RESUMEN
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 18â¯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 15.5â¯years (SDâ¯=â¯22.5), the median number of monthly seizures was 3 (SDâ¯=â¯9.3), and 50.6% were women. Moreover, difficulties in the prescription filling process were associated with a time reduction between seizure relapses (aHRâ¯=â¯2.61; 95%CI 1.49-4.57), showing a similar impact as having a history of three or four types of events (aHRâ¯=â¯2.96; 95%CI 1.23-7.12) and neuropsychiatric comorbidity (aHRâ¯=â¯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.
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Epilepsias Parciales , Epilepsia Generalizada , Epilepsia , Adolescente , Anticonvulsivantes/uso terapéutico , Carbamazepina/uso terapéutico , Colombia/epidemiología , Servicio de Urgencia en Hospital , Epilepsias Parciales/tratamiento farmacológico , Epilepsia/tratamiento farmacológico , Epilepsia/terapia , Epilepsia Generalizada/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Recurrencia , Estudios Retrospectivos , Convulsiones/tratamiento farmacológico , Convulsiones/terapiaRESUMEN
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.
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Movilidad en la CiudadRESUMEN
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.