y Maudsley. RESULTADOS: Al inicio del estudio, los 2grupos no mostraban diferencias significativas en cuanto a variables sociodemográficas y clínicas. Tres meses tras finalizar el tratamiento, observamos una mejoría en ambos grupos en todas las variables de resultado, sin obtener diferencias significativas entre los 2 grupos. No registramos efectos adversos ni complicaciones. CONCLUSIONES: Tanto las ondas de choque focales como las ondas de presión radiales son terapias con un perfil de efectividad y seguridad equivalente en el tratamiento de la fascitis plantar

OBJECTIVE: Plantar fasciitis is a common cause of heel pain. The aetiology of this condition remains unclear. Patients typically have pain upon palpation of the medial plantar calcaneal region. Extracorporeal shockwave therapy has shown favourable outcomes in various studies. The aim of this study was to compare the effect of focused extracorporeal shockwave therapy with radial pressure wave therapy. PATIENTS AND METHODS: Seventy-nine non-randomised patients diagnosed with plantar fasciitis were included between January 2017 and June 2018. Patients from the Arnau de Vilanova Hospital in Valencia were treated with focused extracorporeal shockwave therapy, and patients from Llíria Hospital with radial pressure wave therapy. Measured outcome variables were: visual analog scale; ultrasonographic measurement of plantar fascia thickness; self-reported foot-specific pain and disability using the Foot Function Index; self-reported health-related quality of life using the Euroqol-5D; self-reported pain and limitations of activity using the Roles & Maudsley Scale. RESULTS: At inclusion, the 2groups showed no significant differences in demographic or clinical characteristics. Three months after treatment completion, both groups showed improvement in all outcome variables, without statistically significant differences between the 2 groups. No adverse effects or complications were observed. CONCLUSIONS: Both extracorporeal shockwave therapy and radial pressure wave therapy are effective treatments for plantar fasciitis

[Comparison between extracorporeal shockwave therapy and radial pressure wave therapy in plantar fasciitis]. / Comparación de la terapia de ondas de choque extracorpóreas focales y presión radiales en la fascitis plantar.

OBJECTIVE: Plantar fasciitis is a common cause of heel pain. The aetiology of this condition remains unclear. Patients typically have pain upon palpation of the medial plantar calcaneal region. Extracorporeal shockwave therapy has shown favourable outcomes in various studies. The aim of this study was to compare the effect of focused extracorporeal shockwave therapy with radial pressure wave therapy. PATIENTS AND METHODS: Seventy-nine non-randomised patients diagnosed with plantar fasciitis were included between January 2017 and June 2018. Patients from the Arnau de Vilanova Hospital in Valencia were treated with focused extracorporeal shockwave therapy, and patients from Llíria Hospital with radial pressure wave therapy. Measured outcome variables were: visual analog scale; ultrasonographic measurement of plantar fascia thickness; self-reported foot-specific pain and disability using the Foot Function Index; self-reported health-related quality of life using the Euroqol-5D; self-reported pain and limitations of activity using the Roles & Maudsley Scale. RESULTS: At inclusion, the 2groups showed no significant differences in demographic or clinical characteristics. Three months after treatment completion, both groups showed improvement in all outcome variables, without statistically significant differences between the 2groups. No adverse effects or complications were observed. CONCLUSIONS: Both extracorporeal shockwave therapy and radial pressure wave therapy are effective treatments for plantar fasciitis.

Door-to-needle times for patients with ischaemic stroke treated with alteplase by on-site and off-site on-duty neurologists. PRISA study. / Tiempo puerta-aguja entre neurólogo presencial y localizado en ictus isquémico tratado con alteplasa. Estudio PRISA.

BACKGROUND: Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site. METHODS: We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present. RESULTS: Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site-resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72minutes, respectively (P=.003). DNTs were 59, 74, and 68minutes (P=.001), respectively, for the on-site, off-site, and off-site-resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends. CONCLUSION: DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT.

Fístulas arteriovenosas espinales durales: ¿tratamiento precoz endovascular o quirúrgico? / Spinal dural arteriovenous fistulas: Early endovascular treatment or surgery?

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Topographic Diagnosis of Craniopharyngiomas: The Accuracy of MRI Findings Observed on Conventional T1 and T2 Images.

BACKGROUND AND PURPOSE: The topography of craniopharyngiomas has proved fundamental in predicting the involvement of vital brain structures and the possibility of achieving a safe radical resection. Beyond the imprecise term "suprasellar," indiscriminately used for craniopharyngiomas, an accurate definition of craniopharyngioma topography should be assessed by preoperative MR imaging. The objective of this study was to investigate the MRI findings that help define craniopharyngioma topography. MATERIALS AND METHODS: This study retrospectively investigated a cohort of 200 surgically treated craniopharyngiomas with their corresponding preoperative midsagittal and coronal conventional T1- and T2-weighted MR images, along with detailed descriptions of the surgical findings. Radiologic variables related to the occupation of the tumor of intracranial compartments and the distortions of anatomic structures along the sella turcica-third ventricle axis were analyzed and correlated with the definitive craniopharyngioma topography observed during the surgical procedures. A predictive model for craniopharyngioma topography was generated by multivariate analysis. RESULTS: Five major craniopharyngioma topographies can be defined according to the degree of hypothalamic distortion caused by the tumor: sellar-suprasellar, pseudointraventricular, secondary intraventricular, not strictly intraventricular, and strictly intraventricular. Seven key radiologic variables identified on preoperative MRI allowed a correct overall prediction of craniopharyngioma topography in 86% of cases: 1) third ventricle occupation, 2) pituitary stalk distortion, 3) relative level of the hypothalamus in relation to the tumor, 4) chiasmatic cistern occupation, 5) mammillary body angle, 6) type of chiasm distortion, and 7) tumor shape. CONCLUSIONS: Systematic assessment of these 7 variables on conventional preoperative T1 and T2 MRI is a useful and reliable method to ascertain individual craniopharyngioma topography.

A recombinant cystatin from Ascaris lumbricoides attenuates inflammation of DSS-induced colitis.

Helminthiasis may ameliorate inflammatory diseases, such as inflammatory bowel disease and asthma. Information about immunomodulators from Ascaris lumbricoides is scarce, but could be important considering the co-evolutionary relationships between helminths and humans. We evaluated the immunomodulatory effects of a recombinant cystatin from A. lumbricoides on an acute model of dextran sodium sulphate (DSS)-induced colitis in mice. From an A. lumbricoides cDNA library, we obtained a recombinant cystatin (rAl-CPI). Protease activity inhibition was demonstrated on cathepsin B and papain. Immunomodulatory effects were evaluated at two intraperitoneal doses (0.5 and 0.25 µg/G) on mice with DSS-induced colitis. Body weight, colon length, Disease Activity Index (DAI), histological inflammation score, myeloperoxidase (MPO) activity, gene expression of cytokines and cytokines levels in colon tissue were analysed. Treatment with rAl-CPI significantly reduced DAI, MPO activity and inflammation score without toxic effects. Also, IL-10 and TGF-B gene overexpression was observed in rAl-CPI-treated group compared to DSS-exposed control and healthy mice. Furthermore, a reduction in IL-6 and TNF-A expression was found, and this was confirmed by the levels of these cytokines in colonic tissue. In conclusion, rAl-CPI reduces inflammation in a mouse model of DSS-induced colitis, probably by increasing the expression of anti-inflammatory cytokines and reducing pro-inflammatory ones.

The first sixty-five craniopharyngioma operations in France.

Craniopharyngiomas (CPs) are benign epithelial tumors that develop along the hypothalamus-hypophyseal axis and were first described by Jakob Erdheim in 1904. These tumors have represented a challenge for surgeons since the rise of modern neurosurgery. The study of CPs is linked to the development of this surgical discipline in parallel with neuroendocrinology within the French school of neurology, led by Joseph Babinski. For the present study, all CP cases published in the French scientific literature before the development of modern neuroradiology were gathered, and 65 cases that underwent surgical procedures between 1921 and 1973 were selected. From our analysis of them, useful information has been obtained that can be applied to the management of CPs today. Most tumors were adamantinomatous CPs (62 patients) with an infundibulo-tuberal location (40.6%). The most frequent surgical route employed was subfrontal (69%). Selection of the surgical approach and degree of removal did not appear to have been influenced by the presumed topography of the tumor, and resulted in a poor outcome in 47% of patients. However, the authors were able to recognize the presence of symptoms indicating that the tumor had caused hypothalamic and/or infundibular damage, such as seen in the infundibulo-tuberal syndrome, first described by Claude and Lhermitte in 1917. At present, the optimal surgical approach and degree of removal are still the subject of debate, although the presence of clinical signs pointing to hypothalamic involvement by CPs should always be preoperatively accurately assessed to improve surgical outcomes.

Cell Death Mechanisms in Tumoral and Non-Tumoral Human Cell Lines Triggered by Photodynamic Treatments: Apoptosis, Necrosis and Parthanatos.

Cell death triggered by photodynamic therapy can occur through different mechanisms: apoptosis, necrosis or autophagy. However, recent studies have demonstrated the existence of other mechanisms with characteristics of both necrosis and apoptosis. These new cell death pathways, collectively termed regulated necrosis, include a variety of processes triggered by different stimuli. In this study, we evaluated the cell death mechanism induced by photodynamic treatments with two photosensitizers, meso-tetrakis (4-carboxyphenyl) porphyrin sodium salt (Na-H2TCPP) and its zinc derivative Na-ZnTCPP, in two human breast epithelial cell lines, a non-tumoral (MCF-10A) and a tumoral one (SKBR-3). Viability assays showed that photodynamic treatments with both photosensitizers induced a reduction in cell viability in a concentration-dependent manner and no dark toxicity was observed. The cell death mechanisms triggered were evaluated by several assays and cell line-dependent results were found. Most SKBR-3 cells died by either necrosis or apoptosis. By contrast, in MCF-10A cells, necrotic cells and another cell population with characteristics of both necrosis and apoptosis were predominant. In this latter population, cell death was PARP-dependent and translocation of AIF to the nucleus was observed in some cells. These characteristics are related with parthanatos, being the first evidence of this type of regulated necrosis in the field of photodynamic therapy.