Multidisciplinary approach to anaplastic and metastatic meningioma: A case report and review of the literature.

Background: Meningiomas are slow-growing neoplasms, accounting for 20% of all primary intracranial neoplasms and 25% of all intraspinal tumors. Atypical and anaplastic meningiomas are infrequent, representing fewer than 5% of all meningiomas. Unusually, they can show aggressive behavior, and extracranial metastases are extremely rare, representing approximately 0.1% of all reported cases. Case Description: Fifty-six-year-old male patient diagnosed with atypical basal frontal meningioma with multiple resections, both endoscopic endonasal and transcranial. After hypofractionated radiosurgery, the patient showed new tumor recurrence associated to right cervical level II ganglionic metastasis. We opted for complete resection of the meningioma and reconstruction with anterior rectus abdominis muscle flap, as well as selective cervical ganglionectomy. Anatomical pathology showed neoplastic proliferation of meningothelial cells in syncytial cytoplasm, oval or spherical nuclei with slight anisocariosis and hyperchromasia, and intranuclear vacuoles, all compatible with anaplastic meningioma. Conclusion: Due to a lack of consensus on how to treat a metastatic malignant meningioma, this pathology requires a multidisciplinary approach, and treatment needs to be adapted to each particular case. Complete resection of the lesion is the primary goal, and this requires complex procedures involving endocranial as well as extracranial surgeries, which result in composite defects difficult to resolve. Microvascular free flaps are considered the gold standard in reconstructions of large skull base defects, with high success rates and few complications.

Adapting medical education to the COVID-19 pandemic: the experience of 1520 students / [Adaptación de la educación médica a la pandemia COVID-19: la experiencia de 1520 alumnos]

Introduction: Due to the measures imposed by the argentine government during the SARS-CoV-2 pandemic, the capacity of universities and hospitals for the development of face-to-face educational activities has been restricted. Therefore, we set out to explore the perceptions of the educational impact and the experience in the virtual environment of Argentine medical students. Methods: We carried out an observational, analytical, cross-sectional study. The data collection was carried out through a national questionnaire in the period between April 19 and June 15, 2020 through a "snowball" type sampling. Results: The study population involved medical students from Argentina (n = 1520 students). From which we observed that 95.41% (n = 1505) believed that their formation was affected, only 56.14% (n = 850) of the universities were able to virtualize all the subjects, and 97.69% (n = 1479) believed that argentine universities were not fully prepared. As for their experience in virtuality; 92.98% (n = 1364) reported that virtual education allowed them to advance in their career, 76.89% (n = 1128) indicated that the quality of the virtual classes got worse compared to the face-to-face ones, and 58.55% (n = 859) did not have the possibility to take an exam virtually. Conclusion: Consequently, we concluded that the COVID-19 pandemic exposed the need to prepare medical careers for the management of educational contingencies. The results of this research reflect a student population affected in their learning by this situation. Educational policies that take into account the needs expressed by students are crucial.

Introducción: Debido al aislamiento impuesto por el gobierno durante la pandemia por SARS-CoV-2, se restringió la presencialidad en actividades educativas de universidades y hospitales. Objetivo: Nos propusimos explorar el efecto de la pandemia sobre el sistema educativo y la experiencia en el entorno virtual de los estudiantes de medicina de Argentina. Métodos: Llevando a cabo un estudio observacional, analítico, de tipo corte transversal. La recolección de  datos se realizó mediante un cuestionario nacional en el período comprendido entre el 19 de abril y el 15 de junio del 2020 a través de un muestreo tipo "bola de nieve". La población en estudio involucró a estudiantes de medicina de la República Argentina (n=1520 estudiantes). Resultados: Observamos que el 95.41% (n=1505) señaló que su formación se vio afectada, tan solo el 56.14% (n=850) de las universidades pudo virtualizar todas las asignaturas, y el 97.69% (n=1479) expresó que las universidades argentinas no estaban completamente preparadas. En cuanto a la experiencia en virtualidad; el 92.98% (n=1364) comunicó que la educación virtual le permitió avanzar en la carrera, el 76.89% (n=1128) indicó que la calidad de las clases virtuales fue peor que las presenciales, y el 58.55% (n=859) no tuvo posibilidad de rendir algún examen de manera virtual. Conclusión: Concluimos que la pandemia expone la necesidad de preparar a las carreras de medicina para el manejo de las contingencias educativas. Los resultados reflejan una población estudiantil afectada en sus aprendizajes por esta situación coyuntural. Políticas educativas que tomen en cuenta las necesidades expuestas por los estudiantes resultan cruciales.

Total Temporomandibular Joint Replacement and Simultaneous Orthognathic Surgery Using Computer-Assisted Surgery.

BACKGROUND: Disorders of the temporomandibular joint (TMJ) are frequent and are usually associated with other disorders of the facial skeleton. Surgery might be needed to correct TMJ anatomy and function and, in cases where pathologies coexist, a two-stage corrective surgery might be needed. However, the current fashion of single-stage procedures is feasible with the aid of new technologies such as computer-assisted surgery (CAS). This is a step forward toward performing complex procedures such as a TMJ replacement with simultaneous orthognathic surgery. CAS allows designing patient-fitted prosthesis and more predictable and accurate surgeries. Moreover, intraoperative development can be controlled in real time with intraoperative navigation, and postoperative results can be measured and compared afterwards. AIMS: The primary purpose of this article is to present the protocol used in our institution for orthognathic surgery associated with unilateral and bilateral TMJ replacement with patient-fitted prostheses guided with CAS. MATERIALS AND METHODS: We present two cases to illustrate our protocol and its results. RESULTS: In the first case, the difference in millimeters between planning and surgical outcomes was 1.72 mm for the glenoid component and 2.16 mm for the condylar prosthesis; for the second case, differences in the right side were 2.59 mm for the glenoid component and 2.06 mm for the ramus, and in the left side, due to the anatomy the difference was a little greater, without clinical significance. CONCLUSION: Combined surgery of the midface and mandible with total TMJ replacement is feasible and beneficial for the patient. CAS facilitates the planning and design of custom-fit prosthesis and execution of these procedures.

The Two Pandemics.

This article reflects on the importance and the impact of scientific publications in the midst of a global health crisis. It aims to raise awareness about the responsibility of accepting manuscripts in such sensitive times and is intended to motivate the production of high-quality papers through a critical vision.

Usefulness of 18F-Fluorocholine Positron Emission Tomography-Computed Tomography in Locating Lesions in Hyperparathyroidism: A Systematic Review.

IMPORTANCE: Identifying parathyroid glands correctly before a surgical procedure is essential to perform minimally invasive surgery. First-line tests with discordant or negative results underscore the need for more accurate imaging tests, thus decreasing the requirement for bilateral neck exploration or reintervention. OBJECTIVE: To review the available evidence to determine positive predictive value, negative predictive value, sensitivity, and specificity in clinical cases in which 18F-fluorocholine positron emission tomography-computed tomography (PET/CT) could be useful as a method to locate the lesions, and the benefits and controversial aspects of the method. EVIDENCE REVIEW: A search was conducted using the PubMed Central and Cochrane Library databases for studies published in English from July 26, 2014, to November 30, 2018, using the search terms 18 choline, 18F choline, 18F-choline, 18 fluorocholine PET CT, hyperparathyroidism, primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism, persistent hyperparathyroidism, recurrent hyperparathyroidism, ectopic hyperparathyroidism, and parathyroid adenoma. Other inclusion criteria were reporting at least 1 of the following measurements: negative or positive predictive value, sensitivity, and specificity of 18F-fluorocholine PET/CT in the diagnosis of hyperparathyroidism (HPT). Exclusion criteria were language other than English, use of a tracer other than 18F-fluorocholine, reports of a single case, and studies not related to HPT. The Oxford Centre classifications for levels of evidence were used. FINDINGS: Sixteen studies fulfilled the inclusion criteria, comprising a total of 619 patients. Selected studies included 10 prospective cohort studies, 5 retrospective cohort studies, and 1 case series. Of the subtypes of HPT diagnosed using 18F-fluorocholine PET/CT, 579 were primary HPT, 22 were secondary HPT, 1 was tertiary HPT, and 7 were associated with multiple endocrine neoplasia type I. Pathologically, the neoplasms comprised 459 adenomas, 59 hyperplasia, and 19 double adenomas. CONCLUSIONS AND RELEVANCE: 18F-fluorcholine PET/CT may be indicated when results of first-line tests are negative or discordant and in challenging clinical situations where locating the source of HPT is difficult.

Linfoma primario difuso de células B grandes de mucosa gingival, en paciente VIH y EBV negativos / Primary gingival diffuse large b-cell lymphoma in HIV/EBR negative patient abstract

El linfoma difuso de células B grandes (LDCBG) es el linfoma más frecuente. La presentación clínica puede ser nodal o extranodal y sus síntomas dependen de la localización tumoral; en la mayoría de los casos están asociados a algún tipo de inmunodeficiencia. Referiremos un caso de LDCBG de presentación atípica en una localización muy infrecuente. Es importante tener en cuenta estas situaciones, ya que pueden simular otros procesos patológicos, retrasando así su correcto diagnóstico y por lo tanto un adecuado tratamiento. (AU)

Diffuse large cell lymphoma B (LDCBG) is the most common type of lymphoma. It´s clinical presentation can be nodal or extranodal and it's symptoms depend where the tumor is located and whether is associated or not with an immunodeficiency disease. We present an atypical presentation of a LDCBG in a very unusual location. It´s important to consider these kind of appearance, as they can mimic other oral pathological processes, delaying their correct diagnosis and therefore an appropriate treatment. (AU)