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Introduction: Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking. Methods: Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults. Results: We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation. Conclusions: We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.

To determine the association of Borrelia burgdorferi infection with Alzheimer’s disease or mild cognitive impairment (MCI) in older adults. Case–control study. Patients older than 60 years, both sexes, were included. Three groups were created: with probable Alzheimer’s disease cases with NINCDS–ADRDA criteria, MCI cases in those not meeting NINCDS–ADRDA criteria for dementia, but who had an abnormal cognitive evaluation and independence in instrumental activities of daily living (IADL), cognitively healthy controls were diagnosed with normal cognitive evaluation and independence in IADL were identified in the community. Western blot IgG against B. burgdorferi in serum was done in all the participants. Non-conditional logistic regression was applied to estimate the association of Alzheimer’s disease or MCI and seropositive to B. burgdorferi. Thirty-eight patients with Alzheimer’s disease, mean age of 75.6 ± 3.4 years, 69% were females, education 8.3 ± 4.8 years. 39 patients with MCI, mean age of 72.2 ± 6.8 years, 85% were females, education 11.2 ± 4.2 years. A total of 11/38 (29%) were positive to B. burgdorferi with Alzheimer’s disease, 9/39 (23%) with MCI, and 11/108 (10%) of controls. In patients with Alzheimer’s disease, an adjusted odds ratio (aOR) = 3.65 (95% CI 1.2–11.1) adjusted for education and a history of cerebrovascular disease (CVD) was estimated, and in patients with MCI an aOR = 3.2 (95% CI 1.1–9.1) for a history of diabetes mellitus and CVD was estimated. In our study, there was an increased risk of Alzheimer’s disease and MCI in seropositive IgG patients to B. burgdorferi. Establish if Borrelia burgdorferi infection is associated with Alzheimer's disease and/or mild cognitive impairment (MCI) in older adults. In patients with Borrelia burgdorferi infection and Alzheimer's disease, an adjusted Odds Ratio (AOR) = 3.65 (95% CI = 1.2−11.1) was estimated, which was similar to that of patients with Borrelia burgdorferi infection and MCI with an AOR = 3.2 (95% CI = 1.1−9.1). In our study, there was an increased risk of Alzheimer's disease and MCI in seropositive IgG patients to B. burgdorferi.

El objetivo de este trabajo es acercarse a las vías de “retiro” de pandilleros en el país, a fin de mostrar el panorama general de las opciones existentes y describir sus características esenciales. La metodología se basa en la aplicación de dos técnicas de investigación: la revisión documental y las entrevistas en profundidad. Se exponen categorías de análisis importantes con respecto a los expandilleros, como por ejemplo las de “calmado”, “retirado” y “peseta”, cada una de las cuales plantea escenarios y prospectivas diferentes. Además, se explora el papel del Gobierno, el rol de la sociedad civil (incluyendo las iglesias católica y evangélica; en especial, las pentecostales), la participación del sector privado y ciertos mecanismos de las pandillas mismas. En definitiva, a todo el estudio le subyace una reflexión de carácter “identitario”, por cuanto concierne a la construcción, deconstrucción y eventual reconstrucción de la identidad, a nivel personal y grupal, de los miembros y exmiembros de maras o pandillas.

Este artículo constituye un modesto aporte al décimo número de la revista “Policía y Seguridad Pública”, y tiene como objetivo general hacer un breve análisis, muy preliminar y genérico, del estado actual del clima organizacional en la PNC a partir de dos momentos elementales de referencia: su fundación y su situación presente.La metodología empleada incluyó la aplicación de las técnicas de revisión documental, entrevistas en profundidad y encuesta. Casi la totalidad de los datos analizados fueron recabados en un acotado período de tiempo; y, asimismo, el conjunto de informantes que se consultaron estuvo delimitado por un cierto perfil preestablecido. Por ello, los hallazgos y los resultados globales deben ser adecuadamente localizados, dimensionados y tomados con cautela, así como las conclusiones y las recomendaciones que se derivan de aquéllos.

To determine the association of Borrelia burgdorferi infection with Alzheimer's disease or mild cognitive impairment (MCI) in older adults.Case-control study. Patients older than 60 years, both sexes, were included. Three groups were created: with probable Alzheimer's disease cases with NINCDS-ADRDA criteria, MCI cases in those not meeting NINCDS-ADRDA criteria for dementia, but who had an abnormal cognitive evaluation and independence in instrumental activities of daily living (IADL), cognitively healthy controls were diagnosed with normal cognitive evaluation and independence in IADL were identified in the community. Western blot IgG against B. burgdorferi in serum was done in all the participants. Non-conditional logistic regression was applied to estimate the association of Alzheimer's disease or MCI and seropositive to B. burgdorferi.Thirty-eight patients with Alzheimer's disease, mean age of 75.6 ± 3.4 years, 69% were females, education 8.3 ± 4.8 years. 39 patients with MCI, mean age of 72.2 ± 6.8 years, 85% were females, education 11.2 ± 4.2 years. A total of 11/38 (29%) were positive to B. burgdorferi with Alzheimer's disease, 9/39 (23%) with MCI, and 11/108 (10%) of controls. In patients with Alzheimer's disease, an adjusted odds ratio (aOR) = 3.65 (95% CI 1.2-11.1) adjusted for education and a history of cerebrovascular disease (CVD) was estimated, and in patients with MCI an aOR = 3.2 (95% CI 1.1-9.1) for a history of diabetes mellitus and CVD was estimated.In our study, there was an increased risk of Alzheimer's disease and MCI in seropositive IgG patients to B. burgdorferi.

Guillain-Barré Syndrome (GBS) is an acute polyneuropathy characterized by symmetrical weakness of the limbs with hyporeflexia or areflexia with a maximum progression within four weeks and can impair respiratory function and implies disability at a long. The aim of this paper was to describe the clinical, epidemiological and neurophysiological features of patients with GBS at the Hospital de Especialidades del Centro Medico Nacional Siglo XXI (HECMNSXXI)An observational, retrospective cross-sectional study, data were collected form clinical records of adults with GBS hospitalized in HECMNSXXI from March 2012 to March 2016. The recorded variables were demographics, previous infection, clinical presentation, disability scores, prognosis scores and neurophysiological subtypes.Clinical records of 94 patients were analysed with a mean age of 53 years, 61% male, with previous infection in 80%. Albumin cytologic dissociation was present in 50%. Medical Research Council (MRC) sum scores mean was 32, the SGB disability score at admittance with a mean of 3.63. The axonal subtype was in 68%, and demyelinating in 29%, not conclusive in 3%.In this study the demographic and clinical features are similar to other previous reports, we documented a greater proportion of axonal subtype, which are related with important disability and worse prognosis.El síndrome de Guillain-Barré (SGB) es una polirradiculoneuropatía aguda caracterizada por debilidad simétrica progresiva de las extremidades con hipo o arreflexia, que progresa en un máximo de 4 semanas y que puede llevar a la falla respiratoria y a discapacidad a largo plazo. El objetivo de este trabajo fue describir las características clínicas, epidemiológicas y neurofisiológicas de pacientes con SGB del Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HECMNSXXI).Se realizó un estudio observacional de tipo transversal retrolectivo. Se obtuvieron datos de expedientes clínicos de adultos con diagnóstico de SGB hospitalizados en el HECMNSXXI en el periodo de marzo de 2012 a marzo de 2016. Se registraron variables demográficas, clínicas y neurofisiológicas.Se incluyeron 94 pacientes con un promedio de edad de 53 años, en su mayoría hombres, con infección previa en 80%. La fuerza muscular medida con la escala del Medical Research Council (MRC) fue en promedio de 32, la escala de discapacidad del SGB (Hughes) al ingreso tuvo un promedio de 3.63. La variedad axonal se encontró en 68%, la desmielinizante en 29% y en 3% no concluyente.Se documentan en esta muestra características demográficas y clínicas similares a lo reportado en la literatura, así como la mayor proporción de variedades axonales, las cuales tienen mayor severidad en la presentación clínica así como mal pronóstico.

Este artículo tiene por objetivo general examinar y analizar preliminarmente, el proceso a través del cual se dividió la pandilla Barrio 18 en “los Sureños” y “los Revolucionarios”. La metodología empleada se ha basado en la aplicación de las técnicas de revisión documental y entrevistas en profundidad. Este trabajo arranca de un esfuerzo previo, en el que, con una visión holística, se entiende a las maras o pandillas apartir de cuatro criterios: 1) Su forma organizacional; 2) Su composición; 3) La naturaleza de sus acciones; y 4) Su conjunto de valores y normas socioculturales. La definición de pandilla como categoría en clave de identidad resulta esencial. La necesidad de construir una definición holística de pandilla tiene el objetivo de evitar “suavizar” el accionar delictivo de los pandilleros, así como “sobre-criminalizar”a las pandillas.Revista Policía y Seguridad Pública 5(1) 2015: 149-178

This article’s general objective is to provide a prelimary examination and analysis of the process through which Barrio 18 split into “los Sureños” and “los Revolucionarios”.The methodology this study was based on, used specialized techniques such as documentreview and in-depth interviews. This work starts from a previous effort, in which, through a holistic vision, gangs or maras are understood from four different perspectives: 1) Their organizational structure; 2) Their composition; 3) The nature of their actions; and 4)Their set of values and socio-cultural norms. The definition of gang as a key category as far as their identity is essential. The need to build a holistic definition of gang is meant to “tone down” gang member’s criminal activities, as well as to “over-criminalize” gangs.Revista Policía y Seguridad Pública 5(1) 2015: 149-178

Purpose: To determine the outcome of immediate suture adjustment in adjustable suture strabismus surgery using a general anaesthetic technique. Methods: Adjustable suture strabismus surgery was performed in 69 patients using a target-controlled infusion of propofol-remifentanil. Sutures were adjusted immediately following surgery and patient satisfaction and ocular alignment were assessed at 3 months postoperatively. Results: Preoperatively, 71% (49/69) of patients were divergent (group 1) and 29% (20/69) were convergent (group 2). Following surgery, the mean deviation in group 1 was 3.5 ± 13.08Δ exodeviation for near and 0.8 ± 10.66Δ exodeviation for distance. The mean postoperative deviation in group 2 was 2.6 ± 9.1Δ esodeviation for near and 2 ± 9.0Δ esodeviation for distance. Overall, 80% (45/69) were within 10Δ of orthotropia. Conclusions: Single-stage adjustable suture strabismus surgery produces good results and is well suited to day case surgery.

El sistema Sur (o, tomado como acrónimo, “Southern United Raza”) reúne a diversos grupos pandilleriles, llamados Sureños, los cuales se distinguen y sitúan en contraposición a otros sistemas de pandillas que de manera genérica y lata podrían denominarse “no-Sureñas”. Los grupos, los perfiles y las idiosincrasias Sureñas son diversas y no constituyen “un” grupo en el sentido estricto del término; más bien se trata de una multiplicidad de agrupaciones que comparten una identidad y una forma de ser y de comportarse, en lo individual y en lo colectivo. Se trata de miembros de pandillas pertenecientes a un complejo sistema pandilleril instaurado décadas atrás en ciudades del sur del estado de California por hijos de inmigrantes hispanos. Es ese intrincado sistema el que de un modo híbrido y criollo se está instalando a pasos cada vez más acelerados en las ciudades de El Salvador. Es el establecimiento de este sistema, y en general la manera de vivir de los deportados Sureños en el país, lo que pretende explorarse en este trabajo de investigación. El objetivo del estudio es examinar, describir y explicar tanto los sistemas culturales como las acciones concretas de las bandas Sureñas en El Salvador, en lo que representaría un primer acercamiento etnográfico a ellas en el país. La metodología de investigación empleada es variada e incluye técnicas como la revisión documental, las entrevistas en profundidad y, principalmente, la etnografía. Entre los informantes consultados figuran miembros y ex miembros de pandillas Sureñas, funcionarios públicos y otros informantes clave que conocen el funcionamiento del Sur. Los hallazgos y las conclusiones medulares abordan temas como el sistema Sur, los tipos de Sureños y sus actividades, el Sur en El Salvador, la perspectiva del Estado y otras formas de Sureños en El Salvador. DOI: http://dx.doi.org/10.5377/ryr.v39i0.1826 Realidad y Reflexión Año 14, N° 39: 7-49

A new relaxing-incision surgical procedure was used for the correction of presbyopia and/or hyperopia. The technique consisted of 3 arcuate incisions of 60°, separated by nonincised spaces of 60°, intercalated among themselves. In all 4 reported cases of the total 15, an inferior multifocal cornea was created. Although a larger number of cases are needed, it is clearly possible to correct presbyopia on the cornea without any degree of accommodation.

JUSTIFICATIVA E OBJETIVOS: O Transfusion-Related Acute Lung Injury (TRALI), é definido como um edema pulmonar não cardiogênico, relacionado à transfusão de sangue ou derivados, evoluindo com necessidade de ventilação mecânica na grande maioria dos casos. O objetivo deste estudo foi apresentar um caso de TRALI em pós-operatório imediato de neurocirurgia. RELATO DO CASO: Paciente do sexo masculino, 69 anos, sem comprometimento pulmonar prévio, foi submetido à ressecção cirúrgica de glioblastoma multiforme, apresentando complicações intra-operatórias (broncoespasmo e diminuição da saturação de oxigênio), após ter recebido plasma fresco congelado, sendo diagnosticado TRALI. O paciente foi mantido sedado, sob ventilação mecânica e monitorização hemodinâmica invasiva, com melhora progressiva do quadro, recebendo alta da unidade de terapia intensiva (UTI) no 8º dia de pós-operatório. CONCLUSÕES: O TRALI deve ser investigado nos pacientes que recebem hemoderivados e apresentam alterações pulmonares.

To estimate the effects on homicide rates of the gang truce that was brokered in El Salvador in 2012.Mathematical models based on municipal-level census, crime and gang-intelligence data were used to estimate the effect of the truce on homicide rates. One model estimated the overall effect after accounting for the linear trend and seasonality in the homicide rate. In a moderated-effect model, we investigated the relationship between the truce effect and the numbers of MS13 (Mara Salvatrucha 13) and Eighteenth-Street gang members imprisoned per 100 000 population. We then ran each of these two models with additional control variables. We compared values before the truce - 1 January 2010 to 29 February 2012 - with those after the truce - 1 March 2012 to 31 December 2013.The overall-effect models with and without additional control variables indicated a homicide rate after the truce that was significantly lower than the value before the truce, giving rate ratios of 0.55 (95% confidence interval, CI: 0.49-0.63) and 0.61 (95% CI: 0.54-0.69), respectively. For any given municipality, the effectiveness of the truce appeared to increase as the number of MS13 gang members imprisoned per 100 000 population increased. We did not observe the same significant relationship for imprisoned Eighteenth-Street gang members.In the 22 months following the establishment of a national gang truce, the homicide rate was about 40% lower than in the preceding 26 months. The truce's impact appeared particularly strong in municipalities with relatively high numbers of imprisoned MS13 gang members per 100 000 population.Estimer les effets sur le taux d'homicide de la trêve des gangs qui a été signée au Salvador en 2012.Des modèles mathématiques établis d'après les recensements municipaux et les renseignements sur les gangs et la criminalité ont été utilisés pour estimer l'effet de la trêve sur le taux d'homicide. Un modèle a permis d'en estimer l'effet global après prise en compte de la tendance linéaire et de la saisonnalité du taux d'homicide. Un modèle à effets modérés nous a permis d'étudier la relation entre l'effet de la trêve et le nombre de membres emprisonnés des gangs MS13 (Mara Salvatrucha 13) et Barrio 18 pour 100 000 habitants. Nous avons ensuite soumis chacun de ces deux modèles à des variables de contrôle supplémentaire. Nous avons comparé les valeurs d'avant la trêve – du 1er janvier 2010 au 29 février 2012 – à celles d'après la trêve – du 1er mars 2012 au 31 décembre 2013.Les modèles d'estimation de l'effet global, avec et sans variables de contrôle supplémentaire, ont indiqué un taux d'homicide après la trêve nettement inférieur aux valeurs d'avant la trêve, avec des ratios de taux respectifs de 0,55 (intervalle de confiance de 95%, IC: 0,49-0,63) et 0,61 (IC 95%: 0,54-0,69). Quelle que soit la municipalité, l'efficacité de la trêve grandissait au fur et à mesure que le nombre de membres emprisonnés du gang MS13 pour 100 000 habitants augmentait. Nous n'avons pas observé de rapport aussi significatif pour les membres emprisonnés du gang Barrio 18.Pendant les 22 mois qui ont suivi l'établissement d'une trêve nationale des gangs, le taux d'homicide était environ 40% plus faible que lors des 26 mois précédents. L'impact de la trêve était particulièrement marqué dans les municipalités où le nombre de membres emprisonnés du gang MS13 pour 100 000 habitants était relativement élevé.Estimar el impacto en las tasas de homicidio de la tregua entre bandas negociada en El Salvador en 2012.Se utilizaron modelos matemáticos basados en un censo municipal, datos sobre crímenes e inteligencia de bandas para estimar el impacto de la tregua en las tasas de homicidio. Un modelo calculó el impacto general tras tener en cuenta la tendencia lineal y la estacionalidad de las tasas de homicidio. En un modelo de efecto moderado, se investigó la relación entre el efecto de la tregua y el número de miembros de las bandas MS13 (Mara Salvatrucha 13) y Calle 18 en prisión por cada 100 000 habitantes. Posteriormente, se implementaron ambos modelos con variables de control adicionales. Se compararon los valores antes de la tregua (del 1 de enero de 2010 al 29 de febrero de 2012) y los de después de la tregua (del 1 de marzo de 2012 al 31 de diciembre de 2013).Los modelos de efecto general con y sin variables de control adicionales indicaron que la tasa de homicidio posterior a la tregua fue mucho menor que el valor antes de la misma, lo que ofrece coeficientes de la tasa del 0,55% (intervalo de confianza, IC, del 95%: 0,49-0,63) y del 0,61 (IC del 95%: 0,54-0,69), respectivamente. En todos los municipios, la eficacia de la tregua parecía aumentar a medida que aumentaba el número de miembros de la MS13 encarcelados por cada 100 000 habitantes. No se observó la misma relación significativa para los miembros de la Calle 18 encarcelados.Durante los 22 meses posteriores al establecimiento de una tregua nacional entre bandas, la tasa de homicidio fue un 40% inferior que en los 26 meses anteriores. El impacto de la tregua fue especialmente significativo en los municipios con un número relativamente alto de miembros de la MS13 encarcelados por cada 100 000 habitantes.تقدير التأثيرات على معدل جرائم القتل نتيجة الهدنة بين العصابات التي تمت إقامتها في السلفادور عام 2012.تم استخدام نماذج رياضية تستند إلى البيانات المتعلقة بتعداد السكان على مستوى البلديات والجرائم والمعلومات الاستخبارية عن العصابات لتقدير تأثير الهدنة على معدلات جرائم القتل. قام نموذج واحد بتقدير التأثير الكلي بعد تفسير الاتجاه الخطي والتغيّرات الموسمية في معدل جرائم القتل. وفي أحد النماذج ذات التأثير المتوسط، قمنا بالتحقيق في العلاقة بين تأثير الهدنة وأعداد المسجونين من أفراد عصابة "إم إس 13" (مارتا ساڤاتروتشا 13) وعصابة "الشارع الثماني عشر" لكل 100,000 من السكان. ثم قمنا بعرض كلا هذين النموذجين مع المتغيرات الضابطة الإضافية. وقمنا بمقارنة القيم الصادرة قبل إقامة الهدنة – بدءًا من يوم 1 يناير/كانون الثاني 2010 حتى يوم 29 فبراير/شباط 2012 – مع تلك القيم الصادرة بعد إقامة الهدنة – بدءًا من يوم 1 مارس/آذار 2012 حتى يوم 31 ديسمبر/كانون الأول 2013.إن النماذج ذات التأثير الكلي المزودة بالمتغيرات الضابطة الإضافية – أو غير المزودة بها – أشارت إلى أن معدل جرائم القتل التي حدثت بعد إقامة الهدنة كان أقل بكثير من قيمة معدل الجرائم قبل إقامة الهدنة، مما يدل على نسب معدلات تبلغ 0.55 (بنسبة أرجحية مقدارها ‏95%: 0.49–0.63) و0.61 (بنسبة أرجحية مقدارها 95‏%: 0.54–0.69)، على التوالي. وبالنسبة لأي من البلديات، فقد بدا أن تأثير الهدنة يزداد حيث ارتفع عدد المسجونين من عصابة "إم إس 13" لكل 100,000 من السكان. بينما لم نلحظ العلاقة ذات الدلالة الإحصائية نفسها للأفراد المسجونين من عصابة "الشارع الثماني عشر".كان معدل جرائم القتل أقل بحوالي ‏40% في الـ 22 شهرًا التالية لإقامة هدنة بين العصابات على المستوى الوطني، مما كان عليه في الـ 26 شهرًا السابقة. وبدا أن تأثير الهدنة قويًا بشكل خاص في البلديات التي تضم أعدادًا كبيرة نسبيًا من الأفراد المسجونين من عصابة "إم إس 13" لكل 100,000 من السكان.旨在估计 2012 年在萨尔瓦多促成的帮派停战协议对凶杀率的影响。.我们使用依据市级普查、犯罪和帮派情报数据制定的数学模型估计停战协议对凶杀率的影响。 在考虑凶杀率的线性趋势和季节性之后，我们使用一种模型估计了总体影响。 在调整后的影响模型中，我们研究了停战协议的成效与每 100 000 人中入狱的救世鳟鱼帮 (MS13) 和十八街黑帮成员人数之间的关系。 然后，我们采用其他控制变量分别运行了这两个模型。 我们比较了停战协议之前的数值——2010 年 1 月 1 日至 2012 年 2 月 29 日——与停战协议之后的数值——2012 年 3 月 1 日至 2013 年 12 月 31 日。.采用和不采用其他控制变量的总体效应模型表明停战协议之后的凶杀率显著低于停战协议之前，比率分别达到 0.55（95％ 置信区间，CI: 0.49–0.63） 和 0.61 (95% CI: 0.54–0.69)。 对于任何指定的直辖市来说，由于每 100 000 人中入狱的 MS13 帮成员人数的增加，停战协议的成效也随之呈现出提高。 我们没有观察到入狱的十八街黑帮成员呈现出同等显著程度的关系。.在全国帮派停战协议签订之后的 22 个月内，凶杀率相较于之前的 26 个月降低了 40% 左右。 在每 100 000 人中入狱的 MS13 帮成员人数相对较高的直辖市中，停战协议的成效尤为显著。.Дать оценку влияния перемирия между бандами, заключенного в Сальвадоре в 2012 году, на показатели числа убийств.Оценка влияния перемирия на показатели числа убийств была дана с помощью математических моделей на основе переписных данных муниципального уровня, данных о преступности и разведывательных данных о бандах. С помощью одной модели общее влияние рассчитывалось после учета линейного тренда и сезонных колебаний показателей числа убийств. В модели модифицированного влияния были изучены связи между влиянием перемирия и количеством членов банды MS13 (Мара Сальватруча 13 (Mara Salvatrucha 13)) и банды 18-й улицы (Eighteenth-Street), заключенных в тюрьму, из расчета на 100 000 жителей. Затем обе эти модели были реализованы с дополнительными контрольными переменными. Значения, относящиеся к периоду до перемирия (от 1 января 2010 года до 29 февраля 2012 года), были сравнены со значениями, относящимися к периоду после перемирия (от 1 марта 2012 года до 31 декабря 2013 года).Реализация моделей общего влияния с дополнительными контрольными переменными и без них показала, что уровни числа убийств после перемирия были значительно меньше значений до него. В результате были получены отношения рисков, равные 0,55 (95%-й доверительный интервал, ДИ: 0,49–0,63) и 0,61 (95%-й ДИ: 0,54–0,69) соответственно. Для каждого муниципального образования было выявлено, что эффективность перемирия напрямую зависела от того, сколько членов банды MS13, заключенных под стражу, приходилось на 100 000 жителей. Такая же заметная связь с количеством заключенных под стражу членов банды 18-й улицы не наблюдалась.Через 22 месяца после заключения национального перемирия между бандами показатели убийств снизились приблизительно на 40% по сравнению с предыдущими 26 месяцами. Влияние перемирия оказалось особенно сильным в муниципальных образованиях с относительно большим количеством заключенных в тюрьму членов банды MS13 (из расчета на 100 000 жителей).

O tromboembolismo pulmonar (TEP) é uma importante causa de morbimortalidade nos pacientes submetidos a procedimentos neurocirúrgicos. O objetivo deste estudo foi apresentar um caso de trombólise intra-arterial pulmonar em pós-operatório recente de neurocirurgia. Paciente do sexo masculino, sendo submetido a clipagem de aneurisma de artéria comunicante anterior, apresentou como complicação no sétimo dia de pós-operatório, tromboembolismo pulmonar maciço, apresentando instabilidade hemodinâmica, sendo optado pela trombólise intra-arterial pulmonar com alteplase. Apresentou evolução satisfatória, sem complicações hemorrágicas, recebendo alta hospitalar. O tromboembolismo pulmonar é uma condição com alta morbi-mortalidade no pós-operatório de neurocirurgia, devendo ser a trombólise ser uma alternativa terapêutica nos casos refratários ao tratamento clínico. Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.

Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.

Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.

JUSTIFICATIVA E OBJETIVOS: O Transfusion-Related Acute Lung Injury (TRALI), é definido como um edema pulmonar não cardiogênico, relacionado à transfusão de sangue ou derivados, evoluindo com necessidade de ventilação mecânica na grande maioria dos casos. O objetivo deste estudo foi apresentar um caso de TRALI em pós-operatório imediato de neurocirurgia. RELATO DO CASO: Paciente do sexo masculino, 69 anos, sem comprometimento pulmonar prévio, foi submetido à ressecção cirúrgica de glioblastoma multiforme, apresentando complicações intra-operatórias (broncoespasmo e diminuição da saturação de oxigênio), após ter recebido plasma fresco congelado, sendo diagnosticado TRALI. O paciente foi mantido sedado, sob ventilação mecânica e monitorização hemodinâmica invasiva, com melhora progressiva do quadro, recebendo alta da unidade de terapia intensiva (UTI) no 8º dia de pós-operatório. CONCLUSÕES: O TRALI deve ser investigado nos pacientes que recebem hemoderivados e apresentam alterações pulmonares. BACKGROUND AND OBJECTIVES: The Transfusion-Related Acute Lung Injury (TRALI), is defined as noncardiogenic pulmonary edema temporally related to transfusion therapy, evolving with ventilation necessity mechanics in the great majority of the cases. This objective of this study was to present case of TRALI in the immediate postoperative of neurosurgery. CASE REPORT: We describe the case of a patient who presented broncoespasm and decreased oxygen saturation after to have received fresh-frozen plasma in the neurosurgery, who presented TRALI. The patient was submitted a invasive hemodynamic monitoring, sedation and supplemental oxygen with mechanical ventilation, with gradual improvement, leaving the intensive care unit in the eight day of postoperative. CONCLUSIONS: The TRALI must be investigated in the patients who receive transfusion therapy and present lung injury.

The Transfusion-Related Acute Lung Injury (TRALI), is defined as noncardiogenic pulmonary edema temporally related to transfusion therapy, evolving with ventilation necessity mechanics in the great majority of the cases. This objective of this study was to present case of TRALI in the immediate postoperative of neurosurgery.We describe the case of a patient who presented broncoespasm and decreased oxygen saturation after to have received fresh-frozen plasma in the neurosurgery, who presented TRALI. The patient was submitted a invasive hemodynamic monitoring, sedation and supplemental oxygen with mechanical ventilation, with gradual improvement, leaving the intensive care unit in the eight day of postoperative.The TRALI must be investigated in the patients who receive transfusion therapy and present lung injury.

Background and Purpose The incidence of cerebellar infarction in a series of patients with stroke is approximately 1.5%. The average patient age in most reported series is 62 years. The most common etiologies in this age group are atherosclerosis and cardiac embolism. The aim of this study was to determine the causes and mechanisms of cerebellar infarction in patients younger than 40 years. Methods We analyzed retrospectively the clinical and radiological data from 21 men and 16 women with cerebellar infarction admitted to our hospital from January 1986 to December 1996. The patients had been studied extensively to determine the etiology of the cerebellar infarction. Results In the 37 patients (mean age, 30 years), 29 infarcts were limited to one territory (15 in the posteroinferior cerebellar artery [PICA]; 14 in the superior cerebellar artery); 8 had nonterritorial infarctions. The most common stroke mechanisms in each territory were as follows: PICA: nonatherosclerotic vasculopathic (67%), cardioembolic (20%), and hematologic and cryptogenic (each 7%); superior cerebellar artery: cardioembolic (42%), cryptogenic (31%), migrainous (21%), and nonatherosclerotic vasculopathic and hematologic (each 7%); and mixed territory: nonatherosclerotic vasculopathic (50%), cryptogenic (25%), cardioembolic (12%), and hematologic (12%). Conclusions The most common mechanism of cerebellar infarctions was arterial occlusion as a result of intracranial vertebral artery dissection (40%), mainly with PICA involvement. Embolism from a cardiac source resulted primarily from patent foramen ovale and rheumatic valvular disease. Hematologic disturbances and migraine were responsible for a few cases.

The main objective of this investigation was to induce (create) corneal astigmatism, with a minimum of surgery, using relaxing incisions that are a combination of arc and radial keratotomies. With this combination we were able to induce large, short-term amounts of astigmatism (up to 20 diopters in rabbits). To obtain the maximum surgical effect, the arc keratotomy must be done in the middle zone of the cornea. We also report the theoretical basis to predict mathematically the desired correction.

Les auteurs decrivent une nouvelle technique chirurgicale pour la correction de la myopie et de l'astigmatisme

The mechanical behavior of athe iris-lens-zonule-ciliary body (ILZC) system under intraocular pressure variations, measured with Scan A, is studied on a series of 20 rabbit eyes. The experiments indicate that the ILZC system behaves like a partition between the anterior and vitreous chambers and not like a supporting structural member. The observed behavior is related to previous clinical observations and to the biostructural model of the eye described in a previous paper by the authors.

Induced deformations, similar to the posterior pole deformations due to advanced myopia, were studied in a series of 30 rabbits. The induced deformations were produced by means of a specially designed cup. An analysis of the applicability of the shell theory is made, and it is concluded that the thin shell theory is applicable to the mechanical study of the eyes. The basic experiment consisted of introducing a controlled deformation at different pressure levels; a wide range of types of increments and times of substained deformations were studied. It is concluded that the scleral tissue is an elastic material and has a fairly high 'Creep' rate. The material properties indicate that the eye can reaccommodate induced pressure, and thus glaucoma and myopia could be present without external indications of 'high pressure' in the eye.

As part of the bio-engineering approach to study myopia and also as a complement to the bio-structural model of the eye presented by the authors, an analog for the study of internal forces is analyzed. The behavior of the model indicates not only that the forces involved in the development of progressive myopia, but those of pre- and post-trabecular glaucomas could be studied and related with such an analog model, supporting the author's feelings that many medical problems could be successfully explained by engineering methods and techniques.

As part of a bio-engineering approach to study myopia, a structural model of the eye is proposed. The model is based on structural laws as employed by civil engineers, and on mechanical properties of the sclera and vitreous previously analyzed by the authors. The described structural behavior relates many loose clinical observations and indicates that progressive myopia should be considered a mechanical problem due to an abnormal vitreous pressure rather than an optics problem. From this bio-engineering approach, vitrectomy is suggested as the appropriate solution.

As part of the search for a bioengineering model of the eye, the interaction between instantaneous changes of pressure in the anterior and vitreous chambers are studied. A description of the experiments as well as data evaluation is given. The results indicate a linear relationship between the chambers and a diaphragm effect of the system lens-iris-zonula-ciliar body.