ObjetivosEvaluar mediante un metaanálisis los efectos de la reperfusión tardía en el IAM (hipótesis de la arteria abierta) sobre la morbimortalidad y la fracción de eyección (Fey). Material y métodosSe incluyeron estudios aleatorizados controlados (EAC) que compararan angioplastia (ATC) con tratamiento médico (TM) en pacientes con infarto agudo de miocardio (IAM) que permanecieran con la arteria ocluida > 12 horas, con un seguimiento > 3 meses. Se realizaron búsquedas electrónicas y en listas de referencias. ResultadosOcho EAC, que sumaron 2.972 pacientes, cumplieron los criterios de inclusión; los estudios incluyeron entre 30 y 2.166 pacientes (media: 77). El intervalo entre el IAM y la ATC fue de 25 horas a 26,3 días (media: 8,3 días). En forma global se detectó una tendencia a la reducción del riesgo de muerte [RR 0,73 (IC 95% 0,46-1,16)] y al incremento del riesgo de IAM [RR 1,15 (IC 95% 0,76-1,72)]. Hubo una tendencia a la reducción en las internaciones por IC con la ATC con un RR de 0,56 (0,26-1,21) y una reducción significativa de procedimientos de revascularización con un RR de 0,82 (0,70-0,97). La Fey en el seguimiento fue 2,39 puntos mayor en el grupo ATC (-0,06-4,84). Sin embargo, la evaluación de los datos según la calidad de los estudios demuestra que el beneficio sobre la mortalidad se concentra en los EAC de menor calidad [0,50 (0,25-0,99)], mientras que no existe tal beneficio en los EAC de mayor calidad [0,89 (0,53-1,51)]. No hubo heterogeneidad significativa, excepto en los efectos sobre la fracción de eyección (p de heterogeneidad = 0,03); el nivel de inconsistencia general fue moderado. Existen evidencias de sesgo de publicación. Conclusiones Sobre la base de estos resultados, el metaanálisis indica que efectuar una angioplastia tar- día en vasos ocluidos en el infarto no aporta beneficios sobre la morbimortalidad. Los resultados entusiastas de los primeros ensayos de pequeñas dimensiones pueden ser atribuidos a sesgos de publicación y a déficits en el diseño. Se registra un discreto incremento en la Fey con la intervención que no se tradujo en beneficios clínicos en esta población de bajo riesgo, aunque sería interesante su estudio en pacientes con compromiso significativo de la función ventricular.
The current mental health system faces an important yet not well-understood problem, which involves addictions that do not respond to treatment. The cases present with ongoing substance abuse, multiple treatment failures, psychiatric conditions, social instability, and work-related problems. The absence of standardized operational criteria creates problems with immediate patient identification, comparing research study results, and healthcare providers' efforts to create structured treatment plans. The article combines existing data about treatment-resistant addiction to create an initial framework that explains its medical characteristics, brain functions, social aspects, and treatment approaches. The research uses depression and schizophrenia treatment-resistant frameworks to develop functional criteria, which include multiple treatment failures, ongoing disability, complex medical conditions, and inadequate response to optimal treatment protocols. Healthcare providers can identify actual refractoriness using established criteria that help distinguish it from pseudo-resistance, which occurs due to incorrect medical diagnoses, insufficient medication exposure, or non-compliance with treatment instructions. The research presents typical medical signs that appear in people who do not respond to substance use treatment through their impulsive behavior, their inability to identify emotions, their background of trauma, their presence of multiple psychiatric conditions, and their exposure to poverty and prison life. The review evaluates present-day pharmacological treatments that combine GLP-1 receptor agonists with ketamine and cannabidiol, partial agonists, and neuromodulation methods (rTMS and tDCS), as well as psychotherapeutic approaches (ACT, DBT, MBRP, and CRA) to improve treatment outcomes. We propose an operational system that integrates diagnostic evaluation with medication treatment and psychotherapy services, brain function assessments, and social assistance programs. This model is focused on a team-based approach aimed at delivering personalized medical care. Patients' non-adherence is considered as a clinical issue rather than a factor of social labeling or exclusion. Empirical testing is needed to validate the proposed evaluation criteria, as well as treatment effectiveness in real-world settings should be confirmed to approve accessible and advanced care for all patients.
OBJECTIVE:Glucose transporter type 1 deficiency syndrome (Glut1DS) is a rare metabolic encephalopathy caused by pathogenic SLC2A1 variants. Ketogenic dietary therapy (KDT) is the mainstay of treatment. In Latin America, Glut1DS remains underdiagnosed due to limited awareness and restricted access to genetic testing. This study describes the clinical and genetic features, management, and response to KDT in an Argentine cohort. METHODS:A retrospective multicenter study was conducted including patients with a clinical and/or genetic diagnosis of Glut1DS. Clinical data, seizure types, neurodevelopmental features, treatment response, and KDT characteristics were collected from medical records using a standardized form. Genetic confirmation was obtained by SLC2A1 sequencing. Descriptive and comparative analyses were performed. RESULTS:Thirty-nine patients with Glut1DS (64% males) were included. Mean age at evaluation was 13.7 years. Median ages at symptom onset and diagnosis were 6 and 55 months, respectively, with a median diagnostic delay of 49 months. Cognitive impairment was present in two-thirds of patients, and movement disorders in 79%. Epilepsy occurred in 74%. Of 39 patients, all but one received KDT, with MCT oil in 64%. Thirty patients remained on KDT, achieving seizure freedom in 86% and >50% reduction in four others. Improvements were reported in motor coordination (38%), cognition and attention (10%), energy (10%), and behavior (8%). No major adverse effects were reported. SIGNIFICANCE:This first national report underscores the clinical diversity of Glut1DS in Argentina and a positive trend toward earlier KDT initiation. Strengthening early diagnosis, systematic follow-up, and equitable access to therapy remains essential.
Abstract Background Intracranial germ cell tumors (iGCT) represent 3–5% of pediatric brain tumors. Their high sensitivity to chemotherapy and radiotherapy led to excellent survival in high-income countries. However, in low-resource settings, they remain associated with high mortality and long-term sequelae. There is limited information on GCT specific resources and outcomes in Latin America. Methods A cross-sectional survey was conducted in Latin-American, collecting data on infrastructure, diagnostics, treatment protocols, and follow-up practices. Results Thirty-five centers responded (60% public). Although 80% reported epidemiological registries, only 37.1% had complete databases. Tumors were predominantly suprasellar. Nearly half of centers (57.1%) lacked a neuro-oncologist; most had access to pediatric subspecialists; endocrinologists (91.4%), neurologists (91.4%), ophthalmologists (71.4%), and neurosurgeons (77.1%). Serum and CSF tumor markers were available at 60%, while 27.8% lacked defined cutoff values, and 22.9% did not routinely assess CSF. Pathology was available in 91.4%, and molecular studies in 60%. Radiotherapy is available in 45.7% with delays >2 weeks (51.4%). Diagnosis without biopsy was established in cases with positive tumor markers (91.4%) or bifocal disease (41.7%). Neoadjuvant chemotherapy was administered in 97%. Germinoma treatment predominantly was carboplatin/etoposide (57.1%), while NGGCT regimens were heterogeneous carboplatin/etoposide alternating with ciclofosfamide/etoposide (34.3%) or with ifosfamide/etoposide (17.3%) PEI (17,3%), BEP, and ICE (11.4%). Whole-ventricular irradiation was administered for localized germinoma and CSI for metastatic disease, while the radiotherapy field in NGGCT metastatic was 88.6% CSI and 8.6% focal. Relapse treatment included ICE (58.8%), high-dose chemotherapy plus transplant (44.1%), and GemPOx (32.4%). Long-term follow-up ≥10 years was reported by 48,6% of centers, while survivorship clinics were inconsistently available despite broad access to palliative care (85.7%). Conclusions Substantial heterogeneity persists in resources and management of pediatric iGCTs across Latin America. These disparities highlight the urgent need for regional harmonization of diagnostic criteria, treatment protocols, and survivorship care to improve outcomes and quality of life for affected patients. *Both autors contributed equally to the study
Abstract Introduction The impairments resulting from Acquired Brain Injury (ABI) can affect the ability of children and adolescents to actively participate in daily activities at home, at school, and within the community. Objective The primary objective of this study was to analyze the level of participation in children and adolescents with ABI six months after completing a neurorehabilitation program. Methods Observational, analytical, and retrospective study that included school-aged patients with ABI who were discharged from the institution in a conscious state between 2020 and 2023. Data from a routine telephone follow-up conducted six months after discharge were used to assess participation through caregiver-reported Child and Adolescent Scale of Participation (CASP) scores. Nineteen participants were included. Results Participants experienced significant restrictions in participation six months after discharge, with the greatest limitations observed in the school domain. Caregivers reported that the item with the highest level of participation was "moving around the home," while the item with the greatest restriction was "moving around the neighborhood and community". Conclusion Children and adolescents with ABI continued to experience significant participation restrictions six months after inpatient rehabilitation, particularly in school-related activities. These findings highlight the need for rehabilitation strategies that support school and community reintegration after discharge.
