Out-of-Pocket Spending and Financial Equity in the Access to Medicines in Latin America: Trends and Challenges: 2010-2020.

There is evidence of persistent inequalities in household financial protection of health and drugs spending in Latin America. Despite the expansion of coverage, strong inequalities persist in access to health and family spending on drugs in the region. Out-of-pocket spending in medicines is regressive in greater need for affordable medicines.

Impacto do treinamento resistido na distribuição de gordura de pessoas com HIV: ensaio clínico randomizado / Impact of resistance training on fat distribution in people living with HIV: randomized clinical trial

Verificar o impacto de oito semanas de treinamento resistido (TR) na distribuição de gordura corporal de pessoas vivendo com o vírus da imunodeficiência humana (HIV) (PVH). Participaram 17 PVHs aleatorizadas em dois grupos: controle (GC, n=6) e treino (GT, n=11). O protocolo de TR foi composto por dez exercícios. A avaliação das dobras cutâneas (DC) tricipital, subescapular, abdominal, coxa e perna dos indivíduos foi realizada antes e depois do período de treinamento. As análises indicaram diferenças significantes (p<0,05) entre os grupos após o período de intervenção, com diminuição de gordura subcutânea no GT e aumento no GC tanto para as DCs da região do tronco (-3,77%, 12,97%) quanto dos membros (-10,28%, 10,08%). No somatório das DCs, o GT teve uma redução média de 6,43%, enquanto o GC aumentou 11,12% após as oito semanas, com diferenças significantes entre os grupos (p<0,05). Oito semanas de TR diminuíram a gordura corporal subcutânea de PVHs.

To verify the impact of eight weeks of resistance training (RT) on body fat distribution of people living with human immunodeficiency virus (HIV) (PLH). Seventeen randomized PLH participated in two groups: control (CG, n=6) and training (TG, n=11). The protocol of RT consisted of ten exercises. The subjects' triceps, subscapular, abdominal, thigh, and leg skinfolds were assessed before and after the training period. The analysis indicated significant differences (p<0.05) between the groups after the period of intervention, with decreased subcutaneous fat in the TG and increased subcutaneous fat in the CG in the areas of the torso (-3.77%, 12.97%) and limbs (-10.28%, 10.08%). By calculating the sum of skinfolds, the TG had an average reduction of 6.43%, while the CG increased by 11.12% after the eight weeks, with significant differences between the groups (p<0.05). Eight weeks of RT decreased subcutaneous body fat in PLH.

Evaluating quality in adolescent mental health services: a systematic review.

OBJECTIVES: To evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies. DESIGN AND DATA SOURCES: Systematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020. STUDY ELIGIBILITY CRITERIA: We focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10-19 years). This included adolescents exposed to interventions or strategies within mental health services. STUDY APPRAISAL AND SYNTHESIS METHODS: Study quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards. RESULTS: Of the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use. CONCLUSIONS AND IMPLICATIONS: There is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings. PROSPERO REGISTRATION NUMBER: CRD42020161318.

Seroprevalence and risk factors associated with Toxoplasma gondii infection in sheep of Veracruz State, southeast Mexico.

Toxoplasma gondii is widely prevalent in sheep and their products pose a risk to public health. The aim of this study was to identify the seroprevalence and risk factors associated with T. gondii infection in sheep in Veracruz State, Mexico. The study was cross-sectional and it was carried out in thirteen municipalities distributed in three regions of Veracruz State. A total of 414 blood samples were collected from four districts of Veracruz State and analyzed for T. gondii antibodies using enzyme-linked immunosorbent assay. Total seroprevalence was 35.90% (149/414; 95.00% CI = 31.40-40.80). Seroprevalence by the municipality was 10.50% to 85.70% and for the district was 28.80% to 47.80%, respectively. Age, breed and productive status were identified as risk factors associated with T. gondii infection significantly. The infection by T. gondii is widely present in the districts of the Veracruz State with a high seroprevalence and risk factors associated with infection.

Seguridad y tolerabilidad de la craneotomía vigíl para tumores cerebrales y otras lesiones supratentoriales / Safety and Tolerability of Vigil Craniotomy for Brain Tumors and Other Supratentorial Lesions

Objetivos: describir la seguridad y tolerabilidad de craneotomía vigíl en la resección de lesiones supratentoriales. Introducción: La craneotomía vigíl es útil para poder remover tumores cercanos, o en áreas elocuentes con seguridad; potencialmente reduce complicaciones, al igual que costos y estancia intrahospitalaria. Material y métodos: Se revisaron los registros desde enero del 2007 a julio del 2018. En el caso de los pacientes con gliomas o tumores intraaxiales se analizó déficit neurológico en base a áreas de elocuencia antes y después del procedimiento, y su recuperabilidad a los 30 días, al igual que volumen de resección. Resultados: Se intentaron 218 craneotomías vigiles, 213 (98.1%) se realizaron con éxito. La edad media fue de 64 años (8-92), 117 (54.9%) hombres, 96 (45%) mujeres. La cantidad de pacientes con lesiones tumorales fueron 171 (80%), las lesiones no tumorales fueron 42 (20%). El volumen de resección en área elocuente fue 73%, cercano a elocuencia 94% y no elocuente 100%. El empeoramiento neurológico ocurrió en el 30%, 16%, 2%, con recuperabilidad a los 30 días en comparación al déficit preoperatorio del 24%, 75% y 100% por área respectivamente. Las convulsiones se presentaron en 11 pacientes (5.1%). La mortalidad previa al alta fue de un paciente (0.5%), complicaciones cardiacas o pulmonares que requirieron intubación posterior a la cirugía fue cero. Conclusión: La técnica de craneotomía vigíl ha mostrado ser segura y tolerable en la mayoría de los pacientes, ha evitado las complicaciones pulmonares en el postoperatorio, posee una baja mortalidad y ha mostrado ser importante para la resección de tumores en áreas elocuentes.

Introduction: Awake craniotomy is a useful technique for removing tumors in or near eloquent cortex, potentially reducing systemic complications, monetary costs and hospital stays. Objective: To describe the security and tolerability profiles of awake craniotomies to resect supratentorial lesions. Methods: Registries from January 2007 to July 2018 were analyzed. In patients with intra-axial tumors, neurological deficits corresponding to areas of eloquent cortex were recorded before and after surgery, as were levels of improvement 30 days post-operatively, and the volume of resection. Results: Over that time period, 218 awake craniotomies were attempted, among which 213 (98.1%) were successfully completed. Mean age was 64 (8-92) years, and there were 117 (54.9%) males, 96 (45%) females. One hundred seventy-one patients had a tumor 171 (80%); 42 (20%) some other disease. The volume of resection based on eloquent cortex was 73%, near-eloquent 94% and non-eloquent 100%. Neurological worsening after surgery was 30%, 16%, 2%, with a resolution of preoperative deficits at 30 days in 24%, 75% and 100% of the patients, respectively, by anatomical area. During surgery, seizures occurred in 11 patients (5.1%). One patient (0.5%) died prior to discharge, but no systemic complications arose that required post-operative mechanical ventilation. Conclusions: Awake craniotomy appears to be a safe and well-tolerated procedure in the majority of patients. In our study, it completely avoided pulmonary complications, had a very low mortality rate, and proved to be useful for removing tumors in eloquent cortex.

Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration.

BACKGROUND/AIMS: Real-life anti-vascular endothelial growth factor (VEGF) therapy use in patients with wet age-related macular degeneration (wAMD) was assessed in a retrospective, observational study in Canada, France, Germany, Ireland, Italy, the Netherlands, UK and Venezuela. METHODS: Medical records of patients with wAMD, who started ranibizumab treatment between 1 January 2009 and 31 August 2009, were evaluated. Data were collected until the end of treatment and/or monitoring or until 31 August 2011. RESULTS: 2227 patients who received ≥1 anti-VEGF injection with a baseline visual acuity assessment and ≥1 postbaseline visual acuity assessment for the treated eye were evaluated. Visual acuity improved until about day 120; thereafter, visual acuity gains were not maintained. Mean change in visual acuity score from baseline to years 1 and 2 was +2.4 and +0.6 letters, respectively. Patients received a mean of 5.0 and 2.2 injections in the first and second year, respectively. There were substantial differences in visual outcomes and injection frequency between countries. More frequent visits and injections were associated with greater improvements in visual acuity. CONCLUSIONS: In clinical practice, fewer injections are administered than in clinical trials. Anti-VEGF treatment resulted in an initial improvement in visual acuity; however, this was not maintained over time. TRIAL REGISTRATION NUMBER: NCT01447043.

Success factors for reducing maternal and child mortality.

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond.

La réduction de la mortalité maternelle et infantile est une priorité des objectifs du Millénaire pour le développement (OMD) et le restera probablement après l'échéance de 2015. Il existe des données sur les investissements, les interventions et les politiques habilitantes nécessaires. On comprend mal pourquoi certains pays ont réalisé des progrès plus rapidement que d'autres pays comparables. Les Facteurs de réussite des études sur la santé des femmes et des enfants ont cherché à combler ce manque de connaissances en utilisant les analyses statistiques et économétriques des données provenant de 144 pays à faible revenu et à revenu intermédiaire et recueillies depuis 20 ans: une analyse comparative qualitative booléenne; une étude bibliographique et des études spécifiques à chaque pays pour les 10 pays à progression rapide pour les points 4 et 5a des OMD. Il n'existe pas de formule standard ­ les pays à progression rapide ont déployé des stratégies personnalisées et se sont adaptés rapidement aux changements. Cependant, ces pays ont en commun des approches efficaces visant 3 grands axes afin de réduire la mortalité maternelle et infantile. Premièrement, ils impliquent de nombreux secteurs pour traiter les facteurs déterminants et cruciaux pour la santé. Près de la moitié de la réduction de la mortalité infantile dans les pays à faible revenu et à revenu intermédiaire depuis 1990 résulte des investissements dans le secteur de la santé, l'autre moitié étant attribuée aux investissements réalisés dans les secteurs extérieurs à la santé. Deuxièmement, ces pays utilisent des stratégies pour mobiliser les partenaires dans la société, en utilisant des données solides et opportunes pour la prise de décisions et la responsabilisation, ainsi qu'une approche de planification triple pour prendre en considération les besoins immédiats, la vision à long terme et l'adaptation aux changements. Troisièmement, ces pays établissent des principes directeurs qui orientent les progrès, harmonisent les actions des parties prenantes et génèrent des résultats dans le temps. Cette synthèse de données contribue à l'ensemble des connaissances requises pour accélérer les améliorations sur la santé des femmes et des enfants en vue de l'échéance de 2015 et au-delà.

La reducción de la mortalidad materna e infantil es una prioridad en los Objetivos de Desarrollo del Milenio (ODM), y probablemente lo seguirá siendo después de 2015. Existen evidencias sobre las inversiones, las intervenciones y las políticas necesarias, pero se sabe menos acerca de por qué algunos países logran un progreso más rápido que otros países comparables. Los estudios relativos a los Factores de Éxito en la Salud de las Mujeres y los Niños han tratado de abordar esta brecha de conocimiento por medio de análisis estadísticos y econométricos de datos de 144 países de ingresos bajos y medianos (PIBM) a lo largo de más de 20 años, análisis comparativos cualitativos booleanos, revisión de la literatura y revisiones específicas de cada país en 10 países bien encarrilados para los ODM 4 y 5a. No existe una fórmula estándar, estos países despliegan estrategias a medida y se adaptan rápidamente a los cambios. Sin embargo, comparten ciertos enfoques eficaces a la hora de abordar tres áreas principales para reducir la mortalidad materna e infantil. En primer lugar, involucran a numerosos sectores para hacer frente a los factores sanitarios decisivos. Alrededor de la mitad de la reducción de la mortalidad infantil en los PIBM desde 1990 es el resultado de inversiones en el sector de la salud, y la otra mitad se atribuye a las inversiones realizadas en sectores fuera del ámbito sanitario. En segundo lugar, estos países utilizan estrategias para movilizar a socios a través de la sociedad, utilizando evidencias oportunas y sólidas para la toma de decisiones y la rendición de cuentas, así como un enfoque de planificación triple para considerar las necesidades inmediatas, la visión a largo plazo y la adaptación al cambio. En tercer lugar, los países establecen principios rectores que orientan el progreso, armonizan las acciones de las partes interesadas y logran resultados en el tiempo. Este compendio de evidencias contribuye al aprendizaje global sobre cómo acelerar las mejoras en la salud de mujeres y niños hacia el 2015 y más adelante.

Costos económicos en craneotomía vigíl para la resección de tumores intracerebrales / Economic costs in a craniotomy monitor for the resection of intracerebral tumors

INTRODUCCIÓN: la técnica de craneotomía vigíl (CV) ha facilitado la extracción de lesiones intracerebrales cercanas a áreas elocuentes debido a la información inmediata que se puede obtener por vía de cortico-estimulación. OBJETIVO: describir los costos económicos comparativos entre CV y anestesia general (CAG). MÉTODO: se estudiaron los casos operados bajo CV, desde noviembre del 2007 a octubre del 2012, en el Hospital de Diagnóstico de El Salvador. Se operaron 63 pacientes bajo CV, de estos, 45 con patología oncológica fueron comparados contra 45 pacientes operados bajo CAG. Se analizan costos de CV versus CAG, los cuales se desglosan en: procedimiento, días de estancia intrahospitalaria y unidades intermedias. RESULTADOS: el costo promedio de CV fue de 6,540 USD (6,300 ­ 6,900) versus 8,550 USD (8,000 - 9,000) de CAG (p.0003). El tiempo en quirófano fue de 257.49 minutos en CV y de 247.51 minutos para CAG (p.0.63). El tiempo promedio hospitalización en CV fue de 2.1 días (1-4) y en CAG de 2.9 días (2-5) (p0.004). Tres (6.6%) pacientes de CV pasaron a unidad de cuidados intermedios (UCIM), de CAG 6 (13.3%) pacientes pasaron a UCIM (p.0.04). La tasa de resección volumétrica según RM control fue de 92% (40-100) en CV versus 95% (62-100) en CAG (p.0.5). CONCLUSIONES: la CV mostró ser más económica que la clásica CCAG e incurre en menor tiempo de hospitalización. Las series no fueron comparables en cuanto a cercanía de las lesiones a áreas elocuentes y a la existencia de complicaciones, ya que la mayoría de casos en dichas áreas fueron operados por CV

INTRODUCTION: awake craniotomy (CV) technique made easier the resection of intracerebral lesions near eloquent cortex due to the immediate information that can be obtained via cortico-stimulation. OBJECTIVE: to investigate comparative costs at our center between CV and general anesthesia (CAG). METHOD: we analyzed the cases that were operated under CV from November 2007 to October 2012 at the Hospital de Diagnóstico de El Salvador. During this period 63 patients were operated using CV. 45 patients with oncological pathology were chosen that could be compared to 45 patients that were operated by the same team but under CAG. Comparative costs were studied and broken down in the direct cost of procedure, hospital stay in regular and intermediate care units. A brief description of the techniques used is provided and clinical results with regards to volumetric resection and neurologicalcomplications. RESULTS: the average cost of CV was 6,540 USD (6,300 ­ 6,900) versus 8,550 USD (8,000 - 9,000) of CAG (p.0003). Operating room time was 257.49 minutes in CV and 247.51 minutes for CAG p.0.63. The average hospitalization time was in CV 2.1 days (1-4) and 2.9 days in CAG (2-5) (p.0.004). Three (6.6%) patients of CV needed Intermediate Care (UCIM), in CAG 6 (13.3%) patients needed (UCIM p.0.04). The proportion of lesions next to or in eloquent cortex was CV (36) versus CAG (15) 2.4:1 (p.0.0031). Volumetric resection according MRI was 92% (40-100) in CV versus 95% (62-100) in CAG, (p.0.5). CONCLUSIONS: awake craniotomy showed to be less expensive than CAG and had less hospital stay. Both series were not comparable with regards to tumor resection in eloquent or near eloquent cortex and complications due to the fact that most of the complex cases were operated under CV

A case of acute multifocal inner retinitis associated with nonspecific viral illness.

PURPOSE: To describe a patient with sudden unilateral loss of vision associated with white inner retinal lesions and a history of a nonspecific viral infection. METHODS: Case report. We reviewed the medical record and retinal angiogram of one patient. RESULTS: The patient presented with a sudden loss of visual acuity in the left eye. Fundus examination revealed multiple white inner retinal lesions and hyperemic optic disks in both eyes. Spontaneous improvement of visual acuity and resolution of the retinal lesions were noted over the ensuing weeks. CONCLUSION: Retinitis can present as a nonspecific response to various infectious agents. We herein report a case of acute multifocal inner retinitis associated with a nonspecific viral illness.

Maternity waiting homes and institutional birth in Nicaragua: policy options and strategic implications.

With the aim of promoting institutional births and reducing the high maternal and child mortality rates in rural and poor zones, the government of Nicaragua is supporting the creation of maternity waiting homes. This study analyzes that strategy and examines the factors associated with the use of maternity waiting homes and institutional birth. To that end, we apply a quantitative approach, by means of an econometric analysis of the data extracted from surveys conducted in 2006 on a sample of women and parteras or traditional birth attendants, as well as a qualitative approach based on interviews with key informants. Results indicate that although the operation of the maternity waiting homes is usually satisfactory, there is still room for improvement along the following lines: (i) disseminating information about the homes to both women and men, as the latter frequently decide the course of women's healthcare, and to parteras, who can play an important role in referring women; (ii) strengthening the postpartum care; (iii) ensuring financial sustainability by obtaining regular financial support from the government to complement contributions from the community; and (iv) strengthening the local management and involvement of the regional government. These measures might be useful for health policy makers in Nicaragua and in other developing countries that are considering this strategy.

Diabetic papillopathy: current and new treatment options.

Diabetes mellitus is a growing global epidemic. Patients with this disease present with a variety of health conditions, including a number of ocular complications that threaten vision, such as proliferative diabetic retinopathy and macular edema. Diabetic papillopathy, another potential ocular complication from diabetes, is a self-limiting, sometimes bilateral disease that may affect both type 1 and type 2 diabetics. It is characterized by optic disc swelling caused by vascular leakage and axonal edema in and around the optic nerve head. Occasionally, it may be accompanied by intraretinal hemorrhages and hard exudates. Diabetic papillopathy tends to be mild and is usually associated with good visual prognosis; however, there are some cases in which permanent visual impairment can develop. The pathogenesis remains largely unknown, but there has been evidence suggestive of its associations with a small cup/disc ratio and rapid reduction in glycemia. There is no validated therapy for diabetic papillopathy; however, current case reports have shown promising results after local injections of corticosteroids as well as bevacizumab (Avastin), a potent monoclonal antibody that has been employed for the treatment of ocular vaso-proliferative diseases such as choroidal neovascular membranes associated with age-related macular degeneration and proliferative diabetic retinopathy.

Surgical treatment of ocular toxocariasis: anatomic and functional results in 45 patients.

PURPOSE: To evaluate the anatomic and functional outcome after surgery in patients with complicated ocular toxocariasis. METHODS: A retrospective review of the medical records of pediatric patients who underwent a surgical procedure for ocular toxocariasis from July 1990 to January 2005. Patients with postoperative follow-up shorter than 6 months were excluded from the study. Best-corrected visual acuity (BCVA) was arbitrarily divided into 5 groups: 1) no light perception (NLP); 2) light perception (LP) and hand motion (HM); 3) finger counting (FC) to 20/400; 4) 20/300 to 20/60; and 5) 20/50 to 20/20. RESULTS: Forty-five patients with a mean age of 8.1 years (range 6-10) were included in the study. The ocular toxocariasis presentation most commonly encountered was peripheral granuloma (38%). Twenty-one eyes presented with BCVA in the LP/HM group, 18 (40%) eyes in the FC to 20/400 group, 5 (12%) eyes in the 20/300 to 20/60 group, and 1 (5%) eye in the 20/50 to 20/20 group. The most common surgical procedure was pars plana vitrectomy (PPV) in 58% of the eyes. Four eyes (9%) presented with postoperative BCVA of NLP, 2 eyes (4%) in the LP/HM group, 12 eyes (27%) in the FC to 20/400 group, 19 eyes (42%) in the 20/300 to 20/60 group, and 8 eyes (18%) in the 20/50 to 20/20 group. CONCLUSIONS: Surgical treatment of severe ocular complications secondary to toxocara infections results in satisfactory anatomic results and may improve the overall visual outcome of these patients.

Ocular parasitic diseases: a review on toxocariasis and diffuse unilateral subacute neuroretinitis.

Parasitic infections may damage various ocular tissues, thereby causing visual dysfunction. In 1950, Wilder described the first case in which larval forms of nematodal intestinal roundworms (Ascaridoidea: Ascaris, Toxocara, Ancylostoma, Necator, and Strongyloides) were implicated as a cause of intraocular disease. This review focuses on two disorders associated with parasitic infections: ocular toxocariasis and diffuse unilateral subacute neuroretinitis.

Intravitreous bevacizumab injection: an experimental study in New Zealand white rabbits.

OBJECTIVES: To determine the effects of intraocular pressure (IOP) and needle diameter on the amount of reflux after intravitreous bevacizumab injection. METHODS: Prospective randomized interventional study. Twelve New Zealand white rabbits weighing approximately 2.5 to 3.5 kg each were randomized 1:1 to group 1 or group 2. Bevacizumab stained with trypan blue was used for intravitreous injection. To lower the IOP, eyes in group 2 underwent anterior chamber paracentesis before intravitreous injection. Two eyes in each group were injected using 27-, 30-, or 32-gauge needles. If a subconjunctival bleb formed after intravitreous injection, its diameter was measured using a caliper. RESULTS: The median IOP in group 1 was 17.5 mm Hg. Eyes injected using 27-gauge and 30-gauge needles showed stained subconjunctival blebs with median sizes of 3 mm and 1.7 mm, respectively; eyes injected using 32-gauge needles showed no subconjunctival bleb formation. The median IOP in group 2 was 10.3 mm Hg. Eyes injected using 27-gauge needles showed stained subconjunctival blebs with a median size of 0.7 mm, and eyes injected using 30-gauge and 32-gauge needles showed no subconjunctival bleb formation. CONCLUSION: Decreasing the IOP before intravitreous injection and using a smaller-gauge needle reduce the risk of drug reflux after intravitreous bevacizumab injection. CLINICAL RELEVANCE: Intravitreous injection is an increasingly common route of drug delivery to treat ocular diseases. Techniques that maximize bioavailability are examined in this study.

Selective and pan-blockade agents in the anti-angiogenic treatment of proliferative diabetic retinopathy: a literature summary.

Diabetes mellitus is a major health concern in the modern world. Several sight-threatening ocular conditions are included in the array of health problems associated with this disease. Understandably, 2 of the more sight-threatening problems, proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), have received a great deal of attention in recent years. Pivotal studies, such as the Early Treatment Diabetic Retinopathy Study and the Diabetic Retinopathy Study, have established laser photocoagulation as the accepted treatment modality. The last decade has seen a surge in clinical data supporting the use of pharmacologic therapy in place of the often damaging laser therapy. Supporting data are based on the establishment of vascular endothelial growth factor (VEGF) as a key facilitator of disease progression in diabetic retinopathy. We will discuss the advantages and disadvantages of both selective and pan-blockade anti-VEGF agents available today in an effort to help guide physicians wishing to use these agents to treat PDR and DME.

Ressecção de tumor cerebral por sistema estereotactico eletromagnético sem arco / Cerebral tumor resection assisted by electromagnetic tracking frameless stereotactic system

O principal objetivo é descrever a tecnologia usada (Compass Cygnus), suas vantagens e desvantagens em ressecções de tumores cerebrais, quando incorporadas em um programa de neuro-oncologia. Utilizamos o sistema estereotactico Compass Cygnuss-PFS , que realiza localização eletromagnética (EMFSS) ; analisamos a tecnologia usada no sistema e descrevemos a realização do procedimento, suas vantagens e desvantagens. Ainda, relatamos nossa experiência inicial na ressecção de tumores com esta tecnologia , no período de ago./08 a jan./09, no programa de neurooncologia do hospital de Diagnóstico de El Salvador. O EMFSS opera com a utilização de tecnologia Flock of Birds (FOB). 20 pacientes foram operados com esta técnica, sendo 18 portadores de tumores primários ou secundários: sua precisão foi considerada adequada em 16 casos (88.8 %), quando comparada a estruturas não deformáveis e não móveis. Ultrasom transoperatório foi utilizado em dois casos . Em dois casos o EMFSS foi considerado inadequado , devido à deformação ou desvio cerebral e um novo registro foi necessário durante a cirurgia. A localização dos tumores foi 5 em área não eloqüente, 8 em área próxima e 5 em córtex eloqüente. A ressecção tumoral volumétrica foi de 87% (40- 100 %). 5 pacientes tiveram complicações(27.7 %), sendo quatro delas transitórias e com resolução em trinta dias e um deles com piora neurológica definitiva. A taxa de mortalidade operatória (30 dias) foi zero. O escore de Karnofski na internação, na alta e no controle em 30 dias foi 80 (60-90), 80 (60-90) e 80 (60-100) respectivamente. Localização eletromagnética é um sistema confiável quando sua acurácia é testada contra estruturas não-móveis e pelo ultrasom: é compacta, e sua direção e sua grande vantagem é permitir um planejamento adequado da craniotomia, bem como a orientação espacial em tumores profundos, onde o ultrasom é inefetivo.

Avances en neurocirugía tumoral. El Salvador C. A / Advances in tumoral neurosurgery in El Salvador

Objetivo: reportar el uso inicial de tecnología y técnicas avanzadas en la cirugía de tumores cerebrales. Analizar la estadística inicial del Programa de Neuro-Oncología de los Hospitales de Diagnóstico (HD) de El Salvador. Material y método: análisis descriptivo, respectivo, preliminar de pacientes operados de tumores cerebrales tanto primarios como secundarios por el Programa de Neuro-Oncología de los HD y el Hospital Militar Central (HMC). Enero del 2007 a enero del 2009. Descripción de técnicas de cirugía guiadas por estereotaxia, CGI, ultrasonido intraoperatorio, cirugía vigil y mapeo cortical. Resultados: en 57 pacientes operados hubo 7 complicaciones (12%) pero no hubo déficit neurológico definitivo ni mortalidad a 30 días de la cirugía; 13 pacientes (22,8%), fueron operados despiertos. Hubo 4 (7%) tumores en áreas elocuentes, 7 (12%) cercanos a áreas elocuentes y 46 (80%) en áreas no elocuentes. Conclusión: a pesar de lo ¶joven÷ del Programa de Neuro-Oncología, ha representado un avance significativo sobre el análisis de resultados quirúrgicos y de otras terapéuticas en los hospitales en que ha sido implementado. La tecnología empleada en dicho programa ha facilitado la maximización de las resecciones quirúrgicas, minimizando las complicaciones.(AU)

Avances en neurocirugía tumoral. El Salvador C. A / Advances in tumoral neurosurgery in El Salvador

Objetivo: reportar el uso inicial de tecnología y técnicas avanzadas en la cirugía de tumores cerebrales. Analizar la estadística inicial del Programa de Neuro-Oncología de los Hospitales de Diagnóstico (HD) de El Salvador. Material y método: análisis descriptivo, respectivo, preliminar de pacientes operados de tumores cerebrales tanto primarios como secundarios por el Programa de Neuro-Oncología de los HD y el Hospital Militar Central (HMC). Enero del 2007 a enero del 2009. Descripción de técnicas de cirugía guiadas por estereotaxia, CGI, ultrasonido intraoperatorio, cirugía vigil y mapeo cortical. Resultados: en 57 pacientes operados hubo 7 complicaciones (12%) pero no hubo déficit neurológico definitivo ni mortalidad a 30 días de la cirugía; 13 pacientes (22,8%), fueron operados despiertos. Hubo 4 (7%) tumores en áreas elocuentes, 7 (12%) cercanos a áreas elocuentes y 46 (80%) en áreas no elocuentes. Conclusión: a pesar de lo “joven” del Programa de Neuro-Oncología, ha representado un avance significativo sobre el análisis de resultados quirúrgicos y de otras terapéuticas en los hospitales en que ha sido implementado. La tecnología empleada en dicho programa ha facilitado la maximización de las resecciones quirúrgicas, minimizando las complicaciones.