Experience of Subcutaneous Levetiracetam in Palliative Care.

BACKGROUND: Seizures are common in palliative care patients and its control is essential in the management of these patients as it helps to reduce suffering at the end of life. Subcutaneous levetiracetam has been used off-license for seizure control in palliative care. OBJECTIVE: The objective of the study was to describe our experience with subcutaneous levetiracetam in two hospitals in Bogota, Colombia. METHODS: We conducted a retrospective review of patients treated with subcutaneous levetiracetam in two hospitals in Colombia during 2019-2021. Data were extracted from medical records, and participants were followed up as outpatients. RESULTS: Twenty-one patients were included into the study. No severe adverse effects or rise in ictal frequency were documented. Twelve patients died during hospitalization and nine continued treatments as outpatients. The principal diagnosis was structural focal epilepsy. The daily dose of levetiracetam ranged from 1,000 mg to 3,000 mg, and the duration of treatment varied among subjects between 1 and 360 days. CONCLUSION: Subcutaneous levetiracetam was well tolerated and effective in controlling seizures in palliative care when oral administration or intravenous access was not an option. Randomized controlled trials are needed to elucidate the efficacy and tolerability of subcutaneous levetiracetam in clinical practice.

Urine proteomics as a non-invasive approach to monitor exertional rhabdomyolysis during military training.

Exertional rhabdomyolysis (ERM), a condition often associated with strenuous exercise, a common practice in the military activities, can be defined as the process of injury and rupture of muscle cell membranes, with leakage of its components into the bloodstream. Creatine kinase (CK) has been used for ERM diagnosis, albeit several studies reported the discrepancy between CK levels and clinical signs or symptoms. In this study, we analyzed the biochemical profile of the blood, and the urinary proteome of ten marine soldiers in a special training course. The samples were collected in two periods, M1 and M2, which correspond to the lowest and highest CK levels during training, respectively. Quantitative urinary proteome profile of M1 and M2 showed changes in proteins involved in immune system and cell adhesion-related pathways after strenuous physical exercise. Changes in the abundance of several proteins was observed in individuals carrying genetic polymorphisms related to greater risk for muscle damage. A panel of proteins (CTSH, PIK3IP1, DEFB1, ITGB1, BCAN, and TNFRSF10C) presented high correlation with classical blood biochemical markers of ERM and AGT MET235Thr and ACE I/D polymorphisms. These proteins represent potential urine markers of muscle damage due to intense physical conditions such as military training activities. SIGNIFICANCE: This study analyzed the blood and urine of a cohort of marine soldiers enrolled in a special training program including missions with low and high exposure to strenuous exercise. The biochemical blood profile, polymorphisms mapping and mass spectrometry-based analyses of the urinary proteome was evaluated in such a controlled samples. A total of 226 urinary proteins associated to immune system, cell adhesion and redox homeostasis were significantly changes during ERM shedding lights on the disease pathogenesis. In particular, a panel of six proteins were associated to classical ERM markers and could be used as early non invasive biomarkers.

A simple and reliable refractometric method to determine the total solids concentration of the cervico-vaginal bovine mucus samples.

Cervico-vaginal mucus (CVM) is a viscoelastic substance continuously produced by secretory cells of the endocervix and the vagina of cows. Its physicochemical composition varies depending on the hormonal status of the estrous cycle. In veterinary medicine refractometry is a widely diffused technique to determine total solids (TS) content of biological samples, but there are not published data of CVM total solids from refractometric measures. Refractometric TS determination contributes to the qualitative constituents analysis of CVM, additionally it is an easier and more inexpensive technique than gravimetric TS determination. The main goal of the present paper was to validate a refractometric method to estimate TS concentration of the soluble fraction of CVM samples. Samples were collected from seventy-three Holando Argentino cows of Santa Fe province farms in Argentina. Cows were classified in three experimental groups: healthy, subclinical (SE) and clinical endometritis (CE) group. To achieve a solubilisation protocol for CVM samples, four Triton™ X-100 concentrations were tested. Refractive index (RI) and gravimetric total solid (gTS) concentration of solubilised samples were determined for the three experimental groups. A mathematical equation was determined with the experimental data from the healthy group, in order to obtain calculated total solid concentration (cTS) from refractivity (R) values. To validate the RI method for CVM samples, cTS concentrations were compared with gTS concentrations from endometritis group samples. Triton™ X-100 0.01% (V/V) improved CVM samples handling and did not change physicochemical parameters (gTS, Na+ and K+ concentration, and RI values). The linear regression equation obtained was: cTS (g/dL) = (R - 0.67)/16.2, r2 = 0.91. Correlation between gTS and cTS concentration was: r = 0.97 for SE group and r = 0.97 for CE group. The homogenization protocol allowed the measurement of physicochemical parameters without altering their values. A high correlation coefficient between cTS and gTS postulates refractometry as an accurate method to determine TS concentration for solubilised CVM samples.

Las diferentes facetas de la encefalitis autoinmune / The different facets of autoinmune encephalitis

RESUMEN INTRODUCCIÓN: La encefalitis autoinmune es causada por mecanismos inmunes antineuronales, su presentación clínica es heterogénea, los criterios clínicos y paraclínicos disponibles orientan el abordaje, sin embargo, el reto ocurre cuando no hay autoanticuerpos detectables en suero o líquido cefalorraquídeo (LCR). METODOLOGÍA: Reportamos cuatro casos destacando la variabilidad de las manifestaciones clínicas, que ante la ausencia de anticuerpos (negativos finalmente en tres de los casos) fueron tratados con inmunoterapia con buena respuesta. CONCLUSIÓN: En sitios donde no se dispone de medición de anticuerpos de manera expedita, o a pesar de ser estos negativos, ante la sospecha clínica, apoyado de estudios de LCR, resonancia magnética nuclear y registro electroencefalográfico, se sugiere iniciar inmunoterapia temprana, usualmente dando lugar a reversibilidad del trastorno neurológico.

SUMMARY INTRODUCTION: Autoimmune encephalitis is caused by antineuronal immune mechanisms, its clinical presentation is heterogeneous, clinical and paraclinical criteria guide the approach, however, the challenge occurs when there are no detectable autoantibodies in serum or cerebrospinal fluid. METHODOLOGY: We report four cases that highlight the variability of clinical manifestations, which in the absence of antibodies (finally negative in three of the cases) were treated with immunotherapy with good response. CONCLUSION: In places where antibody measurement is not available expeditiously, or despite it being negative, given clinical suspicion, supported by CSF studies, magnetic resonance imaging and electroencephalographic recording, it is suggested to start early immunotherapy, usually resulting in the reversibility of the neurological disorder.

Organ Preservation into the 2020s: The Era of Dynamic Intervention.

Organ preservation has been of major importance ever since transplantation developed into a global clinical activity. The relatively simple procedures were developed on a basic comprehension of low-temperature biology as related to organs outside the body. In the past decade, there has been a significant increase in knowledge of the sequelae of effects in preserved organs, and how dynamic intervention by perfusion can be used to mitigate injury and improve the quality of the donated organs. The present review focuses on (1) new information about the cell and molecular events impacting on ischemia/reperfusion injury during organ preservation, (2) strategies which use varied compositions and additives in organ preservation solutions to deal with these, (3) clear definitions of the developing protocols for dynamic organ perfusion preservation, (4) information on how the choice of perfusion solutions can impact on desired attributes of dynamic organ perfusion, and (5) summary and future horizons.

Barreras de acceso a la cirugía de la epilepsia: revisión de la bibliografía / Barriers impeding access to epilepsy surgery: a review of the literature

La epilepsia farmacorresistente es una condición crónica con consecuencias a largo plazo que puede ser tratada quirúrgicamente. La eficacia y la seguridad de la cirugía de la epilepsia del lóbulo temporal se han establecido a través de un gran número de estudios de cohorte retrospectivos y prospectivos y dos ensayos clínicos controlados aleatorizados. A pesar de los excelentes resultados comunicados con la cirugía, la bibliografía sugiere que este procedimiento es un tratamiento subutilizado. Aunque no existe evidencia de esto, entre algunos de los motivos descritos se apuntan el fallo de los médicos de atención primaria y los neurólogos en proveer información, identificar y remitir a los pacientes a un centro de cirugía; los diferentes niveles de tecnología en los centros, lo que provoca distintas estrategias de selección de los candidatos; la creencia de que la cirugía de la epilepsia es un procedimiento arriesgado que debería contemplarse sólo como última opción; la preferencia del paciente por evitar la cirugía; el deseo de los padres de esperar hasta que sus hijos sean lo suficientemente mayores para participar en el proceso de toma de decisiones; el hecho de que las aseguradoras no cubran los gastos asociados con las evaluaciones prequirúrgicas o la carencia de un seguro médico, y la desigualdad racial y social, entre otros. En este artículo se revisan los datos epidemiológicos disponibles en relación con la falta de acceso a la cirugía de la epilepsia (AU)

Drug-resistant epilepsy, a chronic condition with long-term consequences can be treated with surgery. The efficacy and safety of surgery for temporal lobe epilepsy have been established through a large number of retrospective and prospective cohort studies and two randomized controlled clinical trials. Despite the excellent outcomes reported after surgery, the literature suggests that this procedure is an underutilized treatment. While evidence is lacking as to why epilepsy surgery is underused, cited reasons include: failure of primary care physicians and neurologists to provide information and identify patients who could be referred for surgery; different levels of technology at various centers, resulting in different candidate selection strategies; the belief that epilepsy surgery is a risky procedure and that it should be only viewed as the last option; patient preference to avoid surgery; parents wanting to wait until their child is old enough to participate in the decision-making process regarding surgery; unwillingness of insurers to cover the expenses associated with presurgical evaluations or lack of insurance; racial and social disparities, among others. In this paper we review the available epidemiological data about lack of utilization of epilepsy surgery (AU)

Potenciales factores clínicos y sexuales asociados con Actinomyces spp. en un servicio de citología cérvico-uterina de Medellín (Colombia) 2013-2014 / Potential clinical and sexual factors associated with Actinomyces spp. in a service of pap smear, Medellín (Colombia) 2013-2014

Objetivo: determinar los potenciales factores clínicos y sexuales asociados a la infección por Actinomyces spp., en pacientes de un servicio de citología cérvico-uterina de una empresa social del estado del régimen subsidiado de Medellín. Métodos: estudio transversal, realizado con 27.576 registros citológicos recolectados entre 2013- 2014. Los datos se analizaron en SPSS 22, con medidas de resumen, frecuencias y estadística no paramétrica con significación del 0,05, los factores de confusión se controlaron con modelos de regresión logística binaria. Resultados: la prevalencia global de Actinomyces spp., fue 0,4%. Las prevalencias específicas fueron mayores en el grupo de mujeres con edad entre 21 y 50 años. Los factores que presentaron asociación estadística con la infección fueron el método de planificación, el consumo de tabaco y los hallazgos citológicos de inflamación. La odds de infección entre las mujeres que planifican con el DIU fue 268 veces mayor y de las que usan un método de barrera fue 7 veces mayor, en comparación con las mujeres que no planifican; en las mujeres que no fuman fue 1,76 veces mayor frente a quienes fuman, y de 2,5 en las mujeres sin atrofia en la evaluación oncológica frente a quienes no presentaron este hallazgo. Conclusión: la prevalencia de Actinomyces spp., fue mayor en mujeres en edad adulta entre 21 y 50 años, y los potenciales factores clínicos y sexuales que se encontraron fueron: ser usuaria del DIU, no presentar atrofia, no consumir tabaco yusar el método de barrera. Hallazgos que, por tanto, requieren de estudios analíticos que puedan dar cuenta de dichos resultados, además para poder direccionar y fortalecer los programas de educación y atención en salud con respecto a la infección poreste microorganismo, esto revela la importancia de la investigación descriptiva en la formulación de nuevas hipótesis...(AU)

Objective: to determine the potential clinical and sexual factors associated with infection by Actinomyces spp., in patients service of Pap smear of a social enterprise of state of subsidized regime of Medellin. Methods: cross-sectional study conducted with 27,576 cytological records collected from 2013 to 2014. Data were analyzed in SPSS 22, with summary measures, frequencies, and nonparametric statistic, a p value less than 0.05 was considered statistically significant. The confounding factors were controlled with binary logistic regression models. Results: the overall prevalence of Actinomyces spp., was 0.4%. Specific prevalences were higher in the group of women aged between 21 and 50 years. The factors that presented statistical association with infection were the planning method, smoking and cytology findings of inflammation.The odds ratio of infection among women who used IUD was 268 times higher and using a barrier method users was 7 times higher, in compared to women who do not used any planning method; in women who was not smoke 1.8 times higher compared to those who smoke, and 2.5 in women without atrophy in the oncological evaluation compared those who did not present this finding. Conclusion: the prevalence of Actinomyces spp. it was higher in adult women between 21 and 50 years, and potential clinical and sexual factors found were: being IUD user, do not present atrophy, do not consume snuff and use the barrier method. These Findings therefore require analytical studies that may account for these results, in addition to address and strengthen education programs and health care against infection by this organism, this reveals the importance of descriptive research the formulation of new hypotheses...(AU)

Signo de la "lengua brillante" en esclerosis lateral amiotrófica / "bright tongue" sign in amyotrophic lateral sclerosis / Sinal da "lingua lustrosa" em esclerose lateral amiotrófica

La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa. Aunque su diagnóstico sigue siendo clínico, los exámenes adicionales pueden ser utilizados para excluir otras enfermedades, así como para confirmar el diagnóstico. Uno de ellos son las neuroimagenes, donde la más utilizada es la resonancia nuclear magnética (RNM). En la literatura hay pocos signos específicos; el tracto corticoespinal, giro precentral y el cuerpo calloso son los principales sitios de alteración. Un signo patognomónico es el signo de la lengua brillante, debido a la alteración de la lengua en su estructura interna con áreas de aumento y disminución de intensidad de señal, en fases de severo compromiso bulbar con mayor intensidad en T1.

Amyotrophic lateral sclerosis is a progressive neurodegenerative disease, but its diagnosis remains clinical, additional tests may be used to exclude other diseases and to confirm the diagnosis. One of them is the images studies, and the most commonly used is magnetic resonance imaging. In literature there are few signs specific finding as major sites of alteration: the corticospinal tract, precentral gyrus, corpus callosum.. A pathognomonic sign"bright tongue sign'', because alteration in the internal structure with areas of increased and decreased signal intensity in severe bulbar commitment phases with greater intensity in T1.

A esclerose lateral amiotrófica é uma doença neuro-degenerativa. Embora seu diagnóstico ainda seja clínico, os examines podem-se aplicar para excluir outras doenças, assim como para confirmar o diagnóstico. Um de eles são as neuroimagens, onde as mais aplicada é a ressonância nuclear magnética (RNM). Na literatura ha poucas sinales específicas: o trato corticoespinal, giro precentrarl y o corpo caloso são os principais sites de alteração. Una sinal patognómica é a sinal da língua lustrosa, devido a alteração da língua na estrutura interna com áreas de aumento e diminuição de intensidade da sinal, em fases de severo compromisso bulbar com maior intensidades em T1.

Pautas, creencias y prácticas de crianza relacionadas con el castigo y su transmisión generacional / Patterns, beliefs and parenting practices related with punishment and the generational transmission of these in four families of low socio-economic level in the city of Bogotá / Padrões, crenças e práticas parentais relacionadas à punição e transmissão geracional em quatro famílias baixo nivel socioeconômico na cidade de Bogotá

La presente investigación tuvo como objetivo describir las pautas, creencias y prácticas de crianza relacionadas con el castigo y su transmisión generacional en cuatro familias de nivel socioeconómico bajo de la ciudad de Bogotá. Utilizamos entrevistas semiestructuradas, historias de vida, observaciones de campo, y el Software Atlas.ti para analizar los resultados. Encontramos que las pautas de crianza relacionadas con el castigo están enmarcadas en el rol del abuelo o de la abuela como cuidador o cuidadora entre semana, en el del padre o madre como cuidador o cuidadora de fin de semana, y en el del niño o niña como el sujeto travieso. Las creencias se establecen en torno al niño o niña como fuerte y frágil, y al castigo como formador, ambivalente, maltratante y temido.

This study is aimed to describe patterns, beliefs and parenting practices related to punishment and the intergenerational transmission of these in four families of low socio-economic level in the city of Bogotá. We used semi-structured interviews, life histories, field observations and Atlas.ti software to analyze the results. We found that parenting patterns associated with punishment are framed in the role of grandparent as the weak caregiver, the father/mother as weekend caregivers and the child as mischievous. Beliefs are established around the child as strong and fragile, and the punishment as a trainer, ambivalent, abusive and feared.

Este estudo teve como objetivo descrever os padrões, as crenças e as práticas parentais relacionadas à punição e sua transmissão intergeracional em quatro famílias baixo nivel socioeconômico na cidade de Bogotá. Utilizamos entrevistas semi-estruturadas, histórias de vida, observações de campo e o Software Atlas.ti para analisar os resultados. Descobrimos que os padrões de paternidade associada com a punição são enquadrados no papel de avô (ó) como um cuidador durante a semana, no fim de semana o pai / mãe e a educadora, o filho (a) como o ímpio. Crenças são estabelecidas em torno da criança tão forte e frágil, e a punição como um instrutor, ambivalente, abusivo e temido.

Factores que inciden en la motivación académica en un Programa de Medicina, Manizales, Colombia, 2010 / Factors that affect academic motivation in a Faculty of Medicine Manizales, Colombia, 2010

Antecedentes: El análisis de los factores multicausales, tanto internos como externos a la institución, que afectan la motivación académica, cobra relevancia en una facultad que busca la cualificación de la formación que brinda. Materiales y métodos: Se realizó un estudio de corte transversal con una población de 559 estudiantes inscritos en la Facultad de Medicina de la Universidad de Manizales (Manizales, Colombia), en el año 2010, de primero a décimo semestre, con una muestra representativa de 210 estudiantes. Se empleó una encuesta anónima para identificar algunos factores personales y sociales que puedan ser desmotivantes o incluso constituirse en factor asociado para deserción académica. Resultados: Como factores que inciden en la desmotivación académica, sólo 52,7% de los estudiantes respondieron que sienten apoyo institucional, 75,2% refieren algun tipo de maltrato y 52,4% se han sentido acosados sexualmente; 79,5% presentan estrés, en su mayoría moderado. Conclusiones: Se concluye que entre los factores que afectan la motivación académica e inciden en que cerca de la mitad de los estudiantes haya contemplado la posibilidad de abandonar sus estudios se encuentra el no percibir respaldo institucional, el acoso y el estrés. Cerca de la mitad de la población no percibe apoyo institucional, las tres cuartas partes manifestaron percibir algún tipo de maltrato y cerca de la mitad refiere haber sido víctimas de al menos un tipo de acoso, con mayor frecuencia verbal e indirecto; un alto número se ven sometidos a niveles moderados de estrés...