Selvin Zacarías Reyes-García

Background and purpose: Intravenous (IV) thrombolysis for acute ischemic stroke (AIS) is time-dependent and frequently underused in resource-limited settings. We aimed to characterize patients with AIS who did not receive IV thrombolysis at a national referral center in Honduras and to document the barriers to treatment. Methods: We conducted a retrospective, single-center, consecutive case report series of all eligible patients with AIS who were not thrombolyzed at Hospital Escuela Universitario between 1 October and 30 November 2025. We gathered demographics, socioeconomic status, admission severity, process-of-care intervals, contraindications, neuroimaging and thrombolytic availability, complications, and discharge outcomes. Contraindications were classified as absolute or relative according to the 2019 American Heart Association and American Stroke Association (AHA/ASA) guidelines. A thrombolysis eligibility cascade was the principal analysis. The study was approved by the institutional review board. Results: A total of 23 patients were included (median age 70 years; 14 [60.9%] male). Extreme poverty (≥2 unsatisfied basic needs [UBN]) was present in 14 patients (60.9%). All 23 AIS presentations screened during the period were included, and no patient received thrombolysis (institutional thrombolysis rate 0%). The median onset-to-door time was 10.0 h (IQR 7.0–15.0), and only 1 of 22 patients with a recorded time (4.5%) arrived within 4.5 h. Late or unknown onset was the most frequent absolute contraindication (21 [91.3%]); neuroimaging was available in 22 (95.7%) patients, but the thrombolytic agent was unavailable in every patient (availability 0%). In the eligibility cascade, the single patient within the window had no absolute contraindication and could not be treated because no thrombolytic agent was available. The in-hospital mortality rate was 2 (8.7%), and a good functional outcome (modified Rankin Scale [mRS] score 0–2) occurred in 5 of 20 patients with an assessable score. Conclusion: Non-administration of thrombolysis reflected late presentation and, above all, the complete unavailability of the thrombolytic agent, whereas imaging and organizational capacity were largely in place. Drug supply was the proximate, modifiable obstacle to reperfusion in this setting.

In order to investigate the temporal lobe epilepsy in humans, the chronic experimental model of epilepsy in rats, which uses a single and systemic dose of pilocarpine, has been used worldwide. In this model, the occurrence of Status Epilepticus (SE) in the model’s acute phase, has been mandatory and a crucial step for the successful development of the model’s chronic phase, where spontaneous and recurrent seizures (SRS) occur. However, different authors have shown that SE may not be necessary as postulated until now, since rats that received Pilo, but did not evolve in to SE (Non-SE rats) presented mossy fiber sprouting and spontaneous and recurrent seizures in the model’s chronic phase. Although such works have shown similar findings, they also have lasted some gaps. Considering this, our work aimed to investigate possible behavioral, morphological and electrographic alterations in the Pilo’s model chronic phase in rats that did not evolve to SE. For that, video-monitoring analysis was performed for 20 months, EEG recordings and histological analysis were performed by the end of the 20th month in non-SE and control rats. No SRS were observed during observation period in Non-SE and control groups. Additionally, no alterations were observed in the EEG recordings (sleep-wake cycling was regular in both groups). Moreover, the isotropic fractionator technique showed no differences in number of hippocampal neuronal and non-neuronal cells between Non-SE and control groups. No mossy fiber sprouting was observed in Non-SE animals in both analyzed regions (CA3 and dentate gyrus). Behavioral, electrographic and histological findings suggest that Non-SE male rats do not become epileptic in the Pilo’s model chronic phase. According to results we observed that SE development is still necessary to SRS occurrence in the Pilo-induced model of epilepsy in male rats.

Antecedentes: Mundialmente, el ictus es la segunda causa de muerte y la tercera causa de discapacidad. En Honduras, el ictus es la mayor causa de ingreso hospitalario en el sistema público. El tratamiento trombolítico ha demostrado ser eficaz para el ictus isquémico. A nivel público no está disponible este manejo trombolítico agudo. Debido a lo anterior, se analizó una serie de casos para contribuir con información sobre la utilidad de esta opción terapéutica en el Hospital Escuela (HE). Descripción de los casos: Se analizó una serie de siete casos de pacientes con ictus isquémico atendidos en el HE, en período de ventana estándar de 4.5 horas, tiempo transcurrido entre inicio del evento y la intervención terapéutica. Estos pacientes se presentaron con síntomas de déficit focal motor sensitivo, del habla, lenguaje y nervios craneales. Se aplicó consentimiento informado para la administración de medicamentos y se obtuvo consentimiento firmado para publicación de datos asegurando el anonimato de cada paciente. El 85.7% (6/7) de los pacientes tuvo una evolución satisfactoria y sin complicaciones mayores. Conclusiones: A través de esta serie de casos, se identificó una respuesta terapéutica satisfactoria en pacientes con ictus isquémico que recibieron terapia trombolítica en el periodo de ventana. Este tipo de tratamiento, aunque bien establecido en guías de manejo internacionales, evidenció influencia directa en el pronóstico favorable de nuestros pacientes. Lo anterior se constituye en bases para el desarrollo de protocolos locales y fortalecimiento de unidades de atención especializada a nivel público.

Emergency services worldwide have been exceeded in their capacities due to the SARS-CoV-2 pandemic, a generalized situation in countries with robust health systems and aggravated in lagging countries. As a result, focused computer solutions have been developed for self-diagnosis, triage, and follow-up of suspected and confirmed patients of SARS-CoV-2. But as it is a new disease, the symptoms evolve in a short time and the diagnostic protocols must be updated. The applications that integrate algorithms in their code to help sanitary processes need to be modified, recompiled, and published integrating these changes. This article presents a solution through the implementation of a neural network that only requires updating an external file without the need to modify whole applications. Keywords: SARS-CoV-2; Neural Network; Triage; Telemedicine; Cloud; Public Health

The types of epileptiform activity occurring in the sclerotic hippocampus with highest incidence are interictal-like events (II) and periodic ictal spiking (PIS). These activities are classified according to their event rates, but it is still unclear if these rate differences are consequences of underlying physiological mechanisms. Identifying new and more specific information related to these two activities may bring insights to a better understanding about the epileptogenic process and new diagnosis. We applied Poincaré map analysis and Recurrence Quantification Analysis (RQA) onto 35in vitroelectrophysiological signals recorded from slices of 12 hippocampal tissues surgically resected from patients with pharmacoresistant temporal lobe epilepsy. These analyzes showed that the II activity is related to chaotic dynamics, whereas the PIS activity is related to deterministic periodic dynamics. Additionally, it indicates that their different rates are consequence of different endogenous dynamics. Finally, by using two computational models we were able to simulate the transition between II and PIS activities. The RQA was applied to different periods of these simulations to compare the recurrences between artificial and real signals, showing that different ranges of regularity-chaoticity can be directly associated with the generation of PIS and II activities.

Pre-eclampsia (PE) affects approximately 2 to 8% of pregnant women, causing blood pressure above 140 × 90 mmHg and proteinuria, normally after the 20th gestation week. If unsuccessfully treated, PE can lead to self-limited seizures (Eclampsia) that could eventually result in death of the mother and her fetus. The present study reports an experimental model of preeclampsia hypertension in pregnant (HP) and non-pregnant (H) Wistar rats by partially clamping one of their renal arteries. Pregnant (P) and non-pregnant (C) controls were provided. Differently from controls (C and P), H and HP animals presented a steady rise in BP two weeks after renal artery clamping. Injection of pentylenetetrazol (PTZ) induced behavioral and electroencephalographic seizures in all groups, which were increased in number, duration, amplitude and power accompanied by decreased latency in HP animals (p < 0.05). Consistent results were obtained in in vitro experimentation. Immunohistochemistry of hippocampus tissue in HP animals showed decreased density of neurons nuclei in CA1, CA3 and Hilus and increased density of astrocytes in CA1, CA3 and gyrus (p < 0.05). The present findings show that the clamping of one renal arteries to 0.15 mm and PTZ administration were able to induce signs similar to human PE in pregnant Wistar rats.

Human hippocampal slice preparations from patients with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS) are excellent material for the characterization of epileptiform-like activity. However, it is still unknown if hippocampal regions ascornu Ammonis(CA) 1, CA3 and CA4, generate population epileptiform-like activity. Here, we investigated epileptiform activities of the subiculum, CA1, CA2, CA3, CA4 (induced by elevation of extracellular potassium concentration) and the dentate gyrus (induced with hilar stimulation and elevation of potassium concentration) from sclerotic hippocampi of patients with drug-resistant TLE. Five types of epileptiform-like activity were observed: interictal-like events; periodic ictal spiking; seizure-like events; spreading depression-like events; tonic seizure-like events and no activity. Different susceptibilities to generate epileptiform activity among hippocampal regions were observed; the dentate gyrus was the most susceptible region followed by the subiculum, CA4, CA1, CA2 and CA3. The incidence of epileptiform activity pattern was associated with specific regions of the hippocampal formation. Moreover, it was observed that each region of the hippocampal formation exhibits frequency-specific ranges in each subfield of the sclerotic human tissue. In conclusion, this study demonstrates that epileptiform-like activity may be induced in different regions of the hippocampal formation, including regions that are severely affected by neuronal loss.

Proechimys are small terrestrial rodents from Amazon rainforest. Each animal species is adapted to a specific environment in which the animal evolved therefore without comparative approaches unique characteristics of distinct species cannot be fully recognized. Laboratory rodents are exceedingly inbred strains dissociated from their native habitats and their fundamental ecological aspects are abstracted. Thus, the employment of exotic non-model species can be informative and complement conventional animal models. With the aim of promoting comparative studies between the exotic wildlife populations in the laboratory and traditional rodent model, we surveyed a type of synaptic plasticity intimately related to memory encoding in animals. Using theta-burst paradigm, in vitro long-term potentiation (LTP) in the CA1 subfield of hippocampal slices was assessed in the Amazon rodents Proechimys and Wistar rats. Memory, learning and anxiety were investigated through the plus-maze discriminative avoidance task (PM-DAT) and object recognition test. In PM-DAT, both animal species were submitted to two test sessions (3-h and 24-h) after the conditioning training. Proechimys exhibited higher anxiety-like behavior in the training session but during test sessions both species exhibited similar patterns of anxiety-related behavior. After 3-h of the training, Proechimys and Wistar spent significantly less time in the aversive enclosed arm than in the non-aversive arm. But, at 24-h after training, Wistar rats remained less time in the aversive closed arm in comparison with the non-aversive one, while Proechimys rodents spent the same amount of time in both enclosed arms. In the object recognition test, both species were evaluated at 24-h after the acquisition session and similar findings than those of the PM-DAT (24-h) were obtained, suggesting that long-term memory duration did not persist for 24-h in the Amazon rodent. Field excitatory post-synaptic potentials recordings revealed that LTP decays rapidly over time reaching basal levels at 90 min after theta-burst stimulation in Proechimys, contrasting to the stable LTP found in the Wistar rats which was observed throughout 3-h recording period. These findings suggest a link between the LTP decay and the lack of 24-h long-lasting memory process in Proechimys. Nevertheless, why early-phase LTP in Proechimys decays very rapidly remains to be elucidated.