Despite invasive methods are the gold standard for intracranial pressure (ICP) measurement, several non-invasive techniques (nICP) have been proposed as surrogate, although their use remains insufficiently recognized in clinical practice. These include transcranial Doppler blood flow velocity assessment (arterial or venous), optic nerve sheath diameter (ONSD), automated pupillometry, measurement of skull expansion and compliance, brain imaging, double-depth ophthalmic artery blood flow velocity, and ultrasound time-of-flight. The main limitations of all indirect methods are calibration and zeroing, which constrain the absolute accuracy of non-invasive ICP monitoring. For transcranial Doppler-based methods, the 95
BackgroundAtopic dermatitis (AD) is a common chronic inflammatory skin disease in children, often preceding or coexisting with other atopic conditions. Severe AD significantly impacts quality of life and is associated with mental health disorders and sleep disturbances. Dupilumab is approved for moderate-to-severe AD in children aged 6 months and older. However, limited studies have evaluated its efficacy in diverse populations, especially in Latin American children. MethodsWe conducted a multicenter, retrospective study in Colombia, including children aged <= 18 years with moderate-to-severe AD who began dupilumab treatment between January 1, 2018, and January 1, 2024. Data collected included demographics, disease characteristics, treatment history, adverse events (AEs), and disease severity scores. Statistical analyses were performed using R software (p < 0.05). ResultsNinety-two patients were included, with a median age of 14 years at dupilumab initiation. The most common comorbidities were allergic rhinitis (75%) and asthma (34%). Significant improvements in disease severity were observed, with a median reduction of 72% in EASI and 55% in SCORAD between Weeks 10 and 22, and 81% and 69%, respectively, by Weeks 46-58. Ocular AEs were the most frequent (23%), and paradoxical head and neck dermatitis occurred in 15% of patients. No serious AEs were reported, and 94% of patients remained on treatment. ConclusionsDupilumab showed significant clinical improvements in Latin American children with moderate-to-severe AD. AEs were mild and transient. These findings underscore the need for evaluating dupilumab's efficacy in diverse populations for personalized treatment strategies.
Dorsocervical fibro-lipodystrophy, commonly known as “buffalo hump,” presents a challenging deformity often associated with HIV-related lipodystrophy or idiopathic etiologies. Although various surgical techniques have been reported, a comprehensive evaluation of their safety, efficacy, and recurrence rates remains lacking. This systematic review and meta-analysis aimed to evaluate outcomes of surgical interventions, particularly suction-assisted lipectomy, in managing dorsocervical fibro-lipodystrophy. A systematic review with meta-analysis was conducted using PubMed and ScienceDirect. Eligible studies reported surgical outcomes of dorsocervical fibro-lipodystrophy managed with suction-assisted or excisional lipectomy. Meta-analyses used a random-effects model, with heterogeneity and publication bias assessed. Sensitivity analysis was performed. Twenty-two studies encompassing 218 patients were included. Most cases were associated with HIV-related lipodystrophy, and the average patient age was 47.4 years. Suction-assisted lipectomy was the most common approach. The pooled recurrence rate with liposuction was 10.6 www.springer.com/00266 .
BACKGROUND:Penetrating traumatic brain injury (pTBI) affects civilian and military populations resulting in significant morbidity, mortality, and health care costs. No up-to-date and evidence-based guidelines exist to assist modern medical and surgical management of these complex injuries. METHODS:A preliminary literature search informed a need for updated guidelines. Methodologists experienced in TBI guidelines supported 2 co-chairs, a diverse steering committee and three expert working groups. Over half of our panelists were active service military or military veterans and they addressed twenty-six Key Questions (KQs). We searched Ovid MEDLINE®, EMBASE, and Cochrane CENTRAL from inception to August 31, 2022, reference lists, and clinical trial registries. Penetrating, perforating and tangential penetrating brain injuries were included. Predefined criteria were used to identify studies; pre-specified methods were used to assess study quality and strength of evidence for key outcomes. Effects were analyzed qualitatively and quantitatively where appropriate. RESULTS:125 studies provided evidence and another 80 studies provided contextual data for these guidelines. In general there was a paucity of literature and most of the identified evidence was judged to be high risk of bias due to study design. We did not identify any studies meeting inclusion criteria for 12 KQs. The highest quality evidence, rated moderate in strength, was identified for four KQs that covered: cerebral angiography vs computed tomography angiography, the relationship between bihemispheric injury in adult pTBI and mortality, the ability of the Surviving Penetrating Injury to the Brain (SPIN) score to predict mortality, and the relationship between infection and cerebrospinal fluid fistula. Evidence for most KQs came from case series. CONCLUSIONS:The development of up-to-date evidence and consensus based clinical care guidelines and algorithms for pTBI provide guidance to care providers in the prehospital and emergency medicine, surgical and intensive care settings. Few moderately strong conclusions on the benefit of specific management strategies for penetrating brain injury could be made. Detailed reporting of patient outcomes in future studies could advance the field by providing greater evidence for specific treatments by patient population, mechanism of injury, severity of injury, and specific interventions employed.
