RESUMO
Twelve patients between 18 and 53 years of age were included. MAD plus nutritional supplementation was administered to 75% (n = 10) of the participants, one (8.3%) received MAD alone, and 16.7 (n = 2) received Classic Ketogenic Diet (cKD) plus nutritional supplementation. Oral nutritional supplementation, administered in the outpatient setting, provided patients with between 31 and 55% of the total caloric value. In the first month of KDT treatment, 83.3% (n = 10) of patients reduced the number of weekly seizures by 40% (median). At six months of treatment, 75% of patients had at least halved the number of weekly seizures. At 12 months of treatment, the number of weekly seizures had been reduced by 85.7% (median). KDT was well tolerated, and there was no need to discontinue treatment. This study provides real-world information on the use of KDT, particularly MAD in adults, in developing countries. Future studies in larger cohorts will provide further information on different types of KDT, adherence, and patient-reported outcomes.
RESUMO
Resumen Introducción: El delírium es un síndrome neuropsiquiátrico de etiología multifactorial que se presenta de forma frecuente en el adulto mayor hospitalizado. En Santander no hay estudios que describan su incidencia y factores epidemiológicos asociados. Objetivo: Evaluar la incidencia de delírium, características clínicas según el tipo, mortalidad a 30 días de hospitalización y complicaciones asociadas al delírium, en pacientes adultos mayores de 65 años hospitalizados en un departamento del nororiente colombiano. Materiales y métodos: Se incluyeron pacientes ≥ 65 años hospitalizados en sala general de la Clínica FOSCAL. Se excluyeron pacientes con delírium al ingreso, hospitalizados en unidad de cuidado crítico, intubación orotraqueal, Glasgow <8/15 y con limitación para evaluar el delírium de forma adecuada. Resultados: De 492 pacientes hospitalizados con edad promedio de 75 años, la incidencia acumulada fue de 9,3%; con mayor porcentaje en mujeres (63%) y en ≥ 85 años (31,5%). Se evidenció una asociación con mayor estancia hospitalaria (11.0 vs 7.1 días, p <0.05), un mayor deterioro funcional evaluado por escala Barthel y riesgo de mortalidad (HR:2.9 IC95%: 2.1-3.4). El sexo masculino, el estado cognitivo normal, índice de Barthel ≥ 60 y estado nutricional normal fueron factores protectores. Conclusiones: La incidencia de delirium en la población del oriente colombiano tuvo una incidencia similar que a nivel mundial. Se asoció con mayor estancia hospitalaria, declinación funcional y mortalidad. Aplicando escalas de tamizado cognitivo, funcional y nutricional se podrían identificar los pacientes con mayor vulnerabilidad para desarrollo de delirium. MÉD.UIS.2021;34(1):9-17.
Abstract Introduction: Delirium is a neuropsychiatric syndrome of multifactorial etiology that occurs frequently in hospitalized older adults. There are no studies describing the incidence of delirium in Santander and its associated epidemiological factors. Objective: To assess the incidence of delirium, clinical characteristics according to type, mortality after 30 days of hospitalization and complications associated with delirium, in adult patients over 65 years hospitalized in a department in Colombian northeast. Materials and Methods: We included all hospitalized patients ≥ 65 years. We excluded patients with delirium on admission, those hospitalized in intensive care unit, with orotracheal intubation, Glasgow < 8/15, or with factors limiting the ability to assess delirium. Results: 492 hospitalized patients with an average age of 75 years were analyzed. The cumulative incidence of delirium was 9.3%. Of these patients there was a higher percentage of women (63%) and adults ≥ 85 years (31.5%). The greatest association was related to longer hospital stay (11.0 vs 7.1 days, p <0.05), functional impairment evaluated by Barthel scale, and increased risk of mortality (HR:2.9 IC95%: 2.1-3.4). Male sex, normal cognitive status, Barthel index ≥ 60 and normal nutritional status were protective factors. Conclusions: The incidence of delirium in the population of eastern Colombia was similar to the incidence worldwide. Delirium was associated with longer hospital stay, functional decline, and mortality. Applying cognitive, functional, and nutritional screening scales, it would be possible to identify patients with greater vulnerability to delirium development. MÉD.UIS.2021;34(1):9-17.
