Comparison of Postoperative Seizures Between Burr-Hole Evacuation and Craniotomy in Patients With Nonacute Subdural Hematomas: A Bi-Institutional Propensity Score-Matched Analysis.

BACKGROUND AND OBJECTIVES: Postoperative seizures are a common complication after surgical drainage of nonacute chronic subdural hematomas (SDHs). The literature increasingly supports the use of prophylactic antiepileptic drugs for craniotomy, a procedure that is often associated with larger collections and worse clinical status at admission. This study aimed to compare the incidence of postoperative seizures in patients treated with burr-hole drainage and those treated with craniotomy through propensity score matching (PSM). METHODS: A retrospective cohort analysis was conducted on patients with surgical drainage of nonacute SDHs (burr-holes and craniotomies) between January 2017 to December 2021 at 2 academic institutions in the United States. PSM was performed by controlling for age, subdural thickness, subacute component, and preoperative Glasgow Coma Scale. Seizure rates and accompanying abnormalities on electroencephalographic tracing were evaluated postmatching. RESULTS: A total of 467 patients with 510 nonacute SDHs underwent 474 procedures, with 242 burr-hole evacuations (51.0%) and 232 craniotomies (49.0%). PSM resulted in 62 matched pairs. After matching, univariate analysis revealed that burr-hole evacuations exhibited lower rates of seizures (1.6% vs 11.3%; P = .03) and abnormal electroencephalographic findings (0.0% vs 4.8%; P = .03) compared with craniotomies. No significant differences were observed in postoperative Glasgow Coma Scale (P = .77) and length of hospital stay (P = .61). CONCLUSION: Burr-hole evacuation demonstrated significantly lower seizure rates than craniotomy using a propensity score-matched analysis controlling for significant variables.

Public interest in palliative care in Latin America: A Google Trends analysis.

The demand for palliative care is increasing globally, yet a notable lack of awareness continues to present a significant obstacle to its widespread adoption. The use of digital tools like Google Trends can help gauging public interest in specific topics. We used Google Trends to conduct a systematic search of terms related to palliative care from January 1, 2010, to May 10, 2023. The results were filtered by location, including worldwide and Latin American countries. We found a global increase in searches for terms related to palliative care, with a peak in December 2022 associated with the death of Brazilian footballer Pelé. Countries like Brazil, Mexico, and Colombia mirrored this trend, while others like Argentina and Peru did not. Interest in palliative care is on the rise in Latin America, albeit with notable regional variations.

Brain lesions causing parkinsonism versus seizures map to opposite brain networks.

Recent epidemiological studies propose an association between parkinsonism and seizures, but the direction of this association is unclear. Focal brain lesions causing new-onset parkinsonism versus seizures may provide a unique perspective on the causal relationship between the two symptoms and involved brain networks. We studied lesions causing parkinsonism versus lesions causing seizures and used the human connectome to identify their connected brain networks. Brain networks for parkinsonism and seizures were compared using spatial correlations on a group and individual lesion level. Lesions not associated with either symptom were used as controls. Lesion locations from 29 patients with parkinsonism were connected to a brain network with the opposite spatial topography (spatial r = -0.85) compared to 347 patients with lesions causing seizures. A similar inverse relationship was found when comparing the connections that were most specific on a group level (spatial r = -0.51) and on an individual lesion level (average spatial r = -0.042; P < 0.001). The substantia nigra was found to be most positively correlated to the parkinsonism network but most negatively correlated to the seizure network (spatial r > 0.8). Brain lesions causing parkinsonism versus seizures map to opposite brain networks, providing neuroanatomical insight into conflicting epidemiological evidence.

Awake craniotomies in South America: Advancements, challenges, and future prospects.

BACKGROUND: Awake craniotomy has emerged as an advanced surgical technique, characterized by keeping the patient awake during brain surgery. In South America, awake craniotomies have grained traction in neurosurgical practices across various medical centres and hospitals, with notable practitioners contributing to its growth and refinement in the region. PURPOSE: This study aims to explore the integration and impact of awake craniotomies in South American neurosurgical practices. The focus is on understanding the benefits, challenges, and potential transformative effects of the procedure in the region. RESEARCH DESIGN: A comprehensive narrative review and analysis through a thorough examination of the existing literature. RESULTS: The findings indicate that awake craniotomies in South America offer substantial benefits, including cost savings thorugh reduced hospitalization time, quicker recovery and decreased morbidity. Enhanced safety, effective pain management and reduced anaesthesia also contribute to this. CONCLUSION: Whilst the adaptation of awake craniotomies in South America holds great promise in transforming neurosurgical care in the region, significant challenges hinder its widespread adoption. Inadequate infrastructure, limited access to equipment, financial instability, and shortages in trained healthcare providers represent challenges that need to be addressed.

Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America.

Exploring the landscape of intracranial aneurysms in South America unravels a complex interplay of epidemiological factors, clinical manifestations, and therapeutic challenges. The study methodically conducts a comprehensive literature review spanning the years 2003 to 2023, focusing on English-language articles obtained from diverse databases to elucidate the multifaceted nature of intracranial aneurysms in the region. Results and discussions categorize outcomes into positive domains, emphasizing successful treatments, favorable recoveries, and high survival rates, while also shedding light on negative aspects such as residual aneurysms and complications. The research illuminates significant gaps in pathological typing of intracranial aneurysms and exposes challenges in healthcare accessibility, notably the disparities in neurosurgical resources. Management challenges, including constrained infrastructure access, a neurosurgeon shortage, and gender disparities, are underscored. Transitioning to future prospects, the study advocates for strategic interventions, proposing expanded neurosurgical training, multidisciplinary approaches, improved funding, enhanced access to care, and fostering international collaborations. The study concludes by emphasizing the pivotal role of collaborative efforts, intensified training programs, and global partnerships in propelling intracranial aneurysm management forward in South America, ultimately contributing to enhanced patient outcomes across the region.

Pre-extensively drug-resistant and extensively drug-resistant tuberculosis in Latin America and the Caribbean: A systematic review and meta-analysis.

BACKGROUND: The growing threat from pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) poses a major public health concern in Latin America and the Caribbean (LAC). Therefore, this study aimed to summarize the available evidence on the prevalence of pre-XDR-TB and XDR-TB among patients with multidrug-resistant tuberculosis in LAC. METHODS: A systematic review was conducted in the following databases on June 3, 2023: PubMed, Scopus, Ovid Medline, Web of Science, Scielo and LILACS. We estimated pooled proportions using a random effects model (Dersimonian and Laird). The 95% confidence intervals (95% CI) were calculated using the binomial exact method (Clopper-Pearson Method). Subgroup (by time period and country) and sensitivity analyses were performed. RESULTS: Twenty-nine studies were eligible for qualitative synthesis and 27 for meta-analysis (n = 15,565). The pooled prevalence of XDR-TB in the study participants was 5% (95% CI: 3%-6%), while that of pre-XDR-TB was 10% (95% CI 7%-14%). Cuba (6%, 95% CI 0%-17%) and Peru (6%, 95% CI 5%-7%) had the highest pooled prevalence of XDR-TB. Regarding pre-XDR-TB, Brazil (16%, 95% CI 11%-22%) and Peru (13%, 95% CI: 9%-16%) showed the highest prevalence. CONCLUSIONS: The pooled prevalence of pre-XDR-TB and XDR-TB in LAC was 10% and 5%, respectively. Governments should strengthen drug-resistance surveillance and TB programs.

Challenges and opportunities in prostate cancer surgery in South America: Insights into robot-assisted radical prostatectomies-A perspective.

Background and Aims: Prostate cancer imposes a significant health burden, particularly in South America with its high incidence and mortality rates. This article explores the emergence of robot-assisted radical prostatectomy (RARP) as a potential solution in the region. Methods: This study relies on a comprehensive review of relevant literature. The analysis highlights the advantages of RARP, identifies impediments to its implementation, and proposes strategies to overcome these barriers. Results: RARP demonstrates notable benefits, including improved functional outcomes, reduced complications, and minimized incisions. However, the integration of RARP in South America is hindered by challenges such as regional disparities, financial limitations, and data gaps. Limited healthcare infrastructure and a scarcity of skilled professionals further compound the issues. Conclusion: Despite its potential, RARP faces obstacles to widespread adoption in South America. Strategic solutions encompassing technology investment, healthcare infrastructure enhancement, and workforce training are imperative. Overcoming these challenges can establish RARP as a crucial tool in managing prostate cancer in the region, ultimately enhancing patient care and treatment outcomes.

Microsurgical and endovascular treatment of posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis.

INTRODUCTION: Posterior inferior cerebellar artery (PICA) aneurysms are uncommon vascular lesions of the posterior fossa. In addition to aneurysmal morphology, structural anatomic considerations may confer additional procedural risk, and as a result there is currently no consensus as to whether a surgical or endovascular approach offers greater safety and efficacy for patients. EVIDENCE ACQUISITION: We systematically examined peer-reviewed literature describing PICA aneurysm treatment planning from January 2000 to May 2021 using the PRISMA methodology. A meta-analysis of proportions was performed. Certainty of the evidence was assessed using the GRADE approach. EVIDENCE SYNTHESIS: Fifty-eight studies including 1673 PICA aneurysms were analyzed. Overall treatment occlusion rate was 97% (95% confidence interval [CI]: 93-100%) for surgery and 85% (95% CI: 78-92%) for endovascular therapy. The recurrence rate was 6% in the endovascular group and 1% for surgery. Overall morbidity and mortality were 16% and 7%, respectively. Intraoperative complications occurred in 9% of the surgical patients. CONCLUSIONS: Despite a large body of literature, analysis indicates that 62% of studies had moderate or serious risk of bias, suggesting very-low certainty results. Therefore, treatment via either approach should be determined on a case-by-case basis and according to institutional experience.

Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) is the second most common cause of death due to a single infectious agent worldwide after COVID-19. Up to 15% of the cases are extrapulmonary, and if it is located in the central nervous system (CNS-TB), it presents high morbidity and mortality. Still, the global epidemiology of CNS-TB remains unknown. AIM: To estimate the global prevalence and incidence of CNS-TB based on the available literature. METHODS: We systematically searched in MEDLINE, Cochrane Central, Scopus, and LILACS databases (April 2020) and included observational studies evaluating the epidemiology of CNS-TB. Two independent researchers selected and assessed the quality of the studies and extracted relevant data. We performed random-effects model meta-analysis of proportions to estimate the pooled prevalence. The protocol of this study was registered in PROSPERO (CRD 42018103946). RESULTS: We included 53 studies from 28 countries, representing 12,621 patients with CNS-TB. The prevalence of CNS-TB was 2 per 100,000 inhabitants. According to the clinical setting, the prevalence of CNS-TB represented the 13.91% of all cases of meningitis and 4.55% of all cases of TB. The mortality was calculated by tuberculous meningitis due to the lack of data of other presentation, and it rose up to 42.12% in hospitalized patients. The burden of countries' TB, Human Development Index (HDI), and the prevalence of HIV were the most important prevalence moderators, especially in patients with TB. No data on incidence were found. CONCLUSION: The prevalence and mortality of CNS-TB remain high, and TB meningitis is the most frequent presentation. The highest prevalence was reported in developing countries, and its main moderators were the countries' HDI and HIV infection. Our study was limited by high heterogeneity, risk of bias, and potential data under registration from developing countries. The integration of CNS-TB early detection and management into national TB programs and population-based studies from developing countries are needed for better global estimation and response.

Characteristics and outcomes from COVID-19 among Peruvian physicians: a nationwide register-based study.

The healthcare workforce has played an integral role in fighting COVID-19 and continues to do so despite the continuous adverse outcomes. To address this issue, official public data concerning COVID-19 cases and deaths of Peruvian physicians was used to quantify the risk of death and infection by SARS-CoV-2. 20.9% Peruvian physicians were infected and 0.7% died, with the male general practitioners being the most affected group within the workforce. Notably, the Loreto region was disproportionately affected and had the highest cumulative incidence, mortality and case fatality rate. Ultimately, this identified risk group needs to be supported with sufficient resources/tools such as personal protective equipment, training, access to health care, vaccination, etc.

Aceptación de la vacunación contra la COVID-19 durante la primera ola pandémica en Perú / Acceptance of COVID-19 vaccination during the first pandemic wave in Peru

Señor editor: El exceso de muertes debido a la COVID-19 en Perú durante el 2020fueunodelosmáselevadosdelmundo,esto probablemente favorecido por la fragilidad del sistema salud y los determinantes sociales de este país. Si bien una de las principales estrategias para mitigar el impacto de esta enfermedad es la vacunación masiva, la falta de aceptación de la vacuna por parte de la población peruana podría ser uno de los mayores desafíos para lograr dicho objetivo.

Mr. Editor: The excess of deaths due to COVID-19 in Peru during 2020 was one of the highest in the world, probably favored by the fragility of the health system and the social determinants of this country. Although one of the main strategies to mitigate the impact of this disease is mass vaccination, the lack of acceptance of the vaccine by the Peruvian population could be one of the biggest challenges to achieve this goal.

Capacitaciones e investigación realizados por los recursos humanos en salud, Latinoamérica / Training and research carried out by human resources in health, Latin America

OBJETIVO: Se decidió analizar la asistencia a cursos, congresos, la producción de investigación y publicaciones como instrumento para calibrar la formación continuada del personal sanitario en diversos países de Latinoamérica. MATERIAL Y MÉTODOS: Estudio observacional descriptivo basado en una encuesta multicéntrica al personal de salud de ocho países latinoamericanos. Se les preguntó acerca de dos temas: la capacitación que habían realizado (asistencia a congresos nacionales, conferencias internacionales y cursos cortos) y la investigación que habían generado (trabajos originales y otras publicaciones, preguntando cuántos de ellos habían sido publicados). RESULTADOS: La mediana de asistencia a congresos nacionales fue de 3 en toda la vida (rango: 0-400) y 1 durante el último año (rango: 0-23). En los congresos internacionales fue 0 en toda la vida (rango: 0-40) y 0 durante el último año (rango: 0-15). En curso corto fue de 2 en la vida (rango: 0-500) y 0 durante el último año (rango: 0-80). En cuanto a los trabajos originales, la mediana de toda la vida fue 0 (rango: 0-40) y la mediana de estas publicaciones fue 0 (rango: 0-15). Finalmente, la mediana de otras investigaciones de por vida fue 0 (rango: 0-40) y de las publicaciones de estas fue 0 (rango: 0-18). CONCLUSIÓN: Se encontró que los entrenamientos recibidos son muy pocos en toda su vida y en el último año, la investigación es mínima y la publicación es mucho más pequeña. Este es un hallazgo esperado pero coherente con muchos informes, donde se ha demostrado que el autoaprendizaje y la investigación son deficientes

OBJECTIVE: It was decided to analyze the attendance to courses, congresses, the production of research and publications as an instrument to calibrate the continuing education of health personnel in divers Latin American countries. MATERIAL AND METHODS: A descriptive observational study, based on a multicenter survey of health personnel from eight Latin American countries. They were asked about two subjects: the training they had done (attending national congresses, international conferences and short courses) and the research they had generated (original works and other publications, asking how many of them had been published). RESULTS: The median attendance at national congresses was 3 in the whole of life (range: 0-400) and 1 during the last year (range: 0-23). At international congresses it was 0 in all the life (range: 0-40) and 0 during the last year (range: 0-15). A short courses was 2 in a lifetime (range: 0-500) and 0 during the last year (range: 0-80). As for the original works, the median of all life was 0 (range: 0-40) and the median of these publications was 0 (range: 0-15). Finally, the median of other lifetime research was 0 (range: 0-40) and of the publications of these was 0 (range: 0-18). CONCLUSION: It was found that the trainings received are very few in all their life and in the last year, the investigation is minimal, and much smaller publication. This is an expected finding but consistent with many reports, where it has been shown that self-training and research are insignificant