Hospital Maciel is a hospital in Montevideo, located in the western part of the Old City. It is one of the oldest hospitals in Uruguay. The land was originally donated in Spanish colonial times by philanthropist Francisco Antonio Maciel, who teamed up with Mateo Vidal to establish a hospital and charity. The first building was extended between 1781 and 1788, and later expanded on over time. The actual building is dated to 1825 with the plans of José Toribio (son of Tomás Toribio) and later Bernardo Poncini (wing on the Guaraní street, 1859), Eduardo Canstatt (corner of Guaraní and 25 de Mayo) and Julián Masquelez (1889). The hospital has a temple, the Charity Chapel, built in Greek style by Miguel Estévez in 1798.
Neuroworsening (NW) after traumatic brain injury (TBI) is a life-threatening complication affecting at least one in five patients. The current definition remains heterogeneous and does not integrate contemporary neuromonitoring tools that could help reduce this variability. Current diagnostic approaches are predominantly reactive, identifying deterioration only after brain herniation has occurred. To establish an expert consensus to update the definition of NW in TBI by proposing a stratified diagnostic framework aligned with precision and personalized medicine principles, aiming to shift a paradigm that has been in use for the past 50 years. A formal Delphi consensus process was conducted involving 25 experts from the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC). A pre-consensus systematic literature review was performed, followed by structured electronic surveys with Likert-scale and multiple-choice items. Consensus was predefined as ≥80
Abstract Background The hypertension-mediated brain damage is more frequent than cardiac or renal damage, but early silent brain damage is not routinely included in the evaluation of patients with hypertension. Consequently, hypertensive patients with early brain damage are unidentified and their cardiovascular risk underestimated. If we consider cognitive impairment as a surrogate of vascular brain damage, a cognitive test implemented in the routine clinical evaluation of hypertensive patients could detect early cerebral small vessel disease. The aim of the study was to estimate the prevalence of cerebral, cardiac and renal organ damage in hypertensive patients and evaluate the usefulness of the clock-drawing test for brain damage detection. Patients and Methods Multicenter, multinational, cross-sectional study in patients with essential hypertension seen in four centers in Argentina and one center in Uruguay. Organ damage was assessed by means of glomerular filtration rate (GFR, Cockcroft-Gault equation), left ventricular mass index (LVMI) and the clock-drawing test. Results A sample of 441 patients (mean age 63.2 ± 11.8 years, 53.2% female) was included. Of all participants, 60.5% presented impairment of some marker of target organ damage. The heart (elevated LVMI) was affected 32.8% and the kidney (reduced GFR) in 20.4% while silent brain damage (abnormal clock-drawing test) was observed in 38% of all patients. In addition, abnormal clock-drawing test was seen in 47.2% of hypertensive patients with cardiac and/or renal damage, and in 30.7% of patients without cardiac and/or renal damage. Conclusion Silent brain damage was more prevalent than pre-clinical cardiac and/or renal damage. The clock-drawing test turned out to be a useful tool in routine clinical practice to detect early brain damage expressed as mild cognitive impairment in hypertensive patients.
Abstract Introduction Hantavirus disease is an emerging and potentially severe zoonosis of global distribution. In Uruguay, it is transmitted by rodents inhabiting peridomestic, suburban, and rural areas. Global incidence is estimated at 150,000 to 200,000 cases per year, with up to 300 annual cases in the Americas. Since 1997, Uruguay’s Ministry of Public Health (MPH) has monitored Hantavirus cardiopulmonary syndrome (HCPS), the most common clinical presentation in the region. By 2019, a total of 271 cases had been identified in the country, with an estimated mortality rate of nearly 50%. Objectives To describe the clinical, epidemiological, and occupational characteristics of patients with Hantavirus disease in Uruguay during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Methods A descriptive, cross-sectional, observational study was conducted, including all serologically confirmed cases of Hantavirus infection reported to the MPH between 2018 and 2021. Clinical and demographic data were extracted from the mandatory reporting form for zoonotic diseases. Incidence and case fatality rates were calculated, and factors associated with fatal outcomes were analyzed. Results A total of 58 confirmed cases were identified between 2018 and 2021. Most patients were male (62%), with a mean age of 36.5 years (SD 16). A decline in incidence was observed during 2020-2021, with no significant change in case fatality. Direct rodent exposure was the most frequently associated risk factor. Montevideo and Canelones were the most affected departments. Renal and pulmonary involvement were significantly associated with mortality. Conclusion Hantavirus remains a relevant public health concern in Uruguay. Although a decrease in incidence was observed during the COVID-19 pandemic years, case fatality rates remained high. The findings underscore the need for sustained surveillance and early recognition, particularly in urbanizing regions.
Unruptured intracranial aneurysms smaller than 5 mm represent a frequent clinical dilemma, particularly in regions where local outcome data are scarce. Evidence from Latin American populations remains limited, despite differences in case complexity, treatment strategies, and healthcare systems. We conducted a multicenter, retrospective observational study including adult patients with unruptured intracranial aneurysms < 5 mm treated between 2017 and 2023 at eight specialized centers in five Latin American countries. Clinical, morphological, and treatment-related variables were analyzed. One-year mortality and functional outcome were assessed using the modified Rankin Scale (mRS). Multivariable logistic regression models were used to identify independent predictors of mortality and poor functional outcome (mRS ≥ 3). A total of 1,098 patients were included (mean age 57.6 years; 55
Objectives: Subarachnoid hemorrhage (SAH) secondary to rupture of aneurysms smaller than 5 mm represents a high-risk clinical condition, even in specialized centers. Despite therapeutic advances, uncertainty persists regarding prognostic factors in this specific subgroup. This study aimed to evaluate 1-year clinical outcomes and identify independent predictors of mortality and poor functional outcome in a Latin American cohort. Materials and Methods: We conducted a multicenter, retrospective, observational study including 421 adult patients with SAH due to rupture of aneurysms ≤5 mm, treated between 2017 and 2023 at eight reference centers across five Latin American countries. Clinical, radiological, anatomical, and therapeutic variables were analyzed. Univariate analyses and multivariate binary logistic regression models were used to identify independent predictors of 1-year mortality and poor functional outcome, defined as modified Rankin Scale ≥3. Results: Mean age was 55.4 years, and 60% of patients were female. Severe SAH (World Federation of Neurosurgical Societies grades 4–5) was present in 32% of cases at admission. One-year mortality was 18%, and 31% of patients experienced a poor functional outcome. In multivariate analysis, independent predictors of mortality included age >65 years, diabetes mellitus, severe SAH, aneurysmal rebleeding, acute hydrocephalus, and the occurrence of medical or treatment-related complications. Poor functional outcome at 1 year was independently associated with age >65 years, prior SAH, severe SAH, aneurysmal rebleeding, acute hydrocephalus, cerebral edema, and in-hospital medical or treatment-related complications. Conclusions: In patients with SAH from ruptured aneurysms smaller than 5 mm, prognosis is primarily driven by initial neurological severity and the development of acute complications rather than by treatment modality. These findings underscore the importance of early risk stratification, prompt complication management, and multidisciplinary care in real-world neurovascular practice, particularly in regions with heterogeneous healthcare resources.
