Hospital Zambrano Hellion

Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) have redefined the standard of care for hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (BC). However, patterns of use and access across Latin America remain poorly characterized. We conducted a cross-sectional survey of Latin American medical oncologists with experience in treating advanced BC using CDK4/6i. The survey assessed drug availability and clinical decision making across various scenarios. Descriptive statistics were used to summarize responses. A total of 116 oncologists from 15 countries participated. Ribociclib was the preferred agent (56.8%), driven largely by its overall survival benefit across pivotal trials. Abemaciclib was favored in endocrine resistance, central nervous system metastases, and patients with cardiac or hepatic comorbidities. Palbociclib was preferred in geriatric and male patients. Despite high reported national availability of CDK4/6i, access at the institutional level was uneven. Among oncologists working primarily in private practice, 54.3% reported that their prescribing patterns would differ if treating publicly insured patients, compared with only 22.6% of public sector oncologists who reported the opposite. Although CDK4/6i are accepted as essential therapies for advanced BC, substantial institutional access barriers persist in Latin America. Clinical preferences reflect both emerging evidence and local constraints. Broader integration of CDK4/6i into public formularies and continuous generation of real-world data are critical for improving equity and outcomes in the region.

To evaluate clinical outcomes, treatment response and predictors of seizure freedom after vagus nerve stimulation in patients with drug-resistant epilepsy in a Mexican cohort. We conducted a retrospective multicenter cohort across 13 epilepsy centers in Mexico (2003-2024) including patients aged ≥4 years with drug-resistant epilepsy or epileptic encephalopathy. Treatment response was defined as at least 50% seizure reduction and Engel outcomes. Logistic regression identified predictors of seizure freedom. Model performance was assessed with receiver operating characteristic analysis, area under the curve, Hosmer-Lemeshow test, and a confusion matrix. Ninety-three patients (51 children, 42 adults) were included. At 1 year, median monthly seizure frequency decreased by 82.5% (40-7; p < .001). The incidence of status epilepticus declined by 92.8%, acute prolonged seizures by 80.9%, the burden of antiseizure medications by 25%, and epilepsy-related hospitalizations by 100% (all p < .001). Overall, 68.8% achieved ≥50% reduction and 11.8% became seizure-free. On univariate analysis, comorbidities, multiple seizure types, higher baseline seizure frequency, greater number of antiseizure medications, and magnet use were inversely related to seizure freedom, while normal brain MRI showed a direct relationship. On multivariable analysis, only baseline seizure frequency ≥30/month independently predicted seizure freedom (p = .047), corresponding to 97.7% lower odds. A predictive model incorporating comorbidities and number of antiseizure medications improved discrimination (p < .001) with 86.6% sensitivity and 81.8% specificity. Vagus nerve stimulation was associated with substantial seizure frequency reduction, lower morbidity, and less healthcare utilization, with a favorable safety profile. Baseline seizure burden emerged as the key predictor of seizure freedom and may guide patient selection, supporting earlier vagus nerve stimulation consideration in drug-resistant epilepsy.

This scoping review aims to map the existing evidence on Galassi III arachnoid cysts and identify knowledge gaps in the current literature. Galassi III arachnoid cysts are rare intracranial lesions characterized by significant midline displacement and associated with space-occupying effects. Despite their rarity, they have higher intervention rates than other types, yet optimal management remains unclear. Understanding their prevalence, pathophysiology, clinical characteristics, natural history, management strategies, and outcomes is critical for enhancing research on evidence-based management strategies aimed to improve patient care. This review will include clinical studies and review articles investigating patients with Galassi III arachnoid cysts. Studies should address the prevalence, pathophysiology, physical characteristics, natural history, presenting symptoms, treatment strategies, and/or outcomes associated with Galassi III arachnoid cysts. Studies published in English or Spanish will be included. This scoping review will follow JBI methodology and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search will be conducted in the PubMed, Scopus, and Web of Science Core Collection databases using a structured electronic search strategy developed in collaboration with a research librarian. Gray literature will be incorporated by searching clinical trial registries for studies involving patients with Galassi III arachnoid cysts. No publication date restrictions will be applied. The selection process will involve 3 steps, and relevant data from included studies will be extracted using a standardized form. Quantitative and qualitative methods will be employed to synthesize the data. Results will be presented in graphic, tabular, and narrative formats. OSF https://osf.io/evbqk/overview.

Brainstem cavernous malformations (BSCMs) represent a surgical challenge due to their location deep within critical neural pathways. While histologically benign, BSCMs exhibit an aggressive clinical course, with a higher risk of bleeding and rebleeding than supratentorial cavernomas, often leading to significant neurological deficits. Management options include surveillance, radiosurgery, and microsurgical resection. Surgical treatment is especially complex, as it requires a delicate balance between the expected risk of rebleeding against the potential surgical morbidity. Favorable outcomes have been reported after microsurgical resection in multiple series. A precise understanding of brainstem safe-entry zones is essential to access these lesions and minimize parenchymal transgression. We present the case of a young patient with bleeding from a pontine middle peduncular BSCM. Microsurgical resection was performed through a retrosigmoid transhorizontal fissure approach in a semi-sitting position, optimizing working angles while minimizing cerebellar retraction. This approach provides safe access through the middle cerebellar peduncle, allowing a more versatile dissection away from critical neural pathways compared to other safe-entry zones, minimizing brainstem manipulation. Key surgical nuances and relevant considerations in the decision-making process are demonstrated in this three-dimensional operative video. A complete resection was achieved, and the patient remained neurologically intact on long-term follow-up. The patient consented to the procedure and publication of this work. This case illustrates the surgical and anatomical complexity of pontine BSCMs and highlights the importance of tailoring the surgical approach to the lesion´s location, planned pial access, required exposure, dissection trajectory, and surgeon experience.

Ventricular arrhythmias are a leading cause of death among patients with cardiovascular diseases and are associated with elevated levels of catecholamines. Mitochondrial Ca2+ transport is essential for initiating an adrenergic response. However, continuous stimulation might lead to mitochondrial Ca2+ overload and dysfunction within cardiac tissue. This study investigates the role of mitochondrial Ca2+ in lethal arrhythmogenesis and the effects of its modulation. Male C57BL/6 mice were administered either Ru360 (oxo-bridged dinuclear ruthenium ammine complex) a potent and selective mitochondrial Ca2+ transport inhibitor, or normal saline via intravenous injection. A baseline electrocardiogram (ECG) was recorded, followed by subcutaneous administration of isoprenaline. The ECG was monitored for an additional 20 min, after which cardiomyocytes and mitochondria were isolated for further characterization studies. Isoprenaline administration led to ventricular tachycardia and fibrillation, but Ru360 pretreatment successfully prevented these arrhythmias. Mitochondria from isoprenaline-treated hearts showed higher Ca2+ content, indicating overload that compromised mitochondrial function and membrane integrity, evidenced by decreased respiratory control, reduced Ca2+ retention capacity and diminished membrane potential. Isoprenaline also increased oxidative stress, illustrated by elevated peroxide production, electron leak and acute oxidative modifications, and erratic cellular Ca2+ dynamics. This mitochondrial dysfunction correlated with a decreased respirasome activity, but not a difference in respirasome abundance quantified by complexome profiling, which was prevented by Ru360 pretreatment. Mitochondrial Ca2+ overload significantly contributes to arrhythmias by disrupting respirasome function and increasing oxidative stress, impairing cellular Ca2+ dynamics. Modulating mitochondrial Ca2+ transport might be a promising strategy for developing innovative antiarrhythmic therapies.

Spinal cord injury (SCI) causes temporary or permanent changes and alterations in patients’ motor, sensory, or autonomic function, significantly impacting their quality of life and requiring clear goals and optimization of anesthesia and perioperative care for acute and chronic spinal cord injuries. SCI results from various etiologies and involving two principal pathophysiological mechanisms: primary and secondary injury. The first is result of the traumatic event, with irreversible neuronal damage, the second is generated as a consequence and in the minutes after the first and can continue for weeks or months causing degenerative damage to the spinal cord. It is in the secondary lesion where the objectives of anesthetic and perioperative management should be focused, especially in acute lesion. A conscientious and detailed preoperative evaluation allows to identify, injury level, evolution time, airway evaluation, cervical stability, hemodynamic status, ventilatory function and associated injuries must be determined. It is important to differentiate potential hemodynamic alterations and types of shock to prevent, especially in injuries greater than T6 and if necessary, provide early management in order to maintain adequate spinal cord perfusion. The objective of this review is to identify the pathophysiological mechanisms of spinal cord injury and the secondary systemic alterations and complications, as well as to establish specific optimization objectives during anesthetic management and perioperative care, which could reduce injury progression, prevent and control potential complications, and improve the quality of life of patients with this condition.

IntroductionMenopause hormone therapy (MHT) is the most effective treatment for climacteric syndrome. However, its cardiovascular effects remain complex. The 'timing hypothesis' suggests these effects depend on the timing of initiation, but this has been increasingly questioned. This study evaluates evidence on cardiovascular risks associated with late MHT initiation in healthy women aged ≥60 years or ≥10 years post-menopause.MethodsA comprehensive literature search was conducted from the inception of each database until November 2023. The databases searched included PubMed, SciELO, Embase, and Cochrane. RCTs of human studies examining the cardiovascular effects of MHT in healthy women aged ≥60 years or those ≥10 years post-menopause were included. Eligibility screening, data extraction, risk of bias assessment were performed independently and in duplicate.ResultsNine RCTs comprising 36,051 participants were included. We focus on results from participants aged ≥60 years. The mean follow-up was 7.2 years. Six studies were sub-analyses of the Women's Health Initiative (WHI) trial, while three studies originated from other trials. Results from the WHI indicated no significant increase in cardiovascular risks with either CEE + MPA or Estrogen-only therapy. Non-WHI studies showed an elevated stroke risk with tibolone and higher doses of combined MHT, but no cardiovascular complications were observed with low doses.ConclusionThe increased risk of cardiovascular events in our target population is not statistically significant. There is a lack of high-quality evidence to suggest an increased risk of adverse cardiovascular outcomes in healthy women who initiate MHT at age ≥60 years or ≥10 years post-menopause.