Perfil clínico de pacientes com aneurismas de artéria comunicante anterior submetidos a tratamento cirúrgico

Os aneurismas intracranianos estão presentes em 2 a 5% da população. Dentre eles, os aneurismas da artéria comunicante anterior são os que podem sofrer ruptura com maior frequência. A hemorragia subaracnóide decorrente de um aneurisma cerebral roto é um quadro de extrema gravidade. O estudo teve por objetivo caracterizar o perfil clínico de pacientes portadores de aneurismas de artéria comunicante anterior operados em um serviço de neurocirurgia de Porto Alegre entre agosto de 2008 e janeiro de 2015, comparar com os dados da literatura e verificar a presença de correlação entre dados clínicos, dados morfológicos do aneurisma e desfecho. Foi realizada revisão de prontuários médicos, bem como análise dos exames radiológicos realizados para diagnóstico do aneurisma. No período estudado, 100 pacientes foram operados. Do total, 15 pacientes portavam aneurismas não-rotos e 85 portavam aneurismas rotos, dos quais a maioria se classificava como Hunt-Hess 1 e 2. Aneurismas rotos apresentaram aspect ratio maior que aneurismas não-rotos (2,37±0,71 vs 1,93±0,51, p=0,02). Optou-se pela realização de craniotomia pterional em todos os casos, sendo o lado da abordagem determinado pelo enchimento angiográfico preferencial do aneurisma. Ruptura transoperatória ocorreu em 3% dos casos (n=3) e clipagem temporária foi utilizada em 15% (n=15). Vasoespasmo clínico ocorreu em 43 pacientes (50,6%) portadores de aneurismas rotos. A mortalidade total foi 26%, sendo 25 do grupo de aneurismas rotos (29,4%) e 1 do grupo de aneurismas não-rotos (6%). O desfecho clínico (Glasgow Outcome Scale) foi favorável (GOS 4 ou 5) em 54% dos pacientes, sendo melhor entre pacientes portadores de aneurisma não-roto (p=0,01). Em pacientes portadores de aneurismas rotos, associaram-se à mortalidade a graduação de Hunt-Hess no préoperatório (p<0,001), hidrocefalia (p<0,001) e presença de complicações clínicas (p<0,001); associaram-se a desfecho desfavorável a graduação de Hunt-Hess (p<0,001), escala de Fisher (p=0,015), vasoespasmo clínico (p=0,012), derivação ventricular externa (p=0,015), hidrocefalia (p<0,001) e presença de complicações clínicas (p=0,001). No caso de pacientes portadores de aneurisma não-roto, associou-se à mortalidade apenas a presença de complicações clínicas (p<0,001). Os dados obtidos são comparáveis com a literatura e demonstram que, apesar de avanços no manejo da hemorragia subaracnóide e do tratamento cirúrgico de aneurismas, a mortalidade ainda é alta, em especial devido às diversas complicações clínicas que esses pacientes estão sujeitos.Intracranial aneurysms are present in 2 to 5% of the population. Among these, aneurysms of the anterior communicating artery (ACoA) are those that rupture most frequently. Subarachnoid hemorrhage secondary to a ruptured cerebral aneurysm is an extremely morbid event. The aim of this study was to characterize the clinical profile of patients presenting with ACoA aneurysms treated at a neurosurgical service in Porto Alegre, Brazil, between August 2008 and January 2015; to compare data with the existing literature; and to examine potential correlations between clinical findings, aneurysm morphology, clinical complications and outcome. During the study period, 100 patients underwent surgery for ACoA aneurysm and a review of the medical records and neuroimaging files was performed. Of these, 15 had unruptured aneurysms and 85 had ruptured aneurysms. Of patients with ruptured aneurysms, most had a Hunt-Hess score of 1 or 2. Ruptured aneurysms had a higher aspect ratio than unruptured ones (2.37 ± 0.71 vs 1.93 ± 0.51, p=0.02). Pterional craniotomy was performed in all cases, and the side of the craniotomy was chosen depending on the preferential angiographic filling of the aneurysm. Intraoperative rupture occurred in 3% of cases (n=3), and temporary clipping was performed in 15% (n=15). Clinical vasospasm occurred in 43 patients with ruptured aneurysms (50.6%). The overall mortality was 26%: 25 patients in the ruptured aneurysms group (29.4%) and one in the unruptured group (6%). Outcome, measured by the Glasgow Outcome Scale was favorable (GOS 4 or 5) in 54% of patients, significantly more in those with unruptured aneurysms (p=0.01). In patients with ruptured aneurysms, mortality was associated with preoperative Hunt-Hess score (p<0.001), hydrocephalus (p<0.001), and clinical complications (p<0.001). Unfavorable outcomes were associated with Hunt and Hess score (p<0.001), Fisher grade (p=0.015), clinical vasospasm (p=0.012), external ventricular drainage (p=0.015), hydrocephalus (p<0.001), and presence of clinical complications (p=0.001). In patients with unruptured aneurysms, presence of clinical complications was the only factor associated with mortality (p<0.001). These findings are consistent with the literature and demonstrate that, despite advances in the management of subarachnoid hemorrhage and surgical treatment of aneurysms, mortality is still high, especially due to the various clinical complications that often arise

Systematic Review of Platelet-Rich Plasma for Low Back Pain

Background: Low back pain (LBP) has a high economic burden and is strongly related to the degenerative process of the spine, especially in the intervertebral disc and of the facet joints. Numerous treatment modalities have been proposed for the management of LBP, and the use of platelet-rich plasma (PRP) has emerged as an innovative therapeutic option for degenerative disease of the spine. The present study aims to evaluate the efficacy of PRP injections in managing low back pain. Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a registered at PROSPERO Systematic Reviews Platform, under number CRD42021268491. The PubMed, Web of Science, and Scopus databases were searched to identify relevant articles, along with hand searching to identify gray literature articles, with no language restrictions. Randomized clinical trials (RCTs), nonrandomized trials (NRTs), and case series (CSs) with more than 10 patients were considered eligible. The quality assessment and the risk of bias of the randomized clinical trials were evaluated using the RoB II tool. An evaluation of the description of the preparation methods was performed using an adapted version of the MIBO checklist. Results: An electronic database search resulted in 2324 articles, and after the exclusion of noneligible articles, 13 RCTs and 27 NRTs or CSs were analyzed. Of the 13 RCTs, 11 found favorable results in comparison to the control group in pain and disability, one showed no superiority to the control group, and one was discontinued because of the lack of therapeutic effect at eight-week evaluation. Description of the PRP preparation techniques were found in almost all papers. The overall risk of bias was considered high in 2 papers and low in 11. An adapted MIBO checklist showed a 72.7% compliance rate in the selected areas. Conclusions: In this systematic review, we analyzed articles from English, Spanish and Russian language, from large databases and grey literature. PRP was in general an effective and safe treatment for degenerative LPB. Positive results were found in almost studies, a small number of adverse events were related, the risk of bias of the RCTs was low. Based on the evaluation of the included studies, we graded as level II the quality of the evidence supporting the use of PRP in LBP. Large-scale, multicenter RCTs are still needed to confirm these findings

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data