Multivariable prediction model of drug resistance in adult patients with generalized epilepsy from Colombia: A case-control study.

INTRODUCTION: Patients with drug-resistant epilepsy (DRE) account for most of the burden of epilepsy, and they have poor prognosis in seizure control, higher morbidity, and mortality. OBJECTIVES: The objective of the study was to develop a prognostic model of drug resistance in adult patients with generalized epilepsy from Colombia. METHODS: In this case-control study of patients with generalized epilepsy, patients were separated into two groups: one group with DRE (cases) according to the new International League Against Epilepsy (ILAE) definition after a complete evaluation performed by an epileptologist and the other group without DRE (control). Variables were analyzed to identify statistical differences between groups and were then selected to construct a prognostic model from a logistic regression. RESULTS: One hundred thirty-three patients with generalized epilepsy were studied. Thirty-eight (28.5%) patients had DRE, and 95 (71.5%) did not have DRE. History of status epilepticus, abnormal findings from neurological examination, aura, any degree of cognitive impairment, epileptic seizures at any moment of the day, and any comorbidity were risk factors. The presence of seizures only in the waking state and idiopathic etiology were protective factors. A prognostic model was constructed with previously reported risk factors for DRE and other variables available in the population of this study. In the multivariable analysis, the history of status epilepticus (odds ratio (OR): 5.6, confidence interval (CI): 1.1-20.0, p = 0.031), abnormal findings from neurological examination (OR: 5.7, CI: 2.3-13.9, p = 0.000), and aura (OR: 6.1, CI: 1.8-20.8, p = 0.003) were strongly associated with DRE. CONCLUSIONS: In adult patients with generalized epilepsy, aura, abnormal findings from neurological examination, and history of status epilepticus were predictive factors for DRE.

Estimulación cerebral profunda en enfermedad de Parkinson / Deep brain stimulation in Parkinson disease

RESUMEN Introducción: la enfermedad de Parkinson es considerada la segunda causa de enfermedad neurodegenerativa, en la que se destacan signos y síntomas motores como temblor, bradicinesia, rigidez e inestabilidad postural, acompañados de síntomas no motores como alteraciones del sueño, autonómicas, cognitivas, gastrointestinales, entre otras. El tratamiento farmacológico de la enfermedad al inicio suele ser útil, pero cuando los síntomas persisten, el tratamiento falla o no se toleran sus reacciones adversas, es necesario considerar alternativas como la estimulación cerebral profunda. Metodología: revisión narrativa con énfasis en los aspectos clínicos de la terapia con estimulación cerebral profunda en los pacientes con enfermedad de Parkinson. Discusión: la estimulación cerebral profunda es una técnica quirúrgica en la que se implantan electrodos en regiones cerebrales específicas, generalmente el núcleo subtalámico, globo pálido interno o núcleo ventral intermedio del tálamo, y se conectan a un marcapasos subcutáneo desde donde se modula eléctricamente la actividad de estas áreas. Esta terapia ha mostrado ser costo-efectiva, aporta beneficios considerables en la mejoría de los síntomas de la enfermedad de Parkinson y cuenta con evidencia clínica en los pacientes que han sido seleccionados correctamente.

SUMMARY Introduction: Parkinson's disease is considered the second cause of neurodegenerative disease, in which motor signs and symptoms such as tremor, bradykinesia, rigidity and postural instability are highlighted, accompanied by non-motor symptoms such as sleep, autonomic, cognitive, gastrointestinal among others disturbances. The pharmacological treatment of the disease at the beginning is usually useful, but when the symptoms persist, the treatment fails or its adverse reactions are not tolerated, it is necessary to consider alternatives such as deep brain stimulation. Methodology: This is a narrative review with emphasis on the clinical aspects of deep brain stimulation therapy in patients with Parkinson's disease. Discussion: Deep brain stimulation is a surgical technique in which electrodes are implanted in specific brain regions, usually the subthalamic nucleus, globus pallidus interna or ventral intermediate nucleus of the thalamus, and are connected to a subcutaneous pacemaker from which the activity of these areas is modulated electrically. This therapy has been shown to be cost-effective, provides considerable benefits in improving the symptoms of Parkinson's disease and has clinical evidence in patients who have been correctly selected.

Investigación en el pre grado de medicina: una experiencia universitaria formativa / Research in the medicine undergraduate program: an educational university experience / Pesquisa em graduação de medicina: uma experiência universidataria educacional

Introducción: En nuestro país existe una figura denominada semillero de investigación como una herramienta de promoción de la formación integral de los estudiantes, que tiene el objetivo de promover nuevo talento en áreas investigativas que permita la generación de nuevo conocimiento. En consecuencia, el Departamento Administrativo de Ciencia, Tecnología e Innovación (Colciencias) y las universidades del país han creado múltiples estrategias para potenciar habilidades investigativas en sus estudiantes. Objetivo: Reflexionar acerca de la importancia de la investigación en el pregrado mediante la estrategia pedagógica de los semilleros de investigación en áreas de la salud. Reflexión: Esta estrategia permite mejorar la formación del estudiante y hacerlo competitivo en el contexto nacional e internacional. Sin embargo, estos esfuerzos no son suficientes pues se carece de recursos económicos, planes curriculares flexibles y docentes capacitados en investigación; todos estos factores, sumados al insuficiente interés de los estudiantes, convierten la tarea en un objetivo difícil de lograr. Conclusión: Los semilleros de investigación forman personas en trabajo colaborativo y desarrollan destrezas que permiten la formación integral de los estudiantes.

Introduction: In our country there is a figure called hotbed of research as a tool to encourage the comprehensive training of students, which aims to promote new talent in investigative areas that allow the generation of new knowledge. Additionally, the Administrative Department of Science, Technology and Innovation (Colciencias) and Colombian universities have created multiple strategies to enhance research skills in their students. Objective: To reflect on the importance of research in undergraduate programs by using the hotbed of research teaching strategy in health areas. Reflection: This strategy allows improving students' training and making it more competitive at national and international level. However, these efforts are not enough because it lacks sufficient financial resources, flexible curricula and teachers trained in research; all these factors, along with deficient student interest, transform the task into a difficult goal to achieve. Conclusion: Hotbeds of research educate people in collaborative work, and also develop skills that allow the comprehensive training of students.

Introdução: Na Colômbia existe uma tipo de grupo de estudantes chamado “semillero=sementeira” de pesquisa como uma ferramenta para promover a formação integral dos alunos, que visa promover novos talentos nas áreas da pesquisa com o objetivo de gerar novos conhecimentos. Além disso, o Departamento Administrativo de Ciência, Tecnologia e Inovação (Colciencias) e as universidades do país criaram várias estratégias para melhorar as habilidades de pesquisa em seus alunos. Objetivo: refletir sobre a importância da pesquisa com estudantes na graduação como uma estratégia pedagógica do ensino superior, no campo da saúde. Reflexão: Esta estratégia permite melhorar a formação dos alunos e torná-la competitiva a nível nacional e internacional. No entanto, estes esforços não são suficientes porque não conta com recursos financeiros suficientes, currículos flexíveis e professores treinados em pesquisa; todos esses fatores, mais o insuficiente interesse dos alunos, fazem com que o objetivo seja difícil de alcançar. Conclusão: Os grupos de pesquisa com estudantes formam as pessoas no trabalho colaborativo e desenvolvem habilidades que permitem a formação integral dos alunos.