Frontotemporal Dementia: Dilemma in Discrimination From Similarly Presenting Neurological and Psychiatric Conditions.

Frontotemporal dementia (FTD) is the most common cause of neurocognitive decline, second to Alzheimer's disease (AD) and Lewy body dementia. Its presence offers a unique challenge to physicians trying to detect cognitive deficits, as it not only arises in middle age but also can be misdiagnosed as a primary psychiatric disorder. The following case describes the clinical course of a 50-year-old male with a recent history of sporadic visual and auditory hallucinations, followed by a gradual decline in cognitive function including declining memory, apathy and behavioral disinhibition, and social functioning, which are suggestive of FTD-type. Apart from the gradual decline of his cognitive function, the patient had multiple clinical encounters, during which he was misdiagnosed with schizophrenia. Furthermore, the report showcases the handful of conditions that FTD can be misdiagnosed and discusses the thorough clinical/psychological examination and investigations to be done to arrive at FTD.

Diagnostic Dilemma and Management Difficulties in a Young Patient With Psychosis and Benign Chorea: A Case Report and Review of the Literature.

Psychosis presents with hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, and negative symptoms. It most commonly appears in the setting of schizophrenia, although it could also appear in bipolar disorder, major depression, post-traumatic stress disorder (PTSD) and even in medical conditions and substance use. In young people, the diagnosis of psychosis can present as a challenge due to the overlap of psychotic conditions and other emotional, behavioral, and developmental disorders. In this case report, we present the case of a 19-year-old female with a history of bipolar disorder, oppositional defiant disorder (ODD), depression, anxiety, PTSD, and schizophrenia-spectrum disorder who was admitted to an inpatient psychiatric facility after presenting with acute onset of confusion.

The key to simplified management of an undescended parathyroid adenoma.

Undescended parathyroid adenoma is a rare cause of primary hyperparathyroidism that happens < 1% of cases. If not suspected, it can lead to a negative bilateral parathyroid exploration and extensive iatrogenic trauma. We propose that with proper imaging the correct diagnosis can be established to simplify surgical management. We describe two cases of patients who underwent a targeted neck exploration due to an undescended parathyroid adenoma diagnosed with an appropriate preoperative imaging protocol. With an appropriate imaging protocol for primary hyperparathyroidism and parathyroid hormone aspirates, an undescended parathyroid adenoma can be primarily diagnosed to guide a focused parathyroidectomy.

El adenoma paratiroideo no descendido ocasiona hiperparatiroidismo primario en <1% de los casos. Si no se sospecha, puede llevar a exploraciones negativas y trauma iatrogénico extenso. Proponemos que, con un protocolo imagenológico adecuado, se puede realizar un diagnóstico correcto, simplificando el abordaje quirúrgico. Describimos dos casos en que se realizó una exploración de cuello dirigida debido a un adenoma paratiroideo no descendido diagnosticado con un protocolo de imagen preoperatorio apropiado. Un protocolo de imagen apropiado para hiperparatiroidismo primario y aspirados de PTH pueden diagnosticar de manera inicial un adenoma paratiroideo no descendido para guiar una paratiroidectomía dirigida.

Adherencia Al Tratamiento Antiepiléptico En Pacientes Pediátricos Del Hospital Roberto Gilbert Elizalde En El Año 2014 / Adherence To Antiepileptic Treatment In Pediatric Patients At Hospital Roberto Gilbert Elizalde During 2014

Resumen Introducción: La epilepsia en población pediátrica es una entidad que afecta más a países subdesarrollados. En Ecuador, los ingresos hospitalarios por el mal control de la misma van en aumento habiéndose constatado que la principal causa es una deficiente adherencia al tratamiento antiepiléptico. Objetivo: Demostrar la incidencia de la no adherencia al esquema antiepiléptico y determinar los factores que contribuyen a la misma. Materiales y métodos: Se realizó un estudio transversal en el cual se incluyeron 119 pacientes entre 6 meses y 17 años. Los padres o tutores legales fueron interrogados respecto al grado de adherencia al tratamiento antiepiléptico utilizando el cuestionario de Morisky. Se usó un modelo de regresión logística para medir la fuerza de asociación entre variables. Resultados: Se encontró una incidencia de no adherencia al tratamiento antiepiléptico de 36,97%. Las variables significativamente asociadas fueron la escolaridad de la madre (p=0.018), la información médica previa (p=0.02) y el dejar de darle medicación por falta de dinero (p=0.01). Conclusión: La incidencia de la no adherencia en este estudio fue alta; controlar factores sociodemográficos y relacionados al tratamiento pueden tener un gran impacto en estos pacientes.

Abstract Introduction: Epilepsy in the pediatric population is an entity that mostly affects underdeveloped countries. In Ecuador, hospital admissions due to poor control are increasing and the main cause is poor adherence to antiepileptic treatment. Objective: To demonstrate the incidence of nonadherence to the antiepileptic regimen and determine the factors that contributes to it. Materials and methods: A cross-sectional study was conducted in which 119 patients were included with ages between 6 months and 17 years. The parents or legal guardians were questioned regarding the degree of adherence to antiepileptic treatment using the Morisky questionnaire. A logistic regression model was used to measure the strength of association between variables. Results: An incidence of non-adherence to antiepileptic treatment of 36.97% was found. The significantly associated variables were the mother's schooling (x2=11.83, IC= 10.13 - 13.53, p=0.018), previous medical information (x2=9.35, IC= 7.95 - 10.75, p=0.02) and the failure to obtain medication due to lack of money (x2=5.98, IC= 5.29 - 6.67, p=0.01). Conclusion: The incidence of nonadherence in this study was high; control over sociodemographic factors and related to treatment can have a great impact on these patients.