Eventos paroxísticos que se confunden con epilepsia / Paroxysmal events that are confused with epilepsy

Resumen Los eventos paroxísticos no epilépticos (EPNE) se definen como episodios de aparición brusca y de breve duración que imitan a una crisis epiléptica, originados por una disfunción cerebral de origen diverso y a diferencia de la epilepsia no obedecen a una descarga neuronal excesiva. Su incidencia es mucho más elevada que la epilepsia y pueden aparecer a cualquier edad, pero son más frecuentes en los primeros años de vida. La inmadurez del sistema nervioso central en la infancia favorece que en este período las manifestaciones clínicas sean muy floridas y diferentes de otras edades. Fenómenos normales y comunes en el niño pueden también confundirse con crisis epilépticas. El primer paso para un diagnóstico correcto es establecer si este primer episodio corresponde a una crisis epiléptica o puede tratarse de un primer episodio de EPNE. Es importante seguir un protocolo de diagnóstico, valorando los antecedentes personales y familiares, sin olvidar el examen físico, analizar los posibles factores desencadenantes, los pormenores de cada episodio, si es posible un registro de los episodios, aplicar el sentido común y la experiencia y solamente proceder a los exámenes complementarios básicos como el registro EEG u otras exploraciones en caso de duda o para con firmación diagnóstica. En algunos casos se ha demostrado una base genética. Las opciones terapéuticas son escasas y la mayoría de EPNE tienen una evolución favorable.

Abstract Non-epileptic paroxysmal events (NEPE) are defined as episodes of sudden onset and short duration that mimic an epileptic seizure, caused by a brain dysfunction of diverse origin and, unlike epilepsy, are not due to excessive neuronal discharge. Its incidence is much higher than epilepsy and can appear at any age, but are more frequent in the first years of life. The immaturity of the central nervous system in childhood favors that in this period the clinical manifestations are more spectacular and different from other ages. Normal and common phenomena in children can also be confused with epileptic seizures. The first step for a correct diagnosis is to establish whether this first episode corresponds to an epileptic seizure or could be a first episode of NEPE. It is important to follow a diagnostic protocol, assessing the personal and family history, without forgetting the physical examination, analyzing the possible triggering factors, the details of each episode, if it's possible a record of the episodes, applying common sense and experience and only carrying out basic complementary tests such as EEG recording or others in case of doubt or for diagnostic confirmation. In some cases, a genetic basis has been demonstrated. Therapeutic op tions are scarce and the majority of NEPE have a favorable evolution.

Triggering Factorsfor Breakthrough Seizures among Epileptic Patients. Cross Sectional Study in Epileptic Patients Attending Epilepsy Clinic Mansoura University Hospital, Egypt

Background: The prevalence of breakthrough seizures in persons with epilepsyis very high in developing countries. Consequently, patients and physicians should be aware of the possible factors that may cause breakthrough seizures.Objective: The aim of our study is to determine the possible factors that may be a precipitating cause for breakthrough seizures in patients with epilepsy.Methods: This cross-sectional study included 100 persons with epilepsywith idiopathic epilepsy receiving antiepileptic drugs (AEDs). They were divided into two groups. Group 1 included 50 persons with epilepsywith a history of recent breakthrough seizures. Group 2 included 50 persons with epilepsywho had not experienced any recent breakthrough seizures. Patients were subjected to a thorough questionnaire addressing precipitating factors. All participants were subjected to an electroencephalogram (EEG) and medication adherence assessment.Results: There was no significant differences between group 1 and group 2 regarding age, sex, ageOriginal Research Article of onset of epilepsy, occupation and marital status (P value range 0.5 –0.2). The patients in group 1 were found to have longer durations of epilepsy, lower adherence to AEDs (P= 0.001), moremissed doses of AEDs (P= 0.0001), more side effects of AEDs (P = 0.0005), more sleep deprivation, lower level of AEDs (P= 0.0006), more frequently on AED polytherapy (P = 0.0002), and more flickering lights(P= 0.04) than the participants in group 2. In terms of the EEG, group 1 showed a higher percentage of abnormal EEGs and more frequent focal epileptiform discharges (P = 0.003). Also, pathological findings in MRI brain were associated with higher breakthrough seizures (P = 0.005). No significant difference was found in both group1 and group 2 regarding emotional stress (P = 0.55), substitution of brand AEDs by generic one (P = 0.83), concurrent illness (P = 1), or the use of non AEDs (P = 0.79). Conclusion: The precipitating factors of breakthrough seizures are multifactorial and it is very important to educate patients about these precipitating factors to achieve better control of epilepsy

Diagrama de Ishikawa: causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem através de materiais perfurocortantes / Ishikawa Diagram: causes and solutions of HIV infection in nursing professionals due to sharps use / Diagrama de Ishikawa: causas y soluciones de la infección al vih adquirida por profesionales de enfermado a través de materiales perfurocortantes

Objective: The study's goal has been to analyze, through the Ishikawa Diagram, the causes and solutions of HIV infection in nursing professionals due to sharps handling. Methods: It is a literature review based on the Construction of the Ishikawa Diagram, which was carried out in May 2017 in the PubMed and Virtual Health Library databases. Results: The following are the main causes of HIV infection through sharps: work overload, perception of frail risk, careless use of needles, lack of training. Regarding the solutions: adequate post-exposure management, implementing and monitoring compliance with biosafety standards, improving the notification of accidents with sharps. Conclusion: There is a need to alerting managers towards intervening in the factors that might trigger accidents with sharp materials by the nursing team

Objetivo: Analisar por meio do Diagrama de Ishikawa as causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem no manuseio de materiais perfurocortantes. Métodos: Revisão da literatura baseada na Construção do Diagrama de Ishikawa, realizado em maio de 2017 nas bases de dados Pubmed e Biblioteca Virtual de Saúde. Resultados: Dentre as causas da infecção ao HIV através de perfurocortantes: sobrecarga de trabalho, percepção de risco fragilizada, utilização descuidada de agulhas, ausência de treinamento. Quanto às soluções: gestão pós exposição adequada, implementar e fiscalizar o cumprimento das normas de biossegurança, aprimorar a notificação de acidentes com materiais perfurocortantes. Conclusão: Destaca-se a necessidade de sensibilizar gestores para intervir nos fatores que podem desencadear acidentes com materiais perfurocortantes pela equipe de enfermagem

Objetivo: Analizar por medio del Diagrama de Ishikawa las causas y soluciones de la infección al VIH adquirida por profesionales de enfermería en el manejo de materiales punzocortantes. Métodos: Revisión de la literatura basada en la construcción del diagrama de Ishikawa, realizado en mayo de 2017 en las bases de datos Pubmed y Biblioteca Virtual de Salud.Resultados: Entre las causas de la infección por el VIH a través de punzocortantes: sobrecarga de trabajo, percepción de riesgo fragilizada, utilización descuidada de agujas, ausencia de entrenamiento. En cuanto a las soluciones: gestión post exposición adecuada, implementar y fiscalizar el cumplimiento de las normas de bioseguridad, mejorar la notificación de accidentes con materiales punzocortantes. Conclusión: Se destaca la necesidad de sensibilizar a los gestores para intervenir en los factores que pueden desencadenar accidentes con materiales punzocortantes por el equipo de enfermería

An observational study to assess the knowledge of migraine among patients with migraine at a tertiary care teaching hospital

Background: Migraine is a common debilitating headache the exact cause of which is not known. Efficient and proper treatment of migraine involves accurate diagnosis, educating the patients and to make them aware of the disorder and finding the best medication for the management of pain. This will also increases the patients� adherence to medication and will help in improving their quality of life. The objective of the study was to assess the awareness of migraine patients towards various aspects of migraine in a tertiary care teaching hospital.Methods: This was a cross-sectional observational questionnaire-based study conducted from January to March 2017 in ASCOMS&H, Sidhra, Jammu. The self-administered pre-validated questionnaires pertaining to various aspects of migraine were distributed among the patients diagnosed of having migraine and attending the Neurology Out patient department (OPD). Patients of either sex with a diagnosis of migraine and age ?18 years were included in the study. The data was analyzed with the help of descriptive statistics.Results: In the present study, majority of the patients suffering from migraine were in the age group of 18-40 years (58.6%) and females were more commonly affected about 60.9% than males. There was no family history of migraine in 78.1% of the patients. About 87.4% of the patients had 2-6 attacks of migraine per month. The most common triggering factor cited by the patients was lack of sleep in 29.9% followed by stress in 27.6% and less water intake in 26.4% of the patients.Conclusions: From the present study, it can be concluded that the patients were aware about the associated signs and symptoms but they had inadequate knowledge about all the aspects of the disease. Therefore, it is important to make patients more aware of the disease to increase their compliance to treatment and to improve their quality of life.

Variations of Demography, Risk Factors and Triggering Factors for Acute Myocardial Infarction Patients in Beijing Area Over Recent 40 Years / 中国循环杂志

Objectives: To analyze the variations of demography, risk factors and triggering factors in acute myocardial infarction (AMI) patients in Beijing area over recent 40 years from 1970s to 2010s. Methods: Our research included in 2 groups: 1970s group, 1314 patients from Beijing collaborative group of coronary artery disease prevention and treatment from 1972-01 to 1973-12; 2010s group, 2200 patients from China AMI registry in Beijing area from 2013-01-01 to 2014-09-30. Demographic characteristics including gender, age, farmer proportion, risk factors and triggering factors for AMI occurrence were compared between 2 groups. Results: Compared with 1970s group, 2010s group had more patients>70 years of age (15.8% vs 25.6%, P<0.001), more with male gender (68.3% vs 75.6%, P<0.001) and the higher farmer proportion (6.5% vs 14.5%, P<0.001); 2010s group showed more patients with previous histories of stroke (6.2% vs 10.5%), MI (9.5% vs 11.9%) and diabetes mellitus (DM) (6.2% vs 27.6%), all P<0.05; 2010s group presented that less patients were triggered by mental stress (51.1% vs 15.2%, P<0.001), while more were induced by physical stress (40.0% vs 61.1%, P=0.007). Conclusions: There were significant changes in recent 40 years for AMI patients in terms of age, gender, farmer proportion, previous histories of stroke, MI and DM; it appeared as aging, androphany and ruralized trends. Physical stress and unhealthy lifestyle were the major triggering factors for AMI occurrence nowadays, more specific efforts should be conducted for heart disease prevention and education.

Violent behavior in individuals with schizophrenia

Violence in individuals with schizophrenia and other psychotic disorders is known to be higher than in the general population, according to various definitions of violence, although most people with schizophrenia are not violent. Various factors are reported to increase the risk of violence: demographic characteristics such as male gender, young age, and low socioeconomic status; antisocial personality and history of conduct disorder; comorbidity of substance abuse; psychopathological-clinical variables including positive psychotic symptoms, duration of the untreated psychosis, and the first episode of psychosis; and cognitive disorders. There are 3 types of violent patients with schizophrenia: 1) violent patients with a history of conduct disorder prior to the onset of schizophrenia; 2) violent patients in an acute psychotic episode, with no history of conduct disorder prior to the onset of schizophrenia; and 3) chronically violent patients who show no aggressive behavior prior to their thirties and early forties, and then are engaged in serious violence often including homicide. There are some identified triggering factors including exposure to violence, traumatic brain injury, self-harm, unintentional injury, substance intoxication and parental bereavement. The preventive and treatment strategies will be discussed according to the two different pathways of violence that are classified by the history of conduct disorder. A scientific approach is essential to reduce the rates of violent behaviors and potentially related stigma in patients with schizophrenia.

Delirium en el hospital, una revisión narrativa / Delirium in the hospital, a narrative review

El delirium es una complicación frecuente entre pacientes hospitalizados, particularmente entre adultos mayores y aquellos con deterioro cognitivo. Se ha asociado a mayor mortalidad, estadías hospitalarias prolongadas, deterioro cognitivo, mayores tasas de institucionalización al alta y mayores costos para los sistemas de salud. Su fisiopatología es escasamente comprendida, planteándose en los últimos años un origen inflamatorio predominante. Ello explicaría su transversalidad y relación con la gravedad de cuadros subyacentes. Clínicamente se caracteriza por su inicio agudo con curso fluctuante, inatención, pensamiento desorganizado y un nivel de conciencia alterado. El enfrentamiento diagnóstico exige la búsqueda sistemática de desencadenantes en forma adicional a las manifestaciones del síndrome. Su tratamiento sintomático está basado en los neurolépticos como primera línea y el lorazepam en caso de que los primeros no puedan utilizarse o exista un escenario de indicación especial. Existe evidencia de que el cuadro puede prevenirse mediante la instauración de estrategias multicomponentes.

Delirium is a common complication in hospitalized patients, particularly the elderly and those with cognitive impairment. It has been associated with higher mortality, prolonged hospitalization, cognitive impairment, higher rates of institutionalization at discharge and higher costs for healthcare systems. Its pathophysiology is poorly understood, and more recently a predominantly inflammatory origin has been proposed, which could explain its pervasiveness and association with underlying conditions. Clinically, it is characterized by acute onset with fluctuating course, inattention, disorganized thinking and altered level of consciousness. Diagnostic approach is based on the systematic search for triggering factors as well as the manifestations of the syndrome. Symptomatic treatment is based neuroleptics as first line treatment, and lorazepam when the former cannot be used or there are special indications. There is evidence that the condition can be prevented by resorting to multi-component strategies.

Porfiria cutânea tardia esporádica associada ao uso de estrógenos: relato de caso e revisão de literatura / Sporadic late cutaneous porphyria associated estrogen use: a case report and literature review

Porfiria é a designação de um grupo de doenças enzimáticas que afetam a síntese do heme. São sete os tipos de porfiria, que se diferenciam pela enzima afetada. A porfiria cutânea tardia é acarretada pela deficiência da enzima uroporfirinogênio descarboxilase, gerando manifestações cutâneas e hepáticas aos portadores. Fatores como estrógenos, álcool, HIV, HCV, juntamente com o ferro podem desencadear a doença que é diagnosticada principalmente por análise urinária. O tratamento se dá por flebotomia e administração de cloroquina. No caso relatado a paciente, 54 anos, apresentou bolha na mão esquerda e após alguns meses foi diagnosticada porfiria cutânea tardia, por análise histopatológica alterada e eliminação anormal de uroporfirinas urinárias. O provável fator desencadeante foi o estrógeno, devido à eliminação de possível causa por outros fatores. Após tratamento com cloroquina e eliminação do fator causal, houve remissão da doença.

Porphyria is the designate of an enzyme group of diseases that affect the synthesis of heme. There are seven types of porphyria, which differ by the enzyme affected. Porphyria cutanea tarda is caused for the deficiency of the enzyme uroporphyrinogen descarboxylase, generating skin expression disorders and liver patients. Factors such as estrogens, alcohol, HIV, HCV, getting together with iron can cause the disease is mainly diagnosed by urinalysis. The treatment is done by phlebotomy and administration of chloroquine. In that case related the patient, 54 years old, presented blister on his left hand and after a some months was diagnosed tarda cutaneous porphyria, through histopathology and altered abnormal urinary elimination uroporphyrin. The probable factor precipitating was estrogen, due to elimination of possible causes for other factors. After treatment with chloroquine and elimination of the causal factor, there was remission of the disease.

A prática da automedicação por funcionários de uma Instituição de Ensino Superior portadores de enxaqueca / Practice of self-medication of migraine by employees at a higher education institution

O objetivo desta pesquisa foi identificar, na prática de automedicação, possíveis interações medicamentosas e descrever o perfil dos funcionários portadores de enxaqueca de uma Instituição de Ensino Superior localizada no município de Ijuí-RS. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da UNIJUI. Após a busca dos enxaquecosos, foi aplicado um questionário padronizado com perguntas acerca da patologia. Foram entrevistados, com consentimento, 32 indivíduos, sendo que a maioria (31-97%) tinha idade entre 30 e 39 anos (37,5%), pele branca (94%), eram casados (59%) e, no caso das mulheres, 71% (22) apresentavam ciclo menstrual regular e 55% (17) usavam anticoncepcional oral. Dentre os fatores desencadeantes da enxaqueca, os mais citados foram alguns tipos de alimentos, seguidos do estresse e fatores hormonais associados ao ciclo menstrual. Trinta (93,75%) voluntários praticavam automedicação, sendo que todos faziam uso de analgésicos e associações de fármacos. Portanto, verifica-se uma relação entre a patologia e a automedicação. Foram observadas 15 interações medicamentosas diferentes. Vinte (62,5%) indivíduos foram expostos a, pelo menos, uma interação decorrente da automedicação, ao consumo de medicamentos crônicos prescritos, a álcool e a cigarros. Nesse sentido, cabe ao profissional farmacêutico auxiliar o portador de enxaqueca no reconhecimento dos fatores desencadeantes desse problema para promover o uso racional de medicamentos e incentivar a automedicação responsável.

The aim of this study was to describe the profile of migraine-sufferers employed at a higher education institution located in the town of Ijuí (RS, Brazil) and identify possible drug interactions resulting from the self-medication practiced by those patients. After an active search for migraine patients, a standard questionnaire was used to enquire about their condition and themselves. The study was approved by the Research and Ethics Committee at UNIJUI. Thirty-two consenting adults were interviewed, most of whom (31, 97%) were aged between 30 and 39 years (37.5%), of white skin (94%) and married (59%), while among the women, 71% (22) had a regular menstrual cycle and 55% (17) used an oral contraceptive. Among migraine-triggering factors, most subjects cited specific foods, followed by stress and hormonal factors associated with the menstrual cycle. Thirty (93.75%) volunteers practiced self-medication, all of them making use of analgesics and combinations of drugs, showing that there was a relation between this condition and self-medication. The results revealed 15 different drug interactions. Twenty (62.5%) subjects were exposed to at least one interaction arising from self-medication, chronic prescribed drug use, alcohol and cigarettes. Accordingly, it is up to the pharmaceutical professional to help the migraine patient to recognize triggering factors, to promote the rational use of medicines and encourage responsible self-medication.

Report of ADRG: A Study on Triggering Factors in Korean Adult Atopic Dermatitis Through Questionnaire / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) has been known as one of the multifactorial diseases, which has the genetic background and environmental factors at the same time. Many triggering factors such as perspiration, irritants, aeroallergens, stress, and climatologic factors have been reported to influence the development of this disease. OBJECTIVES: The aim of the present study was to find the triggering factors and to compare these factors among Korean adult AD patients, high risk groups of AD and normal control subjects. METHODS: During open lectures on AD to the common people, we surveyed the questionnaire of nineteen well-known triggering factors to the audience and analyzed the data according to Korean adult AD patients (121), high risk groups of AD (65) and normal control subjects (34). We classified these triggering factors as four groups, such as endogenous triggering factors, exogenous irritants, aeroallergens and others. RESULTS: AD patients had allergic rhinitis, allergic conjunctivitis and allergic asthma at the same time in decreasing order of frequency. Over 50% of AD patients had other AD patients in their families. Among endogenous triggering factors, xerosis and emotional stress were very significant (both p<0.0005) in AD patients. Of exogenous irritants, warm temperature or perspiration, scratching, wool fiber, lipid solvent, and disinfectant showed significance in AD patients. Of these exogenous irritants, especially, warm temperature or perspiration, scratching, and wool fiber were very significant (all p<0.0005) in AD patients, and at the same time warm temperature or perspiration, and wool fiber were also significant (both p<0.05) in high risk groups. In aeroallergens, house dust or dust mites, and pollen had the statistical significance in AD patients. Pollen was very significant (p<0.0005) in AD patients and also significant (p<0.05) in high risk groups. Among other factors, sun light, spicy meals or alcoholic beverages, and insect bite were significant (all p<0.05) in AD patients. CONCLUSIONS: According to the questionnaire, we identified 12 aggravating factors of AD. These were xerosis, emotional stress, warm temperature or perspiration, scratching, wool fiber, lipid solvent, disinfectant, house dust or dust mites, pollen, sun light, spicy meals or alcoholic beverages, and insect bite. Six out of these factors, e.g., xerosis, emotional stress, warm temperature or perspiration, scratching, wool fiber, and pollen were very significant in AD patients. Three out of these six factors including warm temperature or perspiration, wool fiber, and pollen were also significant in high risk groups. We could not identify any significance among dwelling areas, academic backgrounds or occupations, and AD.