Outcomes of Unruptured Low-Grade Brain Arteriovenous Malformations Using TOBAS (Treatment of Brain Arteriovenous Malformations Study) Criteria.

BACKGROUND: Treatment of an unruptured brain arteriovenous malformation (bAVM) is a matter of debate, especially for low-grade bAVM (Spetzler-Martin grade I and II). The aim is to compare the outcomes of patients with low-grade unruptured bAVM after interventional or medical management in a pragmatic manner. METHODS: Adults with unruptured low-grade bAVM diagnosed between 2006 and 2016 were included. The primary end points were death from all causes and disabling stroke that resulted in a modified Rankin Scale (mRS) score >2 at last follow-up. RESULTS: Eighty-four patients presented with an unruptured Spetzler-Martin low-grade bAVM. Among these patients, 55 (65.5%) were treated and 29 (34.5%) were untreated, with no differences regarding clinical and radiologic characteristics. The modality of treatment was embolization in 25.5%, radiosurgery (alone, 30.9%; with embolization, 18.2%), and surgery (alone, 5.5%; with embolization, 20%). The rupture rate was 6.7% person-year in the untreated group; 12.7% (n = 7) of treated and 16.7% (n = 5) of untreated patients achieved the primary evaluation criteria (P = 0.744). Using a Kaplan-Meier curve, the probability of reaching this criterion at 5 years was not different between groups (P = 0.07). Complications resulting in an mRS score >2 at last follow-up occurred in 9.1%, in 80% of cases after embolization. CONCLUSIONS: This study shows no differences between treated and untreated low-grade bAVM. Embolization seems to carry a high risk of complication and should be used with caution. The small number of cases must encourage cautious interpretations especially because of the spontaneous high-rupture rate. One major interest is to investigate center habits in pathology when treatment standards are limited.

The Treatment of Brain AVMs Study (TOBAS): an all-inclusive framework to integrate clinical care and research.

OBJECTIVE The management of brain arteriovenous malformations (bAVMs) remains controversial. The Treatment of Brain AVMs Study (TOBAS) was designed to manage patients with bAVMs within a clinical research framework. The objective of this study was to study trial feasibility, recruitment rates, patient allocation to the various management groups, and compliance with treatment allocation. METHODS TOBAS combines two randomized care trials (RCTs) and a registry. Designed to be all-inclusive, the study offers randomized allocation of interventional versus conservative management to patients eligible for both options (first RCT), a second RCT testing the role of preembolization as an adjunct to surgery or radiotherapy, and a registry of patients managed using clinical judgment alone. The primary outcome of the first RCT is death from any cause or disabling stroke (modified Rankin Scale score > 2) at 10 years. A pilot phase was initiated at one center to test study feasibility, record the number and characteristics of patients enrolled in the RCTs, and estimate the frequency of crossovers. RESULTS All patients discussed at the multidisciplinary bAVM committee between June 2014 and June 2016 (n = 107) were recruited into the study; 46 in the randomized trials (23 in the first RCT with 21 unruptured bAVMs, 40 in the second RCT with 17 unruptured bAVMs, and 17 in both RCTs), and 61 patients in the registry. Three patients crossed over from surgery to observation (first RCT). CONCLUSIONS Clinical research was successfully integrated with normal practice using TOBAS. Recruitment rates in a single center are encouraging. Whether the trial will provide meaningful results depends on the recruitment of a sufficient number of participating centers. Clinical trial registration no.: NCT02098252 (clinicaltrials.gov).

Factores de riesgo de enfermedad cardiovascular en aborígenes Tobas de Formosa: asociación con alimentación, actividad física y representaciones culturales / Risk factors for cardiovascular disease in aboriginal tuffs of Formosa: association with nutrition, physical activity and cultural representations

ntroducción y objetivo: Los pueblos originarios del Gran Chaco han sido en su gran mayoría cazadores-recolectores- pescadores. En la actualidad, estos pueblos están atravesando una rápida transición epidemiológica y nutricional. El objetivo de este estudio fue establecer la prevalencia de factores de riesgo de enfermedades cardiovasculares no detectados en adultos tobas/qom de Formosa (Argentina) y su asociación con la alimentación, el nivel de actividad física habitual y las representaciones culturales sobre el cuerpo saludable. Materiales y Métodos: Se realizó un estudio correlacional, analítico de diseño transversal entre marzo y diciembre del 2010. Se seleccionaron al azar 275 personas mayores de 20 años de edad (141 mujeres y 134 hombres). Se obtuvieron mediciones antropométricas (peso, talla, porcentaje de grasa corporal, circunferencia de cintura), metabólicas (triglicéridos, colesterol HDL y glucosa, todos en sangre y en ayunas) y se determinó la presión arterial y presencia de tabaquismo. También se obtuvieron datos de nivel de actividad física, alimentación y representaciones culturales sobre el cuerpo saludable. Se respetaron las normas bioéticas correspondientes. Los datos se analizaron mediante el test de Chi cuadrado de Pearson (Χ2), test t de Student, correlación lineal de Pearson y regresión logística para evaluar la asociación entre variables antropométricas y variables etabólicas/fisiológicas utilizando el paquete estadístico SPSS 20.0.

SUMMARY: Introduction: The people of the Gran Chaco have traditionally been hunter-gatherers-fishers. Today, these populations are undergoing a fast nutritional and epidemiological transition. The objective of this thesis was to establish the prevalence of non-detected cardiovascular disease factors in Toba/Qom adults of Formosa (Argentina) and its association with diet composition, physical activity and the sociocultural representations of a healthy body. Materials and Methods: I conducted a cross-sectional analytical study between March and December 2010. A total of 275 people 20 years of age and older (141 women and 134 men) were randomly selected and invited to participate. I collected anthropometric measures (body weight, height, waist circumference, body fat percentage), metabolic values (triglycerides, HDL cholesterol and glucose, all fasting blood values), blood pressure measures, and smoking habits. I also collected data on diet quality, physical activity leveland sociocultural representations of healthy bodies. International bioethical guidelines were followed, obtaining informed consent from all the participants. The data were analyzed using the Chi-square test of Pearson (Χ2), Student t test, Pearson linear correlation, and logistic regression to assess the association between anthropometric variables and metabolic / physiological ones, using the SPSS 20.0 statistical package.

Factores de riesgo de enfermedad cardiovascular en aborígenes Tobas de Formosa: asociación con alimentación, actividad física y representaciones culturales / Risk factors for cardiovascular disease in aboriginal tuffs of Formosa: association with nutrition, physical activity and cultural representations

ntroducción y objetivo: Los pueblos originarios del Gran Chaco han sido en su gran mayoría cazadores-recolectores- pescadores. En la actualidad, estos pueblos están atravesando una rápida transición epidemiológica y nutricional. El objetivo de este estudio fue establecer la prevalencia de factores de riesgo de enfermedades cardiovasculares no detectados en adultos tobas/qom de Formosa (Argentina) y su asociación con la alimentación, el nivel de actividad física habitual y las representaciones culturales sobre el cuerpo saludable. Materiales y Métodos: Se realizó un estudio correlacional, analítico de diseño transversal entre marzo y diciembre del 2010. Se seleccionaron al azar 275 personas mayores de 20 años de edad (141 mujeres y 134 hombres). Se obtuvieron mediciones antropométricas (peso, talla, porcentaje de grasa corporal, circunferencia de cintura), metabólicas (triglicéridos, colesterol HDL y glucosa, todos en sangre y en ayunas) y se determinó la presión arterial y presencia de tabaquismo. También se obtuvieron datos de nivel de actividad física, alimentación y representaciones culturales sobre el cuerpo saludable. Se respetaron las normas bioéticas correspondientes. Los datos se analizaron mediante el test de Chi cuadrado de Pearson (Χ2), test t de Student, correlación lineal de Pearson y regresión logística para evaluar la asociación entre variables antropométricas y variables etabólicas/fisiológicas utilizando el paquete estadístico SPSS 20.0.(AU)

SUMMARY: Introduction: The people of the Gran Chaco have traditionally been hunter-gatherers-fishers. Today, these populations are undergoing a fast nutritional and epidemiological transition. The objective of this thesis was to establish the prevalence of non-detected cardiovascular disease factors in Toba/Qom adults of Formosa (Argentina) and its association with diet composition, physical activity and the sociocultural representations of a healthy body. Materials and Methods: I conducted a cross-sectional analytical study between March and December 2010. A total of 275 people 20 years of age and older (141 women and 134 men) were randomly selected and invited to participate. I collected anthropometric measures (body weight, height, waist circumference, body fat percentage), metabolic values (triglycerides, HDL cholesterol and glucose, all fasting blood values), blood pressure measures, and smoking habits. I also collected data on diet quality, physical activity leveland sociocultural representations of healthy bodies. International bioethical guidelines were followed, obtaining informed consent from all the participants. The data were analyzed using the Chi-square test of Pearson (Χ2), Student t test, Pearson linear correlation, and logistic regression to assess the association between anthropometric variables and metabolic / physiological ones, using the SPSS 20.0 statistical package.(AU)

Uso de plantas medicinales en el tratamiento de afecciones transmitidas por el agua en una comunidad toba (Qom) del impenetrable (Chaco, Argentina): una perspectiva etnoecológica y sanitaria / Use of medicinal plants in the treatment of waterborne diseases in a toba (qom) community of the "Impenetrable" (Chaco, Argentina): An ethnoecological and sanitary perspective

Se caracteriza a través de una investigación etnoecológica y participativa, las representaciones y prácticas vernáculas relacionadas con la prevención y tratamiento natural de problemáticas sanitarias que se transmiten a través del agua (como cólera, diarrea, gastroenteritis, disentería, hepatitis), entre los tobas (qom) del Chaco Impenetrable. Se documentaron en este contexto el uso de 64 especies medicinales vinculadas con el alivio de los síntomas gastrointestinales característicos de estas dolencias. Los resultados se discuten en orden a la planificación y desarrollo de estrategias locales de protección de la salud ambiental en comunidades indígenas del Gran Chaco.