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BACKGROUND: The FilmArray Meningitis/Encephalitis(FA/ME) panel brings benefits in clinical practice, but its diagnostic test accuracy (DTA) remains unclear. We aimed to determine the DTA of FA/ME for the aetiological diagnostic in patients with suspected central nervous system(CNS) infection. METHODS: We performed a systematic review with DTA meta-analysis (PROSPERO: CRD42020139285). We searched Embase, Medline (Ovid), and Web of Science from inception until September 1st, 2021. We assessed the study-level risk of bias with the QUADAS-2 tool and applied the GRADE approach to assess the certainty of the synthesised evidence. We included studies that simultaneously measured the reference test (CSF/blood culture for bacteria, and specific polymerase chain reaction for viruses) and the FA/ME in patients with suspected CNS infection. We performed random-effects bivariate meta-analysis models of combined sensitivity and specificity using CSF/blood cultures(reference test 1) and a final diagnosis adjudication based on clinical/laboratory criteria (reference test 2). FINDINGS: We included 19 studies (11,351 participants). For all bacteria with reference test 1 (16 studies/6183 patients) sensitivity was estimated at 89·5% (95%CI 81·1-94·4), and specificity at 97·4% (95%CI 94-98·9). With reference test 2 (15 studies/5,524 patients), sensitivity was estimated at 92·1%(95%CI 86·8-95·3) and specificity at 99.2(95%CI 98·3-99·6) For herpes simplex virus-2(HSV-2), enteroviruses, and Varicella-Zoster virus (VZV), we obtained sensitivities between 75·5 and 93·8%, and specificities above 99% (reference test 1). Certainty of the evidence was low. INTERPRETATION: FA/ME may have acceptable-to-high sensitivities and high specificities for identifying bacteria, especially for S.pneumoniae, and viruses, especially for HSV-2, and enteroviruses. Sensitivities for L.monocytogenes, H.influenzae, E.coli, and HSV-1 were suboptimal. FUNDING: None.

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RESUMEN La encefalopatía hipóxico-isquémica (EHI) es causa importante de mortalidad y discapacidad neurológica en neonatos. La evidencia sugiere que la terapia de hipotermia es capaz de impactar estos desenlaces. Este estudio se realizó con el objetivo de describir las características clínicas y las ayudas diagnósticas realizadas a recién nacidos con EHI sometidos a terapia de hipotermia corporal total con el uso de criterios preestablecidos de ingreso a la terapia, en una muestra de dos instituciones de la ciudad de Medellín. MÉTODOS: Se realizó un estudio descriptivo en el periodo 2017-2018, incluyendo la totalidad de pacientes con EHI ingresados a terapia de hipotermia. RESULTADOS: Se obtuvieron datos de 256 pacientes, con predominio masculino (182; 71,1%). Se evidenciaron fallas en el registro y subjetividad en la aplicación de los criterios de ingreso al protocolo de hipotermia en ambas instituciones. En 197 pacientes (77 %) no hubo reporte de evento centinela, y el expulsivo prolongado fue considerado por los clínicos un hallazgo significativo a la hora de definir el ingreso a la terapia. Hubo, además, pacientes ingresados que no cumplieron con el criterio de APGAR ≤ 5 a los 10 minutos (n = 136). Los resultados sugieren la necesidad de mejorar la adherencia al protocolo de ingreso a la terapia, pero al mismo tiempo señalan la importancia del concepto del clínico a la hora de abordar cada paciente de manera individual.

SUMMARY Hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality in the neonatal population and neurological disability. The evidence shows that hypothermia therapy is capable of impacting these outcomes. This study was carried out with the objective of describing the clinical characteristics and the diagnostic aids made to newborns with HIE undergoing total body hypothermia therapy and the use of criteria for admission to therapy in a sample of two institutions in the city of Medellin. METHODS: A descriptive retrospective study was conducted, including all patients with HIE admitted to hypothermia therapy during 2017 and 2018. RESULTS: The data of 256 patients (males 182; 71.1 %) were obtained. There were flaws in the registry and subjectivity in the application of the entry criteria to the hypothermia protocol in both institutions. In 197 (77 %) patients there was no report of sentinel event and the prolonged labour was considered by the clinicians as a significant finding when defining the entrance to the therapy. There were also admitted patients who did not meet the criterion of APGAR ≤ 5 at 10 minutes (n = 136). The results suggest the need to improve adherence to the protocol for admission to therapy; but at the same time, it points out the importance of the clinician's concept when dealing with each patient individually.

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Objetivo: describir las características clínicas y electroencefalográficas en una muestra de pacientes con síndrome de Lennox-Gastaut diagnosticados en el programa de epilepsia de la Universidad de Antioquia en Medellín entre 2007 y 2012. Materiales y métodos: se trata de un estudio observacional, descriptivo y retrospectivo. La población de estudio estuvo conformada por todos los registros de pacientes con diagnóstico de síndrome de Lennox-Gastaut incluidos en la base de datos del programa de epilepsia de la Universidad de Antioquia y que fueron evaluados por videomonitoreo electroencefalográfico. Las variables clínicas y electroencefalográficas fueron examinadas. Para el análisis se utilizó el programa estadístico SPSS. Resultados: se revisaron 18 videotelemetrías. El promedio de edad fue 19,89 años, con igualdad de género en un 50%. La mitad de los pacientes presentaba antecedentes perinatales de riesgo. La edad promedio de la primera crisis fue de 4,67 años y el número promedio de crisis por semana fue de 31,17. Las crisis más frecuentes fueron las ausencias atípicas en 17 pacientes (94,4%). El medicamento más utilizado fue el ácido valproico. En todos los pacientes se encontró retardo mental y los hallazgos electroencefalográficos característicos del síndrome, tanto en vigilia como en sueño. En el sueño superficial se observó la mayoría de anormalidades. Conclusiones: el síndrome de Lennox-Gastaut es una de las encefalopatías epilépticas más severas de inicio en la niñez, conlleva grandes costos sociales y económicos y tiene un pobre pronóstico debido a sus condiciones mórbidas asociadas.

Objetive: To describe the clinical and electroencephalographic features in a sample of patients diagnosed with Lennox-Gastaut syndrome. The patients were part of the epilepsy program at the University of Antioquia in Medellin between 2007 and 2012. Materials and methods: This was completed with an observational, descriptive and retrospective method. The data used was taken from the records of all patients diagnosed with Lennox-Gastaut syndrome included in the epilepsy program at the University of Antioquia and who were evaluated by EEG video monitoring. Clinical and electroencephalographic variables were analyzed. For the analysis we used SPSS. Resualts: We reviewed 18 video EEG. The average age of the patients was 19,89 years, with the gender being equally being balanced. Half of the patients had a prenatal risk. The average age of the first seizure was at 4,67 years and the average number of attacks per week was 31,17. The most frequent were atypical absence seizures in 17 patients (94,4%). The most commonly used drug was valproic acid. All patients experienced mental retardation and characteristic electroencephalographic findings of the syndrome, during both times of wakefulness and sleep. Most abnormalities were observed during superficial sleep. Conclusions: The Lennox-Gastaut syndrome is one of the most severe epileptic encephalopathies with onset during childhood and with large social and economic costs and poor prognosis due to its associated morbid conditions.

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