Background: Congenital anomalies of the central nervous system (CACNS) are birth defects of the physical structure of the brain or spinal cord that occur during intrauterine growth. The purpose of study was to obtain the incidence, types and risk factors of congenital anomalies of the central nervous system in the 2 teaching hospitals in Enugu, Nigeria. Materials and Methods: This was a hospital based observational study carried out on infants delivered at University of Nigeria Teaching Hospital (UNTH) and Enugu State University Teaching Hospital (ESUTH), Enugu during the periods of January 2013 and December 2018. Diagnosis of neurological congenital anomaly was made through clinical examination by a pediatrician and a neurosurgeon. Stillborns were excluded. Results: During the study period, 15,820 were delivered in the 2 teaching hospitals, out of which 79 infants had CACNS, which gave an incidence of 0.5%. Neural tube defect was the most common neurological anomaly. A significant number of the mothers took herbal concoctions during pregnancy. About one-fifth of the neurological anomalies were diagnosed prenatally. Conclusion: This study showed an incidence of CACNS of 0.5% in the two teaching hospitals in Enugu, South East Nigeria. Neural tube defect was the most common anomaly.

The treatment for cancer has been more widespread and new therapies appear as alternatives in the area to contain the advance of the tumor, having with the immune mechanisms one of the main sources of research and study for a possible advance in the treatment. Checkpoint inhibitors (ICI) are monoclonal therapy, which act by blocking the PD-1, PD-L1 and CTLA-4 molecules, responsible for immune control. However, among the effects caused by therapy, the use of medications is associated with neurological diseases reported as an adverse effect. Neurological complications can affect both the central and the peripheral nervous system, reaching a variety of regions and being related to effects in several diseases. In clinical practice, the report in question shows how the adverse effects of using these therapies work, collaborating with evidence on the use or not of it. This bibliographic review, which used the PUBMED database with the words "antibodies", "monoclonal", "immune control", "checkpoints inhibitors", brings the main neurological diseases associated with therapy, as well as the incidence, symptoms and treatment. Methodology: The present review used as a means of obtaining information the PUBMED platform, in which it was looking for articles using the words "antibodies", "monoclonal", "immune control", "checkpoints inhibitors", in addition to fulfilling the year criteria between 2010 and 2020. The language and countries in which the data were obtained were not selected, so information from articles published in several countries was used.

Introduction: Central nervous system tumors are rare; in 2015 they represented approximately 1.4% of new cancer diagnoses, causing 2.6% of deaths by cancer that year. In Colombia, there are few reports on the epidemiology of brain tumors, and those that exist are local databases that do not have a rigorous and massive registry. Due to limited epidemiological information in our country, this document aims to characterize the epidemiology of brain tumors in Colombia over a 10-year period. Methods: A retrospective descriptive observational study was conducted, using databases of population-based cancer registries in Colombia. We extracted information from a 10-year period recorded in patients with tumors without age group restriction. A descriptive analysis was carried out for all the variables considered, the incidence and mortality rates per 100,000 person years were calculated. Statistical software Stata 14.0 was used. Results: Our analysis was performed with a population of 775 adult patients and 123 pediatric patients, with an incidence of 1.55 per 100.000 individuals in the pediatric population and 3.19 per 100.000 individuals in the adult population. The mortality rate for pediatric and adult patients was 0.063 per 100.000 individuals and 1.86 per 100.000 individuals respectively. The most frequent tumors in the pediatric age group were neuroepithelial tumors, embryonal tumors and ependymal tumors, whereas for adults, the most frequent were neuroepithelial tumors, meningiomas and hematolymphoid tumors. Conclusions: This study constitutes the most recent work on the epidemiology of brain tumors in Colombia. There was a clear general underreporting and statistics lower than those compared with the literature. It is intended to expand coverage and data collection in population-based cancer registries.

Background: Despite proven efficacy of intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) in acute ischemic stroke, there has been slow administration of these therapies in the real world practice. We examined the ongoing quality improvement in acute stroke care at our comprehensive stroke center. Methods: Consecutive patients with acute ischemic stroke from 2013 to 2018 were studied. Patients were managed using Code Stroke algorithm per concurrent AHA guidelines and a simple quality improvement protocol implemented in 2015. Demographics and clinical data were collected from the Get-With-The-Guideline-Stroke registry and electronic medical records. Patients were divided into 3 groups per admission and implementation date of quality improvement initiatives. Quality measures, including rates of intravenous tPA and EVT, door-to-needle (DTN) time, and door-to-puncture (DTP) time, were analyzed with general mean linear regression models and Jonckheere-Terpstra test. Results: Of the 1,369 eligible patients presenting within 24 hours of symptom onset or wakeup stroke, the rate of intravenous tPA was 20%, 30% and 22%, respectively, in 2013-2014, 2015-2016, and 2017-2018. In contrast, EVT rate was 9%, 14% and 15%, respectively. Based on Jonckheere-Terpstra test, there was significant ongoing improvement in the median DTN time (57, 45, 39 minutes; p < 0.001) and DTP time (172, 130, 114 minutes; p =0.009) during the 3 time periods, with DTN time = 60 and =45 minutes in 80% and 63% patients, respectively, in 2017-2018. Conclusions: Getting with the guidelines and simple quality improvement initiatives are associated with satisfactory rates of acute stroke therapy and ongoing improvement in door to treatment times.

This clinical study evaluates over medium-to-long term the hypothesis that intermittent spontaneous ocular choroidal vasculature-related congestive and nociceptive corneoscleral envelope distention have a pathogenetic role in genesis of episodic lateralizing migraine headache attacks. No neuro-anatomic or -physiologic difference prevails between the three divisions of the trigeminal nerve, but migraine dominantly affect the ophthalmic division. Use of topical ophthalmic solution for managing acute headache attacks of migraine has given contradictory results in controlled trials. I report the distribution of weekend-migraine headache attacks on a single-participant (N=1) level for 2 patients over a 3-year period (2017-2020) without misuse of any recreational drug other than caffeine on week-days. After a run-in basal period of 6-months recorded on their Smartphones app, with their informed consent, a trial was carried out with topical long-acting ß-blocker timolol maleate 0.5% w/v ophthalmic solution once weekly on Saturday night just before sleeping with no other advice to promote nocturnal sleeping or early awakening the next morning; only alcohol binge was proscribed. No week-end attacks of lateralizing migraine headache were reported in the 2 patients over a period of 3- years, a long-term consistent response. The biologically-plausible and defensible mechanistic link between migraine, intraocular pressure, ocular choroidal vasculature, nociceptive corneoscleral envelope aberration, and the pharmacologic basis for therapeutic ocular hypotension for prophylaxis of migraine headache attacks is elucidated for the first time in migraine literature.