Mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS) is a leading cause of drug-resistant epilepsy. Surgical resection, particularly anterior temporal lobectomy (ATL), achieves high rates of seizure freedom, but outcomes vary. Identifying reliable preoperative predictors may optimize patient selection and surgical success. To systematically evaluate preoperative clinical, neuroimaging, and neuropsychological factors associated with postoperative seizure outcomes in MTLE. A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched for cohort studies (2010–2025) reporting predictors of seizure freedom after MTLE-HS surgery. Eligible studies assessed one or more preoperative factors (clinical, EEG, imaging, neuropsychological) in relation to postoperative outcomes. Data were extracted for qualitative synthesis, and methodological quality was assessed with the Newcastle–Ottawa Scale (NOS). From 615 records, 24 studies were included, encompassing patients treated with ATL, selective amygdalohippocampectomy (SAHE), or stereotactic laser ablation. Seizure freedom rates (Engel I/ILAE 1) ranged from 50
Background Recurrent acute myocarditis is an uncommon clinical scenario that may suggest the presence of an underlying genetic cardiomyopathy.Case summary A 30-year-old woman presented to the emergency department with recurrent acute myocarditis in 2020 and 2022 and presented to the consult with chest pain in 2023. A syndromic diagnostic workup ruled out infectious, autoimmune, and toxic aetiologies. Cardiac magnetic resonance imaging revealed subepicardial and mid-myocardial oedema and fibrosis, predominantly affecting the left ventricle, which was subsequently confirmed by an endomyocardial biopsy showing chronic inflammation and interstitial fibrosis. Genetic testing ultimately identified a pathogenic partial deletion in the desmoplakin cardiomyopathy DSP gene, establishing the underlying cause. Management included antiarrhythmic therapy, genetic counselling, lifestyle modifications, and the implantation of a cardioverter-defibrillatorDiscussion Desmoplakin cardiomyopathy is a genetic disorder that can mimic recurrent myocarditis through inflammatory 'hot phases'. Recognition of this phenotype is essential in patients with recurrent myocarditis, especially when imaging findings show left-dominant fibrosis and arrhythmic features. Early diagnosis has important implications for treatment, prognosis, and prevention of sudden cardiac death.
INTRODUCTION:The optimal role of invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (C-ARDS) remains uncertain. During the pandemic, many patients with ARDS were managed without IMV, creating a unique opportunity to examine whether IMV is an independent risk factor for mortality rather than a marker of disease severity alone. This study aimed to estimate the adjusted association between IMV and in-hospital mortality in patients with C-ARDS. METHODS:We performed a secondary analysis of a previously published prospective cohort of adults hospitalized with confirmed C-ARDS at a tertiary center located at high altitude (2,640 m, Bogotá, Colombia). Covariate balancing propensity scores (CBPS) were used to derive inverse probability of treatment weights (IPTW). Weighted logistic regression was then applied to estimate the average treatment effect (ATE) of IMV on in-hospital mortality. As a secondary objective, respiratory mechanics during the first 5 days of IMV were described to evaluate adherence to lung-protective ventilation. RESULTS:A total of 1,724 patients with complete data were included; median age was 68 years, 65.9% were male, and overall mortality was 44.8%. Of these, 897 patients (52.0%) required IMV. Mortality differed markedly between groups: 65% in ventilated patients vs. 22% in non-ventilated patients. After IPTW adjustment, IMV remained independently associated with higher mortality (ATE-adjusted OR 7.67; 95% CI 6.20-9.48; p < 0.001). Respiratory mechanics were available for 838 (93.4%) ventilated patients. Median tidal volume, plateau pressure, and driving pressure were initially within protective ventilation targets; however, non-survivors showed small progressive increases in plateau and driving pressures over time. CONCLUSIONS:In this propensity score-weighted cohort of patients with COVID-19-related ARDS, IMV was strongly associated with in-hospital mortality after adjustment for measured confounders. Ventilatory parameters were generally within protective ranges during the early course of ventilation, although non-survivors showed less favorable longitudinal pressure trajectories. These findings support careful patient selection, optimization of non-invasive support when feasible, and strict adherence to lung-protective ventilation strategies. Residual confounding cannot be excluded.
Chest radiograph (CXR) interpretation remains a fundamental yet challenging skill for undergraduate medical students, requiring both perceptual and integrative reasoning. Near-peer instruction and structured checklists have been proposed to enhance learning, but evidence from randomized designs is limited. We conducted a randomized educational trial among final-year medical students (n = 50). All participants attended a two-hour lecture on CXR interpretation delivered by intensive care medicine residents. The intervention group received additional training using a systematic checklist for image analysis. Performance was assessed through a 16-item test (interpretation and diagnosis domains). Nonparametric tests and Spearman correlations were applied; internal consistency and item discrimination were analyzed. Compared with controls, the intervention group achieved higher median scores in interpretation (6 vs. 3), diagnosis (4 vs. 3), and total score (10 vs. 6) (all p < 0.05). Interpretation and diagnosis scores were not correlated (Spearman ρ = 0.12, p = 0.40). Cronbach’s alpha was 0.592, with 56
Colombia’s PAPSIVI program is the world’s largest psychosocial support service for victims of armed conflict providing support for over half a million civilians. However, service delivery has only previously been examined in small studies, making it difficult to understand to what extent PAPSIVI delivers interventions that are adequately targeted to individuals with the most serious exposures to the armed conflict, and to what extent attendees remain engaged with interventions. We investigated how different conflict exposures related to PAPSIVI intervention assignment and engagement. We linked anonymised national data from the register of victims of the Colombian armed conflict to data from N = 534,818 PAPSIVI attenders. Analysis used logistic and linear regression with cluster robust standard errors, adjusted for a range of potential confounders. Intervention types were broadly provided in line with PAPSIVI guidelines, with victims experiencing torture, sexual violence, and forced recruitment more likely to receive individual sessions, while community-level impacts received community interventions. Female sex, ethnic minority status, and receiving state-subsidised healthcare were associated with higher intervention engagement. Those with previous mental health diagnoses had increased odds of attending individual or family sessions but lower odds of group or community sessions, consistent with recommendations for more intensive intervention for those with higher mental health needs. 29% of individual session attendees only received a single session, potentially indicating early dropout or unsuitable service provision for a proportion of attendees. This study provides insights into support provision for civilian victims of conflict indicating that psychosocial support provision can be managed effectively at very large scales.
