Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice. / Estudio observacional multicéntrico retrospectivo sobre el manejo clínico y terapéutico de los diferentes tipos de estatus epiléptico en la práctica clínica.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. METHODS: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. RESULTS: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic-clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30min) in 13.1%, established (30-120min) in 20.2%, refractory (more than 120min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. CONCLUSIONS: In our study, we found that SE did not respond to treatment within 2h in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted.

The Contribution of Diabetes Education in the Treatment of People with Type 2 Diabetes and Risk of Cardiovascular Disease.

Diabetes has caused 5.1 million deaths, primarily from cardiovascular disease. Large clinical studies have proven the importance of intensive control of diabetes from diagnosis to prevent microvascular and macrovascular complications of the disease in the long term. Diabetes education conducted by an interdisciplinary team of doctors, nurses, nutritionists, psychologists, and others is a necessary tool to ensure effective behavioral change and help overcome the obstacles that may hinder self care. Several studies have been analyzed in this review, in which we find a variety of results. Diabetes education has proven to be essential to patient compliance with their T2DM treatment; the main objective is to prevent acute and chronic complications, especially cardiovascular ones, which are the main causes of mortality.

Cannabis derivatives therapy for a seronegative stiff-person syndrome: a case report.

WHAT IS KNOWN AND OBJECTIVE: Stiff-person syndrome (SPS) is an uncommon and disabling disorder characterized by progressive rigidity and episodic painful spasms involving axial and limb musculature. SPS treatment is mostly based on benzodiazepines, baclofen, immunosuppressants and intravenous immunoglobulin. Cannabis derivatives [tetrahydrocannabinol (THC) and cannabidiol (CBD)] are available as an oromucosal spray (Sativex(®)), indicated as add-on treatment, for symptom improvement in patients with moderate to severe spasticity because of multiple sclerosis (MS). Our objective is to report a case of seronegative SPS successfully treated with THC-CBD oromucosal spray. CASE SUMMARY: We report a case of a 40-year-old man presenting with progressive muscle stiffness and intermittent spasms for 6-years. The diagnosis of stiff-person syndrome was based on the clinical features and neuroelectrophysiologic findings of continuous motor unit activity. Glutamic acid decarboxylase autoantibodies was absent in our patient, in both serum and cerebrospinal fluid (CSF). Cannabis derivatives oromucosal spray was introduced after a series of unsatisfactory traditional medical treatments. After 14 months treated with THC-CBD oromucosal spray, improvement was verified in the eight dimensions of the scale of SF-36 quality of life questionnaire. WHAT IS NEW AND CONCLUSION: Clinical experience with cannabis derivatives in patients with multiple sclerosis is accumulating steadily, but there is no current literature about its efficacy for SPS. Because MS and SPS share some neurological symptoms such as spasticity and rigidity, it is thought that THC-CBC can be an option for SPS patient. Our case report suggests that THC-CBD oromucosal spray is an alternative treatment for patients with refractory SPS, and further validation is appropriate.

Ethnobotanical survey and antibacterial activity of some plants used in Guinean traditional medicine.

A total of 418 healers have been interviewed in Guinea, a coastal country of West Africa, ranging between 7 degrees 30 and 12 degrees 30 of northern latitude and 8 degrees and 15 degrees of western longitude. Plant species used by the local inhabitants to treat infectious diseases were identified using ethnobotanical, ethnographic and taxonomic methods. During these investigations, 218 plants were registered, of which the following were the most frequently used: Erythrina senegalensis, Bridelia ferruginea, Crossopteryx febrifuga, Ximenia americana, Annona senegalensis, Cochlospermum tinctorium, Cochlospermum planchonii, Lantana camara, Costus afer, Psidium guajava, Terminalia glaucescens, Uapaca somon and Swartzia madagascariensis. Most plants, and especially the leaves, were essentially used as a decoction. In order to assess antibacterial activity, 190 recipes were prepared and biologically tested, among which six showed activity (minimal inhibitory concentration<125 microg/ml) against Bacillus cereus, Mycobacterium fortuitum, Staphylococcus aureus, or Candida albicans, i.e., Entada africana, Chlorophora regia, Erythrina senegalensis, Harrisonia abyssinica, Uvaria tomentosa, and a mixture of six plants consisting of Swartzia madagascariensis, Isoberlinia doka, Annona senegalensis, Gardenia ternifolia, Terminalia glaucescens and Erythrina senegalensis.

Human group C rotavirus in children with diarrhea in the Federal District, Brazil.

Group C rotaviruses are fastidious in their in vitro cell culture requirements. Recent serosurveys indicate that antibody to group C rotavirus is present in 3-45% of the human population in certain geographic locations, suggesting that rotavirus group C infection is more prevalent than previously believed and that the low rate of detection of these agents is probably due to the lack of sensitive diagnostic assays. From March to December 1994, 406 fecal specimens were collected from children under five years of age who were outpatients at the emergency services of nine public hospitals in Brasília, Federal District, Brazil. In addition to the samples from children, one public outpatient unit requested virological investigation of a stool sample from an HIV-seropositive adult male with diarrhea of sudden onset. All samples were analyzed by enzyme immunoassay for group A rotavirus and adenovirus (EIARA) and by polyacrylamide gel electrophoresis (PAGE). One hundred and seven (26%) were positive for group A rotavirus. Four samples from children and the sample from the HIV-seropositive patient, although negative by EIARA, showed a group C rotavirus profile by PAGE and were positive for rotavirus by electron microscopy. Using specific VP6 and VP7 primers for group C rotavirus, a reverse transcriptase-polymerase chain reaction (RT-PCR) was performed and products were detected by agarose gel electrophoresis and ethidium bromide staining. These products were confirmed to be specific for group C rotavirus by using digoxigenin-oligonucleotide probes, Southern hybridization and chemiluminescent detection. The five positive group C rotavirus samples were detected in August (3 samples) and September (2 samples). To the best of our knowledge, this is the first report of group C rotavirus detected in the Federal District, Brazil and in an HIV-seropositive patient with acute gastroenteritis.

[Epidemiology of rotavirus infections in the Federal District, Brazil]. / Aspectos epidemiológicos das infecções por rotavírus no Distrito Federal, Brasil.

Rotavirus testing was performed on fecal samples of 607 infants and young children aging from 0 to 6 years with acute diarrhoea between May 1986 and April 1990. Samples were analyzed by polyacrylamide gel electrophoresis (PAGE). Rotaviruses were detected in 123 samples (20.27%); from those, 107 (87.00%) were classified as subgroup II (long profile). Rotaviruses were not detected in the control group of healthy children, but it were present in 7.80% of the children hospitalized for other causes but acute diarrhoea. Most of the children with rotavirus infection ranged from 6 to 24 months of age (73.98%). The mean of positive cases during the rainy months (October to April) was of 9.60% and during the dry period was of 34.48%. The highest values were 53.17 and 73.27% in June and July, the coldest months of the year.

Geocomputation techniques for spatial analysis: are they relevant to health data?

Geocomputation is an emerging field of research that advocates the use of computationally intensive techniques such as neural networks, heuristic search, and cellular automata for spatial data analysis. Since increasing amounts of health-related data are collected within a geographical frame of reference, geocomputational methods show increasing potential for health data analysis. This paper presents a brief survey of the geocomputational field, including some typical applications and references for further reading.

Les pathologies ORL chez les sujets diabétiques : une étude de 281 patients à l'hôpital national Donka

Introduction et objectifs. L'association du diabète aux pathologies oto-rhino-laryngologiques est un fait classique. Cette association constitue par la difficulté thérapeutique et la gravité de ses complications, un problème clinique et thérapeutique. Notre étude avait pour but de décrire la prise en charge des pathologies ORL chez les diabétiques à l'Hôpital National Donka. Méthodologie. Il s'agit d'une étude transversale descriptive effectuée au mois de mai 2015. Elle a concerné tous les patients diabétiques vus en ambulatoires ou hospitalisés aux services ORL-CCF et d'Endocrinologie-Diabétologie de l'Hôpital National Donka, présentant un signe ORL et ayant accepté de participer à l'étude. Résultat. La prévalence des pathologies ORL chez les diabétiques était de 33%. Les sujets âgés d'au moins 56 ans étaient les plus représentés (75%) avec un écart type de 15 et des extrêmes de 2 et 90 ans. Les patients sans revenu étaient les plus atteints (58,6%). 78,9% des patients vivaient en zone urbaine. La quasi- totalité des patients ont été examiné en ambulatoire (92,9 %). Le diabète de type II a dominé la série (94,6%). L'hypertension artérielle représentait 51,6% des pathologies associées. L'hyperglycémie à jeun a été retrouvée chez 84,6% des patients (P=0,01). La rhino sinusite était la pathologie la plus fréquente (72,3%). Les antibiotiques, l'antalgique, la corticothérapie ont été les plus utilisés. Conclusion. Chez le sujet diabétique avec affection ORL, le diabète est le plus souvent mal contrôlé. La rhinosinusite est la pathologie la plus fréquente

Estudio observacional multicéntrico retrospectivo sobre el manejo clínico y terapéutico de los diferentes tipos de estatus epiléptico en la práctica clínica / Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice

Introducción: El estatus epiléptico es una urgencia neurológica asociada a una mortalidad y morbilidad significativa. Analizamos las características en nuestra población. Métodos: Se recogieron los datos de manera retrospectiva de la historia clínica electrónica de adultos con diagnóstico de estatus epiléptico en 5 centros hospitalarios durante 4 años. Resultados: Se obtuvieron datos de un total de 84 episodios en 77 pacientes, con edad media de 60,3 años. El 52,4% tenían historia previa de epilepsia. Clasificación según el tipo de estatus: 47,6% tónico-clónico; 21,4% parcial complejo; 17,9% parcial motor; 6% parcial simple; 3,6% mioclónico y 3,6% sutil. Si analizamos el momento que finalizó el estatus según las fases definidas para este estudio obtenemos: 13,1% precoz (hasta 30 min); 20,2% establecido (entre 30-120 min); 41,7% refractario (más de 120 min) y 13,1% superrefractario (continúan o recurren después de más de 24 h de anestesia). Diez casos (11,9%) fallecieron sin haberse controlado el estatus. El porcentaje acumulativo de éxito alcanzado con el primer tratamiento fue de 8,3%; segundo 27,3%; tercero 48,7%; cuarto 58,2%; quinto 70,1%; sexto 80,8%; séptimo 83,2% y octavo 84,4%. Conclusiones: En nuestro estudio encontramos que el estatus no se controló en las primeras 2 h en casi la mitad de los casos, y un 11,9% fallecieron sin controlarse, sin haber diferencias significativas entre el tipo de estatus. En casi la mitad se logró el control del estatus con el tercer tratamiento, pero en algún caso se precisó hasta 8. Son necesarios registros amplios que permitan analizar el manejo en los distintos tipos y fases (AU)

Introduction: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. Methods: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. Results: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic-clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30 min) in 13.1%, established (30-120 min) in 20.2%, refractory (more than 120 min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. Conclusions: In our study, we found that SE did not respond to treatment within 2h in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted (AU)

Decálogo sobre el uso seguro de los lavabos en unidades de cuidados aumentados / No disponible

No disponible

Descripción de un brote polimicrobiano en una unidad de cuidados intensivos durante la ola pandémica de COVID-19 de marzo de 2020 / No disponible

INTRODUCCIÓN: La ola pandémica de COVID-19 de marzo de 2020 mermó las medidas de control de infección en las UCI. Se describe un brote polimicrobiano, sus posibles factores de riesgo, relación con la COVID-19 y medidas que facilitaron su control. MÉTODOS: estudio observacional longitudinal retrospectivo. RESULTADOS: se estudiaron 149 pacientes, 23 casos presentaron microorganismos de interés, 9 más de uno. Se aislaron 15 Klebsiella pneumoniae BLEE, 5 KPC, 8 hongos filamentosos y 5 bacilos gramnegativos no fermentadores. La tasa de ataque fue de 0,154 siendo superior para ingresos COVID-19 (0,262) frente a otros motivos (0,015), con una diferencia de 0,247 (0,148-0,345; p < 0,001). Se implementaron medidas de control sobre los riesgos detectados. CONCLUSIÓN: ser paciente COVID-19 se asoció con mayor riesgo de ser caso, consideramos como posibles desencadenantes el mayor contacto requerido con equipos de protección y la pérdida temporal de control sobre la multirresistencia, tanto de información como de competencia

INTRODUCTION: The pandemic wave of COVID-19 in March 2020 undermined compliance with infection control measures in ICUs. A polymicrobial outbreak, its possible risk factors, relationship with COVID-19 and measures that facilitated its control are described. METHODS: retrospective longitudinal observational study. RESULTS: 149 patients were studied, 23 cases presented microorganisms of interest, 9 more than one. 15 Klebsiella pneumoniae ESBL, 5 KPC, 8 filamentous fungi and 5 non-fermenting gram-negative bacilli were isolated. The attack rate was 0.154, being higher for patients admitted for COVID-19 (0.262) compared to other reasons (0.015), with a difference of 0.247 (0.148-0.345; p < 0.001). Control measures were implemented on the risks detected. CONCLUSION: being a COVID-19 patient was associated with a higher risk of being a case, we consider as possible triggers the greater contact required with protective equipment and the temporary loss of control over multidrug resistance, both of information and of competence

Aplicación de nuevos criterios diagnósticos de enfermedad celiaca en Castilla-La Mancha / Application of new criteria for diagnosis of celiac disease in Castilla-La Mancha

Objetivo: Estudiar la aplicación de los nuevos criterios diagnósticos de enfermedad celiaca en Castilla-La Mancha, así como las características de los pacientes. Material y métodos: Estudio descriptivo transversal, con recogida prospectiva de datos en 7 hospitales de pacientes diagnosticados entre el 1 de julio de 2011 y el 31 de diciembre de 2012. Se analizó la frecuencia con la que se reúnen requisitos para el diagnóstico sin biopsia intestinal mediante la aplicación de los nuevos criterios y el seguimiento de los mismos. Resultados: Se incluyeron 158 pacientes (un 63,3% mujeres) con una media de edad de 5,5 años. La presencia de síntomas compatibles fue detectada en el 54,4% de los pacientes. El hallazgo analítico más frecuente fue la ferropenia (29,7%), y se encontró anemia en el 8,9% e hipertransaminasemia en el 5,7%. El 79,1% presentaba en el momento del diagnóstico títulos de anticuerpos antitransglutaminasa más de 10 veces superiores al valor de corte de normalidad, con positividad comprobada de anticuerpos antiendomisio en el 49,6% de ellos. El 39,2% de los pacientes cumplían requisitos para ser diagnosticados mediante la aplicación de los nuevos criterios. Se realizó biopsia intestinal en el 32,2% por diferentes motivos, y todos estos casos presentaban una lesión de grado 3 según la clasificación de Marsh. Conclusiones: La introducción de los nuevos criterios diagnósticos para la enfermedad celiaca podría suponer en nuestro medio una reducción del 40% de los procedimientos endoscó- picos en estos pacientes. La variabilidad interprovincial en el acceso a determinadas técnicas no permite su aplicación de manera homogénea en nuestra comunidad, y actualmente se tiene que recurrir al estudio histológico en muchos casos (AU)

Objective: To study the use of the new diagnostic criteria for celiac disease in the Castilla-La Mancha region, and the characteristics of these patients. Material and methods: Prospective data were collected in 7 hospitals within a descriptive transversal study that included patients diagnosed between July 2011 and the end of December 2012. The frequency with which they met requirements for diagnosis without intestinal biopsy based on the new criteria and the monitoring thereof were analyzed. Results: A total of 158 patients (63.3% female), with a median age of 5.5 years, were included in the study. In 54.4% of these patients celiac disease related symptoms were detected. The most frequent laboratory findings were ferropenia (29.7%), anemia (8.9%) and hypertransaminasemia (5.7%). At diagnosis, 79.1% of the patients had transglutaminase antibody titers 10 times above the upper limit of the normal range, with proven positive endomysial antibodies in 49.6% of them. Of the total patients, 39.2% fulfilled the new diagnostic criteria and 32.2% undergone an intestinal biopsy for different reasons. In all these cases, grade 3 lesions according to Marsh classification for celiac disease were found. Conclusions: The introduction of the new diagnostic criteria for celiac disease could lead to a 40% reduction in endoscopic procedures for these patients in our region. The interprovince variability in the access to certain techniques, does not allow the global use of these new criteria in the studied region where histology continues to be the main available option (AU)

High HPV genetic diversity in women infected with HIV-1 in Brazil.

The present study on genetic diversity of human papillomaviruses in women infected by HIV in Brazil describes the frequency, the genotypes, and five new variants of HPV. One hundred fifty cervical smears of HIV-positive women were subjected to cytological examination, and the DNA samples obtained were assayed by MY09/MY11 amplification, followed by RFLP typing. The overall HPV-DNA-positive rate was 42.7%. One hundred twenty-two samples (81.3%) had benign cellular alterations or normal cytological results, and HPV DNA frequency among them was 30.3%. Otherwise, 96.4% of samples with altered cytology were positive for HPV DNA. A high diversity of genotypes was observed. HPVs-16 and 81 were the most prevalent (14.1%) and were followed by HPVs 52, 35, 62, 33, 53, 56, 66, 70, 18, 58, 6b, 11, 31, 39, 40, 61, 71, 32, 54, 59, 67, 68, 85, and 102. Five new variants of the high-risk HPVs 18, 33, 53, 59, and 66 were detected. Possible associations between the detection of HPV genotypes and the cytological classification, HIV viral load, CD4 count, and antiretroviral treatment were also examined. We observed that a high proportion of HIV-infected women are infected with HPV and may carry oncogenic genotypes, even when cytological evaluation shows normal results.

Incidencia de infección de herida quirúgica en artroplastia de cadera / Incidence of surgical wound infection after hip replacement

Objetivo: Estudiar la incidencia de infección de herida quirúrgica tras recambio de una prótesis de cadera. Material y Método: Estudio de cohorte prospectivo. Se estudiaron 98 pacientes, 45,9% hombres y 54,1% mujeres (p>0.05), intervenidos de recambio de cadera entre abril y agosto de 2009. Se estudiaron la incidencia acumulada de infección de sitio quirúrgico, la razón estandarizada de infección, la densidad de incidencia y los factores de riesgo relacionados. Resultados: La incidencia acumulada de infección de herida quirúrgica fue del 3,1%, con una razón estandarizada de infección del 0,84% al compararla con la tasa nacional. Todas las infecciones fueron causadas por Staphylococcus aureus (66,6%) y Staphylococcus epidermidis (33,3%). No se encontró ningún factor de riesgo relacionado con la infección. Conclusión: La incidencia de infección del sitio quirúrgico fue ligeramente inferior a la tasa nacional. No encontramos relación con ninguno de los factores de riesgo estudiados (AU)

Objetive: We sought to study the incidence of surgical site infection after hip replacement. Material and Methodology: A Prospective cohort study was conducted with 98 patients, 45.9% men and 54.1% women (p>0.05), covering all patients who underwent HR as elective surgery from April to August 2009. Cumulative incidence, density of incidence of surgical site infection, standardised infection rate and related risk factors were studied. Results: The study covered. Cumulative incidence was 3.1%, with a standardised infection rate of 0.84% visà- vis the national rate. All infections were caused by Staphylococcus aureus (66.6%) and Staphylococcus epidermidis (33.3%). No related risk factor with the infection was found. Conclusion: No risk factor was identified. Incidence of hip infection after implantation of a prosthesis was slightly lower than the national rate (AU)

Human group C rotavirus in children with diarrhea in the Federal District, Brazil

Group C rotaviruses are fastidious in their in vitro cell culture requirements. Recent serosurveys indicate that antibody to group C rotavirus is present in 3-45 per cent of the human population in certain geographic locations, suggesting that rotavirus group C infection is more prevalent than previously believed and that the low rate of detection of these agents is probably due to the lack of sensitive diagnostic assays. From March to December 1994, 406 fecal specimens were collected from children under five years of age who were outpatients at the emergency services of nine public hospitals in Brasília, Federal District, Brazil. In addition to the samples from children, one public outpatient unit requested virological investigation of a stool sample from an HIV-seropositive adult male with diarrhea of sudden onset. All samples were analyzed by enzyme immunoassay for group A rotavirus and adenovirus (EIARA) and by polyacrylamide gel electrophoresis (PAGE). One hundred and seven (26 per cent) were positive for group A rotavirus. Four samples from children and the sample from the HIV-seropositive patient, although negative by EIARA, showed a group C rotavirus profile by PAGE and were positive for rotavirus by electron microscopy. Using specific VP6 and VP7 primers for group C rotavirus, a reverse transcriptase-polymerase chain reaction (RT-PCR) was performed and products were detected by agarose gel electrophoresis and ethidium bromide staining. These products were confirmed to be specific for group C rotavirus by using digoxigenin-oligonucleotide probes, Southern hybridization and chemiluminescent detection. The five positive group C rotavirus samples were detected in August (3 samples) and September (2 samples). To the best of our knowledge, this is the first report of group C rotavirus detected in the Federal District, Brazil and in an HIV-seropositive patient with acute gastroenteritis.