SEDE SANTA CRUZ
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Item Caso clínico: Sindrome DRESS: A propósito de un caso asociado a fenitoína(2024) Mendez Gonzales, Edmundo Miguel; Zelada, Banny; Videz, DanielEl síndrome DRESS es una reacción adversa de manifestación principalmente dermatológica pudiendo comprometer órganos internos, siendo una de las patologías poco frecuentes, siendo un diagnostico importante sin dejar de lado al síndrome de Stevens- Johnson y a la necrólisis epidérmica toxica. Se trata de un caso clínico que presento una reacción adversa muy poco frecuente en la practica clínica la misma que puede estar relacionada a varios fármacos , entre todos ellos la fenitoína la bibliografías son vastas pero los casos clínicos descritos en nuestro medio son nulos. La principal preocupación en relación al caso clínico fue la leucocitosis marcada además de los picos febriles persistentes ,las erupciones cutáneas que no revierten al tratamiento inicial con antihistamínicos los hallazgos relevantes clínicos y laboratoriales fueron , ascenso marcado de los azoados , cultivos sin desarrollo de gérmenes , además de hepatitis química . Con los hallazgos clínico y evaluación de la escala de RegisCAR se realiza el diagnostico de síndrome de DRESS inducido por fenitoína , se suspendió la medicación cambiándola por levetiracetam además de administración de corticoides con evolución clínica buena.Item Early identification of patients with Chagas disease at risk of developing cardiomyopathy using 2-D speckle tracking strain: Win, Miranda prediction of Chagas cardiomyopathy(IJC Heart & Vasculature, 2022) Win, Sithu; Miranda-Schaeubinger, Monica; Durán Saucedo, Ronald Gustavo; Carballo Jimenez, Paula; Flores, Jorge; Mercado Saavedra, Brandon; Camila Telleria, Lola; Raafs, Anne; Verastegui, Manuela; Bern, Caryn; Tinajeros, Freddy; Heymans, Stephane; Marcus, Rachel; Gilman, Robert H.; Mukherjee, MonicaBackground: Chagas disease is an endemic protozoan disease with high prevalence in Latin America. Of those infected, 20–30% will develop chronic Chagas cardiomyopathy (CCC) however, prediction using existing clinical criteria remains poor. In this study, we investigated the utility of left ventricular (LV) echocardiographic speckle-tracking global longitudinal strain (GLS) for early detection of CCC. Methods and results: 139 asymptomatic T. cruzi seropositive subjects with normal heart size and normal LV ejection fraction (EF) (stage A or B) were enrolled in this prospective observational study and underwent paired echocardiograms at baseline and 1-year follow-up. Progressors were participants classified as stage C or D at follow-up due to development of symptoms of heart failure, cardiomegaly, or decrease in LVEF. LV GLS was calculated as the average peak systolic strain of 16 LV segments. Measurements were compared between participants who progressed and did not progress by two-sample t-test, and the odds of progression assessed by multivariable logistic regression. Of the 139 participants, 69.8% were female, mean age 55.8 ± 12.5 years, with 12 (8.6%) progressing to Stage C or D at follow-up. Progressors tended to be older, male, with wider QRS duration. LV GLS was −19.0% in progressors vs. –22.4% in non-progressors at baseline, with 71% higher odds of progression per +1% of GLS (adjusted OR 1.71, 95% CI 1.20–2.44, p = 0.003). Conclusion: Baseline LV GLS in participants with CCC stage A or B was predictive of progression within 1-year and may guide timing of clinical follow-up and promote early detection or treatment.Item Effects of exposure to forest fire smoke on respiratory health in Rural communities of San José de Chiquitos, Bolivia(Medrxiv, 2025) Toledo German E; Gutierrez-Olguin BA; Mercado-Saavedra BN; Instituto de Investigación de Medicina, Universidad Católica Boliviana San Pablo; Facultad de Ciencias Farmacéuticas y Bioquímicas, Universidad Autónoma Gabriel René MorenoForest fires in Bolivia have increased in frequency and intensity, posing environmental and human health threats. This study evaluated the impact of air pollution from forest fires on the health of San José de Chiquitos, Santa Cruz, Bolivia's population. A cross-sectional study was conducted in two affected communities (Los Ciros and Pororó), collecting epidemiological and environmental data in September 2024. The results show that the symptoms most reported by the population exposed to smoke were respiratory (difficulty breathing in 71.4% of cases), followed by irritation in mucous membranes (77.1%), throat (80.0%), and eyes (85.7%). Although no significant differences were observed in all conditions, Los Ciros had a higher prevalence of symptoms, suggesting that poorer baseline health status could aggravate the effects of smoke. The most frequent mitigation measures were the use of masks (63.6%), staying indoors (54.5%), and the use of wet cloths (21.2%), without finding a significant association between these strategies and the reduction of symptoms. This study highlights the need to improve air pollution protection strategies in communities affected by wildfires and develop prevention policies to mitigate their effects on public health.Item Intraoperative ultrasound for surgical resection of high-grade glioma and glioblastoma: a meta-analysis of 732 patients(Neurosurgical Review, 2024) Pichardo-Rojas, Pavel S.; Zarate, Carlos; Arguelles-Hernández, Julieta; Barrón-Lomelí, Aldo; Sanchez-Velez, Roberto; Hjeala-Varas, Amir; Gutierrez-Herrera, Ernesto; Tandon, Nitin; Esquenazi, YoshuaItem Surgical Management of Acute Subdural Hematoma: A Meta-Analysis(Neurosurgery, 2024) Pichardo-Rojas, Pavel S.; Rodriguez-Elvir, Francisco A.; Hjeala-Varas, Amir; Sanchez-Velez, Roberto; Portugal-Beltrán, Emma; Barrón-Lomelí, Aldo; Freeman, Priscilla I.; Dono, Antonio; Kitagawa, Ryan; Esquenazi, YoshuaAbstract Background and objective: Traumatic acute subdural hematoma (ASDH) is a medical emergency that requires prompt neurosurgical intervention. Urgent surgical evacuation may be performed with craniotomy (CO) and decompressive craniectomy (DC). However, a meta-analysis evaluating confounders, pooled functional outcomes, and mortality analyses at different time points has not been performed. Methods: A systematic search was conducted until August 28, 2023. We identified studies performing ASDH evacuation with CO or DC. Outcomes included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), GOS-Extended, mortality, procedure-related complications, and reoperation. Variables were assessed using risk ratio (RR) and mean difference. Results: Among 684 published articles, we included the Randomized Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation of ASDH (RESCUE-ASDH) trial, 4 propensity score-matched (PSM) cohorts, and 13 observational cohort studies. A total of 8886 patients underwent CO or DC. GCS at admission in unmatched cohorts was significantly worse in the DC group (mean difference = 2.20 [95% CI = 1.86-2.55], P < .00001). GOS-Extended scores were similar among CO and DC (RR = 1.10 [95% CI = 0.85-1.42], P = .49), including the RESCUE-ASDH trial. GOS at the last follow-up in unmatched cohorts significantly favored CO (RR = 1.66 [95% CI = 1.02-2.70], P = .04). Similarly, while short-term mortality favored CO over DC (RR = 0.69 [95% CI = 0.51-0.93], P = .02), both the RESCUE-ASDH trial and the PSM-cohorts yielded similar mortality rates among groups (P > .05). Mortality at the last follow-up in unmatched patients favored CO (RR = 0.60 [95% CI = 0.47-0.77], P < .0001). Procedure-related complications (RR = 0.74 [0.50-1.09], P = .12) and reoperation rates (RR = 0.74 [0.50-1.09], P = .12) were similar.Item Pituitary Apoplexy and the Current Understanding of Its Management: A Meta-Analysis of 908 Patients(World Neurosurgery, 2024) Marin-Castañeda, Luis A.; Gorbachev, Jowah; Lopez-Zepeda, Perla de Teresa; Camila Choque-Ayala, Luz; Shubhangi, Fnu; De Nigris Vasconcellos, Fernando; Pichardo-Rojas, Pavel S.Background: Pituitary apoplexy (PA) is characterized by acute hemorrhage or infarction of the pituitary gland. Management can be either conservative or surgical. Evidence favoring either is still limited to observational studies. This meta-analysis evaluates the effectiveness of both approaches on patient outcomes. Methods: A systematic search was performed until February 2024. We included cohort studies of patients with PA. Patients were divided into 2 groups: a conservative management group and a surgery group, including early and late surgery. Outcomes of interest were assessed categorically using risk ratio (RR) and Mantel-Haenszel's random effects model. Results: Of the 273 published articles, 15 cohort studies comprising 908 patients were included. There was no statistically significant difference between groups in recovery of ophthalmoplegia (RR=1.09, confidence interval [CI]=1.00-1.18, P=0.05), visual field (RR=1.09, CI=0.91-1.3, P=0.35), visual acuity (RR=1.05, CI=0.87-1.26, P=0.61), hypopituitarism (RR=1.37, CI=0.81-2.32, P=0.25), and tumor recurrence (RR=0.74, CI=0.34-1.61, P=0.45). This was similar for conservative management versus early surgery in recovery of visual field (RR=0.92, CI=0.62-1.37, P=0.68), visual acuity (RR=1.01, CI=0.81-1.26, P=0.93), and ophthalmoplegia (RR=0.92, CI=0.53-1.61, P=0.77).Item Nationwide potential groundwater recharge trends in Bolivia: a remote sensing approach and a policy-ready decline indicator(Environmental Research Letters, 2025-06-27) Guzmán Rojo, Mónica; Pérez Hurtado, César; Gómez Vargas, Zorel; Centro de Investigación Para el Desarrollo Sostenible del Oriente Boliviano, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, Bolivia; Centro de Investigación y Transferencia para la Productividad Empresarial, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, BoliviaGroundwater provides global water security, supplying over half of the world’s drinking water. In Bolivia, it is particularly important for mitigating drought impacts and sustaining municipal supply. Yet national planning still lacks a clear picture of how groundwater recharge is changing. This study maps potential groundwater recharge change for all 338 municipalities from 1983 to 2022 and presents a policy-oriented risk indicator. Monthly precipitation (P), evapotranspiration (ET), and runoff (R) were obtained from TerraClimate (≈4 km) and FLDAS (≈10 km). A water-balance model converted these variables to potential groundwater recharge. Mann–Kendall and Theil–Sen statistics quantified long-term trends, and Pettitt’s test located years of abrupt change. The Annual Reduction of Potential Groundwater Recharge (RAPReHS) was derived to classify each municipality into one of five risk levels based on long-term groundwater recharge trends. Negative trends are significant in 65% of municipalities, and 71% record at least one breakpoint, most often between 2012 and 2015. Santa Cruz shows the steepest mean decline (–1.9 mm yr−1), yet similar losses occur along the Chapare–Yungas corridor of La Paz and Cochabamba, the southern lowlands of Beni, and the Chaco of Tarija. By contrast, Pando and parts of northern Beni retain near-neutral or slightly positive slopes, highlighting strong hydro-climatic heterogeneity. Spatial comparison between RAPReHS results and, deforestation and fire statistics reveals strong alignment. Municipalities in the ‘high’ and ‘severe’ classes spatially overlap with the main zones of primary forest loss recorded in Bolivia between 2000 and 2022. The RAPReHS framework, therefore, provides a reproducible, policy-ready lens through which to track groundwater as land-use pressures and climate variability intensify.Item Efficacy of Protein-Based Therapies in Modulating Pathology and Symptoms of Alzheimer’s Disease: A Systematic Review(2024) Rivero Paniagua, Yhazmin; Feeney Camacho, Nicole; Urioste Daza, Jhuliana; Universidad Católica Boliviana “San Pablo” (Santa Cruz, Bolivia)Introduction: Beta-amyloid plaques and tau neurofibrillary tangles disrupt brain function, leading to the progressive cognitive and functional decline characteristic of Alzheimer’s Disease (AD). Current treatments provide only symptomatic relief, failing to address the underlying pathology. Protein-based therapies, including monoclonal antibodies and recombinant protein vaccines, aim to target these pathological mechanisms by clearing beta-amyloid deposits and modulating tau activity. This review evaluates the efficacy of these therapies in improving cognitive and functional outcomes while exploring their limitations and potential. Methods: This systematic review was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions (version 6.3). A comprehensive search of PubMed, Scopus, and Web of Science was performed. Inclusion criteria focused on studies evaluating protein-based therapies targeting amyloid-beta or tau in Alzheimer’s Disease. Data on cognitive and functional outcomes, safety, and biomarkers were extracted and synthesized to identify trends and gaps in the evidence. Results: Eight studies involving 724 participants met the inclusion criteria. Monoclonal antibodies, such as aducanumab, reduced amyloid-beta plaques within 24–48 weeks, but cognitive improvements were inconsistent. Recombinant vaccines, like Lu AF20513, induced strong immune responses in 65–80% of patients, especially with immunostimulant patches. Biomarkers such as alpha-2-macroglobulin showed promise in monitoring treatment efficacy. Adverse events, including mild infusion reactions, were more frequent with antibody therapies, highlighting the need for further optimization. Conclusion: Protein-based therapies show potential in Alzheimer’s Disease treatment by targeting amyloid-beta plaques and tau pathology. Monoclonal antibodies and recombinant vaccines offer promising results in reducing pathological hallmarks and improving immune responses. However, cognitive and functional benefits remain inconsistent, and adverse events are common. Further research is necessary to optimize these therapies, validate biomarkers, and ensure broader clinical applicability.Item Efficacy and safety of trofinetide in patients with Rett syndrome: a systematic literature review(2024) Menacho Meroly, Saucedo CamilaIntroduction Rett syndrome (RTT) is a rare neurodevelopmental disorder with limited treatment options. Trofinetide has emerged as a potential therapeutic agent due to its neuroprotective and anti-inflammatory properties. This systematic review evaluates the efficacy and safety of trofinetide in patients with Rett syndrome. Methods We identified 44 articles from two databases (PubMed and Scopus). After removing duplicates, we applied the inclusion criteria, which were restricted to systematic reviews and meta-analyses of randomized controlled trials (RCTs) published within the last 5 years, available in English, and reporting efficacy outcomes measured with validated tools such as the Rett Syndrome Behavior Questionnaire (RSBQ) and the Clinical Global Impression-Improvement (CGI-I). Non-randomized trials and studies with insufficient data were excluded. Results This review included three studies with 916 patients on trofinetide for Rett syndrome. Trofinetide showed significant improvements in RSBQ (MD: -3.40 to -3.53) and CGI-I scores (MD: -0.34 to -0.35). Common side effects were diarrhea and vomiting, but no severe adverse events were reported. Conclusions This systematic review supports the efficacy of trofinetide in improving behavioral and functional outcomes in Rett syndrome. The treatment demonstrated significant reductions in symptom severity, particularly in communication and motor skills, as measured by the Rett Syndrome Behavior Questionnaire (RSBQ) and Clinical Global Impression-Improvement (CGI-I). While trofinetide was generally well-tolerated, common side effects like diarrhea and vomiting were reported. Further research with longer follow-up periods is needed to confirm the long-term efficacy and safety of trofinetide in RTT patients.