Hospital Base Guillermo Almenara Irigoyen

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease that most commonly affects the renal, carotid, and vertebral arteries. We present the case of a 40-year-old male patient with a history of recurrent transient ischemic attack (TIA). Supra-aortic computed tomography (CT) angiography revealed >80% luminal stenosis of the left carotid bifurcation and left internal carotid artery (LICA). The affected arterial segment was resected and replaced with a PTFE graft. The surgery was uneventful, achieving adequate flow restoration between the reconstructed vessels. The patient was followed in the Vascular Surgery Unit with antiplatelet agents and ultrasound (US) monitoring every six months, demonstrating adequate flow in the interposed polytetrafluoroethylene (PTFE) graft. This case highlights the value of surgical repair in symptomatic carotid FMD when endovascular treatment is unsuitable.

Abstract Background Epidemiological and phenotypic variability across regions for IBD is well recognised; however, data from Latin America (LATAM) remain limited. Furthermore, specific data Crohn’s Disease (CD) related perianal fistula (PF-CD), a severe phenotype of CD is not available from across LATAM countries. This study aimed to compare the demographic, clinical, and phenotypic characteristics of PF-CD across four LATAM cohorts. Methods A retrospective study was conducted including patients with an established diagnosis of PF-CD from Argentina (N = 75), Chile (N = 49), Colombia (N = 145), and Peru (N = 22). Variables assessed included age at fistula diagnosis, CD duration prior to fistula onset, and prior exposure to immunomodulators and corticosteroids. Inter-country comparisons were performed using the chi-square test for categorical variables and the Kruskal–Wallis test for continuous variables. Results Based on the demographic profile described in Table 1, the cohort included 291 patients with a median age of 30 years at Crohn’s disease diagnosis and 31 years at PF-CD diagnosis, with a predominance of non-stricturing, non-penetrating disease (55%) and colonic or ileocolonic involvement (79%). As shown in Table 2, the median delay from CD diagnosis to PF-CD onset was 21 months [6–48], with substantial variation across countries. Overall, 54% of fistulas were classified as simple and 46% as complex. Active proctitis was present in 44% of patients, with the highest proportions observed in Argentina and Peru. Proctectomy was required in 3% of the cohort, though with notable inter-country variation. These findings highlight the clinical heterogeneity of PF-CD across Latin American settings. Conclusion This multicentre LATAM analysis demonstrates substantial inter-country variability in PF-CD presentation, including differences in disease behaviour, fistula complexity, and time to fistula development. Nearly half of patients presented with complex fistulas, and active proctitis was frequent across cohorts. These results underscore the importance of improving early detection and optimising multidisciplinary management. Overall, the findings highlight the phenotypic heterogeneity of PF-CD in Latin America and support the need for region-specific clinical strategies. Conflict of interest: Dr. Pavez, Carolina: No conflict of interest Juliao Baños, Fabián: No conflict of interest Balderramo, Domingo Cesar: No conflict of interest Cedron Cheng, Hugo Guillermo: No conflict of interest Hernandez-Rocha, Cristian: No conflict of interest Parra Izquierdo, Leidy Viviana: None Osorio, Laura: No conflict of interest Gil Parada, Fabio Leonel: No conflict of interest Puentes-Manosalva, Fabian: No conflict of interest Pizarro, Paula A.: No conflict of interest Etchevers, Maria Josefina: No conflict of interest Sobrero, Maria Josefina: No conflict of interest Montero, Joaquin: No conflict of interest Gil, Anibal Hector: No conflict of interest Sanchez, Maria Belen: No conflict of interest Sambuelli, Alicia: no Balaban, Ezequiel: No conflict of interest Rohwain, María José: No conflict of interest Alvarez-lobos, Manuel: No Conflicts Bellolio, Felipe: No conflict of interest Sepúlveda, Ignacia: No conflict of interest Hernandez, Elisa: No conflict of interest Pérez, Tamara: No conflict of interest Estay, Camila: No conflict of interest Rojas, René: No conflict of interest Sepulveda, Rolando: No conflict of interest Perez Alfaro, Ignacio: No conflict of interest Paredes Mendez, Juan: No conflict of interest Cervera Caballero, Luis: No conflict of interest Sebastian, Shaji: No conflict of interest Catalàn-Serra, Ignacio: No conflict of interest

In this study, we develop and analyze an extended SEIR-type compartmental model that incorporates vaccination and treatment to describe the dynamics of acute respiratory infection transmission. The model subdivides the infectious population into several symptomatic stages and an asymptomatic class, which allows the evaluation of control strategies across different levels of infection severity. The basic reproduction number R0 is analytically derived, and its sensitivity to vaccination and treatment rates is examined to assess the impact of public health interventions on epidemic control. Numerical simulations demonstrate that the joint implementation of vaccination and treatment can markedly reduce disease prevalence and lead to infection elimination when R0<1. The results emphasize the critical role of parameter interactions in determining disease persistence and show that combining both interventions produces stronger epidemiological effects than either one alone. Machine learning techniques, specifically Support Vector Machines (SVMs), are employed to classify epidemiological outcomes and support parameter estimation. The biological markers evaluated were not effective discriminants of infection status, underscoring the importance of integrating mechanistic modeling with data-driven approaches. This combined framework enhances the understanding of epidemic dynamics and improves the predictive capacity for decision-making in public health.

BACKGROUNDPrimary malignant cutaneous adnexal neoplasms are rare and can spread locally or to lymph nodes, and very infrequently to distant sites, such as the brain. Their management is poorly documented, and there are no established clinical practice guidelines for treatment.OBSERVATIONSA 57-year-old male underwent surgery 2 years earlier for adenocarcinoma of the cutaneous adnexa of the right arm. He was admitted to the emergency department with a 15-day history of drowsiness, dysarthria, and signs consistent with frontal lobe involvement. Preoperative MRI revealed a heterogeneous left frontal lobe tumor with contrast enhancement of a solid mass. A craniotomy and complete tumor resection were performed. He then received radiosurgery (27 Gy). MRI studies at 1 and 6 months postoperatively showed complete resection. These tumors are rare and originate from hair follicles, sebaceous glands, or sweat glands. They have an overall 5-year survival rate of 78.2%, but the metastasis rate can range from 15% to 30%. The treatment approaches are not well described in the literature; combinations of surgery, chemotherapy, immunotherapy, targeted therapy, and radiotherapy are utilized.LESSONSMalignant cutaneous adnexal neoplasms are rare conditions that need precise diagnosis and prompt multidisciplinary treatment.https://thejns.org/doi/10.3171/CASE25447

Background:Bloodstream infections (BSI) caused by carbapenemase-producing Enterobacterales (CPE) represent a significant threat to patients with acute leukemia due to their high mortality. Ceftazidime–avibactam (CAZ-AVI) has emerged as a therapeutic alternative against these infections; however, its efficacy in immunocompromised patients remains unclear.Objective:To determine the impact of ceftazidime–avibactam on mortality due to BSI caused by CPE in patients with acute leukemia.Design:A retrospective cohort study was conducted at the Hospital Nacional Edgardo Rebagliati Martins in Lima, Peru.Methods:We included patients diagnosed with acute leukemia who developed BSI due to CPE during their hospital stays. Mortality was assessed for up to 30 days after BSI onset.Results:We evaluated 41 patients with a median age of 51 years; 56.1% had acute myeloid leukemia and 43.9% had acute lymphoblastic leukemia. Mortality at 30 days occurred in 60.9% of patients. The most frequent type of chemotherapy administered was induction (51.2%). Empiric antibiotic therapy with meropenem was administered to 97.6% of the patients, and ceftazidime–avibactam was prescribed as a targeted therapy to 48.8%. In the multivariate Cox regression model, the prescription of ceftazidime–avibactam reduced the risk of death (adjusted hazard ratio, 0.29; 95% CI: 0.09–0.92; p = 0.012) compared with those who received other antibiotic therapies, such as colistin.Conclusion:In patients with acute leukemia who developed bloodstream infections due to CPE during hospitalization, the prescription of ceftazidime–avibactam reduced 30-day mortality risk.