Factors involved in time reduction between seizure relapses in patients with epilepsy attending emergency rooms in Medellín, Colombia.

BACKGROUND: Seizure relapses are the leading cause of admission to emergency rooms (ER) in people with epilepsy. OBJECTIVE: To analyze administrative and clinical factors associated with the duration between seizure relapses in people with epilepsy admitted to the Neurological Institute of Colombia (Medellin) between July 2018 and July 2019. MATERIALS AND METHODS: A retrospective follow-up study of 156 patients over 18 years old, diagnosed with epilepsy, and treated for over a year. The outcome variable was the time between seizure relapses, identified through the record of ER attendances. In addition, difficulties in the prescription filling process (delay, omission, or brand change) and clinical characteristics were analyzed as potential associated influence factors. The statistical analysis was performed using the Prentice, Williams & Peterson-Gap Time survival model for recurrent events. Finally, Adjusted Hazard Ratios (aHR) with 95% confidence intervals (95%CI) are also presented. RESULTS: One hundred fifty-six patients were analyzed. Their average age of diagnosis was 15.5 years (SD = 22.5), the median number of monthly seizures was 3 (SD = 9.3), and 50.6% were women. Moreover, difficulties in the prescription filling process were associated with a time reduction between seizure relapses (aHR = 2.61; 95%CI 1.49-4.57), showing a similar impact as having a history of three or four types of events (aHR = 2.96; 95%CI 1.23-7.12) and neuropsychiatric comorbidity (aHR = 1.89; 95%CI 1.04-3.54). CONCLUSION: Neuropsychiatric comorbidity, history of several types of events, and experiencing difficulties with prescription filling are associated with lower benefit from treatment to control seizure relapses.

Ataque cerebrovascular agudo como presentación de neurocisticercosis: reporte de un caso / Ischemic stroke as a presentation of neurocysticercosis: report of a case

RESUMEN La cisticercosis es una infección parasitaria, prevalente principalmente en países en vía de desarrollo, con una seroprevalencia en Colombia de 8,6 % (1). Generalmente, el diagnóstico se realiza en el contexto de una de sus formas más graves, la neurocisticercosis, que a su vez presenta un espectro grande de manifestaciones que van desde crisis epilépticas hasta accidentes cerebrovasculares agudos. Este reporte describe el caso atípico de una mujer joven con infarto cerebral secundario a neurocisticercosis, complicación que representa un reto clínico importante y que se debe considerar en el diagnóstico diferencial.

SUMMARY Cysticercosis is a parasitic infection prevalent mainly in developing countries, with a seroprevalence in Colombia of 8.6 %. Diagnosis is usually made in the context of one of its most serious forms, neurocysticercosis, which in turn has a large spectrum of manifestations ranging from epileptic seizures to acute cerebrovascular accidents. This report describes the atypical case of a young woman with cerebral infarction secondary to neurocysticercosis, a complication that represents an important clinical challenge and that should be taken into account in the differential diagnosis.

Patrones de uso de fármacos antidemencia en un grupo de pacientes de Colombia / Patterns of antidemential drug use in a group of patients from Colombia

Introducción. Los beneficios del manejo farmacológico con medicamentos antidemencia aún no están del todo demostrados, e incluso hay carencia de trabajos que describan su perfil de utilización. El presente trabajo buscó determinar los patrones de prescripción de fármacos antidemencia en una población de Colombia. Pacientes y métodos. Estudio descriptivo de corte transversal. Mediante una base de datos sistematizada de 3,5 millones de afiliados al sistema de salud colombiano, se seleccionó a pacientes con dispensaciones ininterrumpidas de fármacos antidemencia entre agosto y octubre de 2016. Se analizaron variables sociodemográficas, farmacológicas y comedicaciones. Se estimaron los costes de las terapias a partir del precio de referencia de los medicamentos. Resultados. Se identificó a 8.372 pacientes con una edad media de 79,5 ± 8,7 años; el 65,3% (n = 5.471) fueron mujeres. El fármaco más utilizado fue la rivastigmina (69,6%), principalmente en presentación transdérmica, seguida de la memantina (31,4%). En general, la dosis media administrada por día fue inferior a la dosis diaria definida. Solamente 568 pacientes (6,7%) usaron terapia combinada. El 84,3% de los pacientes (n = 7.061) usó medicamentos para alguna comorbilidad y el 54,2% (n = 4.535) tenía otro neurofármaco. El coste por 1.000 habitantes/día de la rivastigmina fue de 3,47 dólares, y de la memantina, de 0,30 dólares. Conclusión. Los pacientes con medicamentos antidemencia los están empleando en dosis inferiores a las definidas y presentan una importante frecuencia de comorbilidades y comedicaciones

Introduction. The benefits of pharmacological therapy with anti-dementia drugs are not yet fully demonstrated and there is even a lack of publications describing their use profile. The present work sought to determine the prescription patterns of anti-dementia drugs in a Colombian population. Patients and methods. Descriptive cross-sectional study. Through a systematized database of 3.5 million affiliates to the Colombian health system, patients with uninterrupted dispensing of anti-dementia drugs between August-October/2016 were selected. Sociodemographic, pharmacological and comedication variables were analyzed. The costs of the therapies were estimated from the reference price of the medicines. Results. We identified 8372 patients with a mean age of 79.5 ± 8.7 years and 65.3% (n = 5471) were women. The most widely used medication was rivastigmine (69.6%), mainly in transdermal presentation, followed by memantine (31.4%). In general, the average dose administered per day was lower than the defined daily dose. Only 568 patients (6.7%) used combination therapy. 84.3% of patients (n = 7061) used some additional medication and 54.2% (n = 4535) had another neurologic medication. The cost per 1000 inhabitants/day of rivastigmine was 3.47 USD and for memantine 0.30 USD. Conclusion. Patients with anti-dementia drugs are using them at doses lower than those defined and they present an important frequency of comorbidities and comedications

Efectividad de los apósitos de plata en la prevención de la infección del sitio operatorio en heridas contaminadas / Effectiveness of silver dressings in preventing surgical site infection in contaminated wounds

Introducción: existe controversia sobre la eficacia de los apósitos impregnados de plata en la prevención de la infección del sitio operatorio en heridas contaminadas. Objetivo: evaluar el efecto de los apósitos con plata en pacientes posquirúrgicos con heridas contaminadas en un hospital de III nivel. Métodos: estudio prospectivo, controlado, que comparó los apósitos con plata con las gasas en solución salina en pacientes posquirúrgicos con heridas contaminadas. Las heridas recibieron uno de dos tipos de tratamiento tópico: gasas en solución salina (GS) o apósitos con plata (GP). El efecto final para medir fue la aparición de infección del sitio operatorio (ISO) en los 30 días siguientes a la intervención quirúrgica. Resultados: se analizaron 65 pacientes. La incidencia de ISO fue del 14% (9/65) sin diferencias estadísticamente significativas entre ambos grupos (15,2% frente a 12,5%, p = 0,75). El análisis de regresión multivariado no mostró relación entre el tipo de apósito y la aparición de infección. Conclusión: los apósitos impregnados de plata son seguros y efectivos para la disminución de la ISO. Se requieren estudios adicionales para saber si su efecto es superior al de los apósitos tradicionales.

Introduction: Silver gauzes are designed to treat infected wounds, but there is controversial evidence about their effectiveness in preventing surgical site infections in contaminated wounds. Objective: To evaluate the effect of silver gauzes in patients undergoing surgery with contaminated wounds at a university-based tertiary referral center. Methods: This was a prospective, controlled trial comparing a silver gauze dressing with saline gauze dressings in patients undergoing abdominal surgeries with contaminated wounds. Patients were randomly assigned to receive either a silver gauze (SG) dressing or saline gauze dressings (SD). The primary end point was surgical site infection occurring within 30 days of surgery. Results: 65 patients were enrolled in the review. The incidence of surgical site infection was 14% (9/65). No differences were observed among groups (15.2% vs. 12.5%, p = 0.75). Multivariate analysis revealed no relationship between the type of dressing and surgical site infection. Conclusion: Silver gauzes are safe and effective in preventing surgical site infections in surgeries with contaminated wounds. Further trials are required to find out if they have advantages over standard dressings.

Vendaje neuromuscular: ¿tienen todas las vendas las mismas propiedades mecánicas? / Neuromuscular taping: Do all the different tapes have similar mechanical properties?

ObjetivoEl propósito del trabajo fue evaluar las diferentes características mecánicas ante esfuerzos de tracción en vendas usadas en la técnica del vendaje neuromuscular (Kinesio™ taping). Con ello, se pretende saber si los diferentes colores y marcas obedecen a características mecánicas diferentes. El propósito final es tener información que permita mejorar los protocolos de colocación, con mayor o menor tensión, para optimizar la acción (terapéutica o de otro tipo) del vendaje.MétodosSe cortaron especímenes de vendas de 30cm de largo de las marcas Cure Tape™ (negro, azul, rojo y piel), Sports Tex™ (negro, azul, rojo), Kinsiotape™ (azul y rojo) y Kinesiology Tape™ (azul y rojo). Se aplicaron cargas progresivas para explorar los diferentes esfuerzos a la tracción y las elongaciones relativas hasta llegar a la rotura de las vendas.ResultadosNo se encontraron los mismos comportamientos al comparar colores iguales en las diferentes marcas exploradas. La máxima elongación antes de romper varió entre el 77 y el 106% en las diferentes vendas testadas. La tensión máxima antes de romper varió entre 4,57 y 8,06MPa. Los módulos de Young promedio de las zonas lineales de las gráficas esfuerzo/deformación variaron entre 0,0526 y 0,0966MPa. Finalmente, los grosores de las diferentes vendas se situaron entre 0,44 y 0,55mm.ConclusionesEs recomendable no cambiar de marca ni color para una determinada aplicación del vendaje neuromuscular. De esta manera será más fácil conseguir una tensión de la venda cercana a la óptima mediante un determinado protocolo de estiramiento previo(AU)

ObjectiveThe purpose of the present study was to assess the mechanical characteristics of different types of tape utilized in neuromuscular taping (Kinesio Taping) during stress-strain tests, and find out whether the different brands and colours available in the market show different mechanical characteristics. A secondary purpose was to provide information related to the tape strain during the taping preparation, to optimize the taping effect.MethodsThirty-centimeter pieces of tape [Cure Tape (black, blue, red and pink), Sports Tex (black, blue and red), Kinsiotape (blue and red) and Kinesiology Tape (blue and red)] were cut and fixed. Then, progressive loads until the point of rupture were applied to calculate the stress-strain relationship for each tape.ConclusionsThe large variability found in the mechanical behaviour of the different tapes leads us to recommend the utilization of the same brand and colour for a given purpose. This will allow the physiotherapist to achieve an optimum tension level of the tape with a protocolized tape elongation(AU)

Hominid exploitation of the environment and cave bear populations. The case of Ursus spelaeus Rosenmüller-Heinroth in Amutxate cave (Aralar, Navarra-Spain).

Cave bears (Ursus deningeri and U. spelaeus) and hominids (Homo heidelbergensis, H. neanderthalensis, and H. sapiens) were potential competitors for environmental resources (subterranean and open air). Here, we examined the age at death of cave bear (Ursus spelaeus Rosenmüller-Heinroth) specimens from Amutxate cave in order to shed light on the effect of resource sharing between cave bears and hominids. After studying dental wear of the deciduous and permanent dentitions, the ontogenetic development of mandibles, and incremental layers of cement (annuli), we defined five age groups differentiated by marked development and size gaps. Our findings indicate that after hibernating, bears abandoned the den, thereby leaving the subterranean environment (caves) free for temporary hominid occupation-this would explain the subtle traces of hominid presence in many dens. However, a simple calculation based on age at death of subadult and adult cave bear specimens in Amutxate cave, extrapolated to the whole cave area, showed that the area surrounding this cave hosted bears for at least 9,000 years. This length of habitation, quite similar to the time-span derived from amino acid racemization and electron spin resonance, indicates that bear populations in the Amutxate cave constituted a serious constraint for hominid exploitation of the environment.