Acute seizure epidemiology in a neurological emergency department. / Epidemiologia del descontrol de la epilepsia en un servicio de urgencias neurologicas.

INTRODUCTION: Acute seizures in patients with epilepsy are a potential of source of neurological damage; their causes must be researched. AIM: To explore the epidemiology of acute seizure exacerbations in patients with epilepsy in a neurological emergency department in Mexico City. PATIENTS AND METHODS: Descriptive prospective study of patients with a previous diagnosis of epilepsy that receive medical care in an emergency department due to acute seizures. RESULTS: 100 patients were analyzed between august 2016 and January 2017. 86 patients presented with focal seizures, of which 76 were focal to bilateral tonic-clonic, 2 with impaired awareness and motor onset, 3 with impaired awareness and non-motor onset, 1 without impaired awareness and motor onset, and 4 without impaired awareness and non-motor onset. 14 patients had generalized seizures with motor onset. The causes of exacerbation were as follows: 26 patients due to antiepileptic dose omission, 21 due to a unknown cause, 19 due to infection, 13 due to sleep deprivation, 3 due to stress, 3 were catamenial, 2 due to alcohol abuse and 3 due to other reasons. Of the 26 patients with dose omission, 10 were due to forgetfulness, 7 refused to comply with their prescription, 6 could not afford to buy their prescription and 3 had their prescription changed by another doctor. CONCLUSIONS: In Mexico, antiepileptic drug dose omission represents up to 25% of patients with acute seizure exacerbations; increased patient education on epilepsy hygiene measures may be an area of opportunity for reducing its frequency.

TITLE: Epidemiologia del descontrol de la epilepsia en un servicio de urgencias neurologicas.Introduccion. El descontrol de la epilepsia representa un potencial daño neurologico, por lo que deben investigarse sus causas. Objetivo. Explorar la epidemiologia de pacientes mexicanos con descontrol agudo de epilepsia en un servicio de urgencias neurologicas. Pacientes y metodos. Analisis prospectivo descriptivo de pacientes con diagnostico previo de epilepsia que acuden a un servicio de urgencias por descontrol de las crisis. Resultados. Se analizo a 100 pacientes entre agosto de 2016 y enero de 2017. Ochenta y seis fueron crisis focales, de las cuales 76 fueron focales a bilaterales tonicoclonicas, dos fueron con alteracion de la consciencia de inicio motor y tres de inicio no motor, una sin alteracion de la consciencia de inicio motor y cuatro de inicio no motor. Catorce fueron generalizadas de inicio generalizado motor. Las causas de descontrol fueron: 26 pacientes por falta de adhesion al tratamiento antiepileptico, 21 de causa desconocida, 19 por infeccion, 13 por privacion de sueño, 10 por ajuste de tratamiento, tres por estres, tres por menstruacion, dos por uso de alcohol y tres por otras razones. En los 26 pacientes con falta de adhesion, 10 fueron por olvido de dosis, siete por negarse a tomar el medicamento, seis por causas economicas y tres por indicacion de medico ajeno a la institucion. Conclusiones. En Mexico, la falta de adhesion al tratamiento representa un 25% de los casos de descontrol de la epilepsia, lo que es un area de oportunidad para incrementar la educacion de higiene de crisis y disminuir la frecuencia de estas.

Elevation of activity of creatine phosphokinase (CK) and its isoenzymes in the newborn is associated with fetal asphyxia and risk at birth.

OBJECTIVE: To investigate the relationship of creatine phosphokinase and its isoenzymes with fetal asphyxia and risk at birth. METHODS: Thirty-five pregnant women with high-risk pregnancy were studied. RESULTS: In 21 patients, fetal distress was diagnosed by interpretation of the fetal heart rate tracing (FHR). The remaining 14 women, having normal fetal cardiotocography, were considered as the control group. Total CK and its isoenzymes activity was measured in cord sera and 24 h after birth in peripheral blood. Abnormal FHR patterns correlate well with elevated enzyme activities. Total CK and its isoenzymes (CK-MM, CK-MB, and CK-BB) exhibited higher values in asphyxiated infants as compared to normal neonates. Electrocardiographic ischemia occurred in seven newborns who had elevated CK-MB and CK-BB levels, both at birth and within 24 h postpartum. Chromatographic study showed in normal neonates that the predominant isoenzyme was CK-MM, whereas CK-BB activity was negligible. In the newborns with abnormal FHR, CK-MB and CK-BB were increased with predominance of CK-MB. CONCLUSIONS: Antepartum fetal distress is associated with release of CK-BB, and particularly CK-MB; therefore, these biochemical markers may indicate either brain or myocardial damage.

Effect of naloxone on serum prolactin levels in adult male rabbits.

In order to clarify the possible physiological role of endogenous opioid peptides (EOP), we studied the effect of low doses of naloxone (specific opiate antagonist) on plasma prolactin levels in male rabbits. Five groups of five male rabbits each was injected daily between 8-9 a.m., with naloxone 12.5, 25, 50, 100 and 200 microg/kg/day. An additional group of ten animals was injected with saline solution and considered the control group. Blood samples were taken at baseline before naloxone administration and later at 90 min and 1, 2, 4, 7, 10 days after its administration. Samples were also taken 4 days after stopping naloxone administration (day 14). Plasma prolactin levels were measured by RIA. A significant constant decrease in PRL levels was seen with the 12.5 microg at 90 minutes, while with the remaining doses a progressive decrease was recorded throughout the study.

The magnitude of growth hormone elevation is related with the proportion of monomeric form in acromegaly.

In acromegalic patients monomeric GH form constitutes the larger proportion of circulating GH; however, no data are available concerning the relation between total GH elevation and the predominance of GH forms. Therefore, we studied the relationship between the degree of GH elevation and the proportion of GH isoforms. Sera from 11 patients with active acromegaly were subjected to gel chromatography on Sephadex G-100 column and fractions were collected for RIA to measure GH. The monomeric form of GH was predominant and exhibited a lineal correlation (r = 0.76, p < 0.01) with the circulating GH, thus the higher elevation of GH, the major proportion of monomeric GH. IGF-1 changes correlate with changes in monomeric GH but no better than for total GH. There was a correlation observed (r = 0.65) between the proportion of low GH forms and the presence of hyperglycemia, although the physiological role of the lower molecular GH forms is still unknown. In conclusion, it was demonstrated that the relative proportion of GH molecular forms changes according to the magnitude of the elevation of total GH.

Evaluation of an immunoenzymometric assay (IEMA) using automated system for determination of luteinizing hormone and follicle stimulating hormone.

It has been proposed that automated systems for immunoenzymometric assay (IEMA) may substitute traditional radioimmunoassay (RIA) for measurement of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in blood due to the advantage of being more rapid, higher sensitivity, lower cost and not requiring radioactive reagents. The study was designed to evaluate both systems using serum samples to determine luteinizing hormone (LH) and follicle-stimulating hormone (FSH) concentrations. The automatic system (ES-300) for IEMA utilized two monoclonal antibodies, one of them on the solid phase was the specific extractant for the antigen, and the other was a peroxidase labeled antibody which recognizes a different epitope in the antigen molecule, specifically bound in linear proportion to the antigen concentration. Blood samples were obtained from patients who were treated at the hospital for various clinical problems ("problem group") as well as blood samples from patients in whom FSH and LH concentrations were already known ("high", "medium" and "low" levels) by previous RIA ("control group"). IEMA showed a higher sensitivity, 0.42 and 0.96 mIU/ml for FSH and LH, respectively, whereas RIA was 1.95 mIU/ml for both hormones. Intra- and interassay coefficient of variation were below 10% within the range of 15-150 mIU/ml for FSH and 5-100 mIU/ml for LH; however, the coefficient of variation was 15-25% at lower concentrations of FSH and LH. Accuracy of IEMA was evaluated by recovery percentage, thus when high and medium concentrations of FSH and LH were analyzed the recovery was between 99-104%. On the other hand, the recovery was 110% when low levels of FSH and LH were used. In conclusion, IEMA resulted reliable when FSH and LH concentrations are in the middle and high range; likewise, the detection limit of IEMA was lower than RIA, particularly for FSH. On the bases of these results, IEMA showed several advantages over RIA, but its reliability diminishes when serum samples contain low FSH and LH concentrations. It is important to extend these studies to steroid assays and elaborate a database in each laboratory.

Caracterización hormonal de los adenomas hipofisarios no funcionantes / Hormonal characterization of the non fuctioning pituitary adenomas

Se estudiaron 98 pacientes con adenomas no funcionantes, 34 hombres y 64 mujeres, realizando un estudio hormonal en suero para conocer su perfil endocrino. Con tal objeto, se efectuaron determinaciones de hormona folículo estimulante y hormona luteinizante (FSH, LH), prolactina (PRL), estadiol (E2), testosterona (T), cortisol, hormona del crecimiento (GH), hormona adrenocorticotrópica (ACTH), hormona estimulante del tiroides (TSH) y gastrina (Ga) por radioinmunoanálisis. Los resultados mostraron marcado hipergonadotropismo en el 47//de los pacientes, con niveles séricos de FSH y LH muy elevados y un incremento inesperado de la concentración de Ga (Grupo I). En contraste, el resto de los pacientes tuvo concentraciones normales o bajas de gonadotrofinas y Ga (Grupo II). El grupo I mostró una relación inversa entre los niveles de gonadotropinas y esteroides gonadales (E2 o T) con cifras significativamente menores que los valores normales y los encontrados en el Grupo II (<0,00l) en el cual la relación fue lineal positiva. Tambien se observó una relación directa entre la concentración de FSH conTSH (r=0,75) y Ga (r=0,80), probablemente por los neurotransmisores que determinan la secreción de estas hormonas. La TSH al igual que las hormonas tiroideas, tuvo cifras más elevadas en el Grupo I, mientras que los valores de PRL fueron más bajos (P<0,0001). La concentración de GH y ACTH fuer normal en ambos,no obstante,el 33 por ciento de los pacientes del Grupo II presentó hipocortisolismo e hipotiroidismo. La edad promedio de los pacientes analizada por décadas, no fue estadísticmente diferente entre los grupos y no explica las diferencias encontradas, aunque en el Grupo I predominaron las mujeres. En éstas, la elevación de FSH podría estar condicionada por la deficiencia gonadal, acorde a la edad de las pacientes (49,8 Ð 9,6 años), sin embargo, algunos valores fueron extraordinariamente elevados y existe la posibilidad de que la hipófisis en condiciones patológicas, como es la forma adenomatosa,pueda producir en forma autónoma,moléculas de LH y FSH alteradas y carentes de actividad biológica, o bien, subunidad Ó libre, como se ha demostrado en algunos gonadotropomas. Por otra parte, algunos de los casos con TSH elevada podrían considerarse verdaderos TS-Homas, que no suprimen su secreción a pesar de la elevada concentración de hormonas tiroideas. Así, podría decirse que dentro de los no funcionantes, están enmarcados algunos de estos adenomas. Se concluye que, desde el punto de vista hormonal, los adenomas del Grupo II son los verdaderos no funcionantes