Aixa de Jesus | University of Puerto Rico - Humacao (original) (raw)

Papers by Aixa de Jesus

Research paper thumbnail of Descriptive study of aneurysmal and non-aneurysmal subarachnoid hemorrhage and the role of confirmative DSA in non-aneurysmal subarachnoid patients in Puerto Rico

World Neurosurgery, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of 19 Development of the Puerto Rico Neoplasm and CNS Tumor Registry (PUNCTURE)

Journal of clinical and translational science, Apr 1, 2023

Research paper thumbnail of Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review

Cureus, Jul 8, 2022

Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high ... more Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.

Research paper thumbnail of Prevention of Surgical Site Infection in Lumbar Instrumented Fusion Using a Sterile Povidone-Iodine Solution

World Neurosurgery, Jul 1, 2021

OBJECTIVE Surgical site infection (SSI) is a well-documented complication in patients that underg... more OBJECTIVE Surgical site infection (SSI) is a well-documented complication in patients that undergo posterior spine instrumentation, with most studies reporting an incidence of 1-12%. Some studies have documented that a diluted sterile povidone-iodine (PVI) solution can be safely used in posterior spinal fusion surgeries as an antiseptic. In this study, we analyzed its effectiveness in reducing SSI. METHODS This retrospective study consisted of consecutive elective patients who underwent posterior lumbar instrumentation by a single surgeon from 2016-2019. The first 134 patient's wounds were irrigated before arthrodesis and closure with 1 liter of 0.9% normal saline solution (NSS) and the following 144 with a solution of 35mL of sterile 10% PVI. Both groups were analyzed to determine if wound irrigation with a sterile PVI solution decreased SSI. RESULTS There were nine (6.7%) SSIs in the 0.9% NSS group vs. one (0.7%) in the PVI group (p=0.008). The PVI solution had a RR for SSI of 0.093 (p=0.008) and an adjusted OR 0.113 (p=0.05). Increased BMI and the PLSF-L were significant risk factors for SSI (p=0.04) and (p=0.030), respectively. CONCLUSION Wound irrigation with a PVI solution significantly reduced SSI on elective posterior lumbar instrumentation cases. The subgroup analysis provided significant results to recommend its use for SSI prevention, particularly in overweight and obese patients. We also recommend its use in patients with risk factors for SSI, such as longer operative time and unintended durotomy.

Research paper thumbnail of 19 Development of the Puerto Rico Neoplasm and CNS Tumor Registry (PUNCTURE)

Journal of Clinical and Translational Science

OBJECTIVES/GOALS: To describe and compare clinical data and outcomes for patients with CNS tumors... more OBJECTIVES/GOALS: To describe and compare clinical data and outcomes for patients with CNS tumors and tumor mimics in Puerto Rico who are undergoing surgical and nonsurgical management. Thus, increasing data from an underrepresented group which can serve as a foundation for investigating determinants of outcomes. METHODS/STUDY POPULATION: This proposal will examine patient charts, radiology and pathology reports, financial data, and treatment details from the electronic medical record of patients receiving surgical and nonsurgical treatment for CNS tumors and mimics in the University of Puerto Rico Medical Sciences Campus and all associated institutions. Data will be analyzed retrospectively between January 1, 2014 and June 30, 2022, and prospectively for ten years until December 31, 2032. Patients with primary and metastatic CNS tumors and tumor mimics in the brain, meninges, ventricles, spinal cord, cranial nerves, orbit, facial sinuses, bony skull, vasculature will be included. T...

Research paper thumbnail of Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review

Cureus

Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high ... more Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.

Research paper thumbnail of 90-Day Return Visit to the Emergency Department After an Initial Neurosurgical Evaluation

World Neurosurgery, 2022

OBJECTIVE This study evaluated Emergency Department (ED) neurosurgical re-evaluation rates and th... more OBJECTIVE This study evaluated Emergency Department (ED) neurosurgical re-evaluation rates and their causes. Identifying the most significant reasons that make patients return to the ED for a neurosurgical re-evaluation can help implement changes to reduce the economic and medical burden of patient turnover. METHODS All patients undergoing neurosurgical re-evaluation at our institution ED after an initial neurosurgical evaluation were enrolled in a prospective three-month longitudinal registry. Inclusion criteria were all adult patients 21 years of age or older previously evaluated by neurosurgery at our institution ED who return within 90 days for a neurosurgical re-evaluation. RESULTS We found an overall 90-day ED neurosurgical return visit rate of 2.1%. During the study, 34 patients returned to the ED for a neurosurgical re-evaluation. Patients returned for a neurosurgical re-evaluation at a median of 23.5 days after the initial neurosurgery evaluation. The principal causes for a return visit were altered mental status, headache, and wound infections. Among the returning patients, 59% required hospitalization and 50% required an operation. CONCLUSIONS To our knowledge, this is the first study to prospectively collect data to estimate the 90-day ED return visit rate for a neurosurgical re-evaluation following an initial ED neurosurgical evaluation. Some patients still use the ED to get continued care of their condition despite having access to their primary care physician. Better communication, social worker coordination, and prompt follow-up appointments at the neurosurgical outpatient clinic may reduce return visits.

Research paper thumbnail of Letter to the Editor. Puerto Rico medical schools: neurosurgery residents matched during the 2014–2020 period

Journal of Neurosurgery, Feb 1, 2023

Research paper thumbnail of Posttraumatic hydrocephalus in pediatric patients after decompressive craniectomy

Objective The risk for developing posttraumatic hydrocephalus (PTH) is higher when patients under... more Objective The risk for developing posttraumatic hydrocephalus (PTH) is higher when patients undergo decompressive craniectomy as part of their treatment. The purpose of this study is to determine the prevalence of PTH after decompressive craniectomy in pediatric patients and determine associated risk factors that may lead to PTH. Methods A retrospective analysis was conducted by searching the Puerto Rico neurologic surgery database from 2010 to 2019. All pediatric patients (1–18 years old) at the University Pediatric Hospital of the Puerto Rico Medical Center who had traumatic brain injury and had a decompressive craniectomy were included in the study. Data were reviewed to determine if time to decompressive craniectomy, side of decompressive craniectomy, gender, mechanism of trauma, amount of subarachnoid hemorrhage, and time to cranioplasty were risk factors for the development of PTH. Results Incidence of PTH after decompressive craniectomy was 21%. Neither gender, side of decomp...

Research paper thumbnail of Descriptive study of aneurysmal and non-aneurysmal subarachnoid hemorrhage and the role of confirmative DSA in non-aneurysmal subarachnoid patients in Puerto Rico

World Neurosurgery, 2019

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of 19 Development of the Puerto Rico Neoplasm and CNS Tumor Registry (PUNCTURE)

Journal of clinical and translational science, Apr 1, 2023

Research paper thumbnail of Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review

Cureus, Jul 8, 2022

Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high ... more Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.

Research paper thumbnail of Prevention of Surgical Site Infection in Lumbar Instrumented Fusion Using a Sterile Povidone-Iodine Solution

World Neurosurgery, Jul 1, 2021

OBJECTIVE Surgical site infection (SSI) is a well-documented complication in patients that underg... more OBJECTIVE Surgical site infection (SSI) is a well-documented complication in patients that undergo posterior spine instrumentation, with most studies reporting an incidence of 1-12%. Some studies have documented that a diluted sterile povidone-iodine (PVI) solution can be safely used in posterior spinal fusion surgeries as an antiseptic. In this study, we analyzed its effectiveness in reducing SSI. METHODS This retrospective study consisted of consecutive elective patients who underwent posterior lumbar instrumentation by a single surgeon from 2016-2019. The first 134 patient's wounds were irrigated before arthrodesis and closure with 1 liter of 0.9% normal saline solution (NSS) and the following 144 with a solution of 35mL of sterile 10% PVI. Both groups were analyzed to determine if wound irrigation with a sterile PVI solution decreased SSI. RESULTS There were nine (6.7%) SSIs in the 0.9% NSS group vs. one (0.7%) in the PVI group (p=0.008). The PVI solution had a RR for SSI of 0.093 (p=0.008) and an adjusted OR 0.113 (p=0.05). Increased BMI and the PLSF-L were significant risk factors for SSI (p=0.04) and (p=0.030), respectively. CONCLUSION Wound irrigation with a PVI solution significantly reduced SSI on elective posterior lumbar instrumentation cases. The subgroup analysis provided significant results to recommend its use for SSI prevention, particularly in overweight and obese patients. We also recommend its use in patients with risk factors for SSI, such as longer operative time and unintended durotomy.

Research paper thumbnail of 19 Development of the Puerto Rico Neoplasm and CNS Tumor Registry (PUNCTURE)

Journal of Clinical and Translational Science

OBJECTIVES/GOALS: To describe and compare clinical data and outcomes for patients with CNS tumors... more OBJECTIVES/GOALS: To describe and compare clinical data and outcomes for patients with CNS tumors and tumor mimics in Puerto Rico who are undergoing surgical and nonsurgical management. Thus, increasing data from an underrepresented group which can serve as a foundation for investigating determinants of outcomes. METHODS/STUDY POPULATION: This proposal will examine patient charts, radiology and pathology reports, financial data, and treatment details from the electronic medical record of patients receiving surgical and nonsurgical treatment for CNS tumors and mimics in the University of Puerto Rico Medical Sciences Campus and all associated institutions. Data will be analyzed retrospectively between January 1, 2014 and June 30, 2022, and prospectively for ten years until December 31, 2032. Patients with primary and metastatic CNS tumors and tumor mimics in the brain, meninges, ventricles, spinal cord, cranial nerves, orbit, facial sinuses, bony skull, vasculature will be included. T...

Research paper thumbnail of Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review

Cureus

Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high ... more Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.

Research paper thumbnail of 90-Day Return Visit to the Emergency Department After an Initial Neurosurgical Evaluation

World Neurosurgery, 2022

OBJECTIVE This study evaluated Emergency Department (ED) neurosurgical re-evaluation rates and th... more OBJECTIVE This study evaluated Emergency Department (ED) neurosurgical re-evaluation rates and their causes. Identifying the most significant reasons that make patients return to the ED for a neurosurgical re-evaluation can help implement changes to reduce the economic and medical burden of patient turnover. METHODS All patients undergoing neurosurgical re-evaluation at our institution ED after an initial neurosurgical evaluation were enrolled in a prospective three-month longitudinal registry. Inclusion criteria were all adult patients 21 years of age or older previously evaluated by neurosurgery at our institution ED who return within 90 days for a neurosurgical re-evaluation. RESULTS We found an overall 90-day ED neurosurgical return visit rate of 2.1%. During the study, 34 patients returned to the ED for a neurosurgical re-evaluation. Patients returned for a neurosurgical re-evaluation at a median of 23.5 days after the initial neurosurgery evaluation. The principal causes for a return visit were altered mental status, headache, and wound infections. Among the returning patients, 59% required hospitalization and 50% required an operation. CONCLUSIONS To our knowledge, this is the first study to prospectively collect data to estimate the 90-day ED return visit rate for a neurosurgical re-evaluation following an initial ED neurosurgical evaluation. Some patients still use the ED to get continued care of their condition despite having access to their primary care physician. Better communication, social worker coordination, and prompt follow-up appointments at the neurosurgical outpatient clinic may reduce return visits.

Research paper thumbnail of Letter to the Editor. Puerto Rico medical schools: neurosurgery residents matched during the 2014–2020 period

Journal of Neurosurgery, Feb 1, 2023

Research paper thumbnail of Posttraumatic hydrocephalus in pediatric patients after decompressive craniectomy

Objective The risk for developing posttraumatic hydrocephalus (PTH) is higher when patients under... more Objective The risk for developing posttraumatic hydrocephalus (PTH) is higher when patients undergo decompressive craniectomy as part of their treatment. The purpose of this study is to determine the prevalence of PTH after decompressive craniectomy in pediatric patients and determine associated risk factors that may lead to PTH. Methods A retrospective analysis was conducted by searching the Puerto Rico neurologic surgery database from 2010 to 2019. All pediatric patients (1–18 years old) at the University Pediatric Hospital of the Puerto Rico Medical Center who had traumatic brain injury and had a decompressive craniectomy were included in the study. Data were reviewed to determine if time to decompressive craniectomy, side of decompressive craniectomy, gender, mechanism of trauma, amount of subarachnoid hemorrhage, and time to cranioplasty were risk factors for the development of PTH. Results Incidence of PTH after decompressive craniectomy was 21%. Neither gender, side of decomp...