Dysautonomia in people with epilepsy: A scoping review.

BACKGROUND: Epilepsy is one of the most common neurological diseases and has high morbidity and mortality. Multiple methods for assessing dysautonomia have been reported; however, the patient characteristics and epilepsy features that drive any method selection are unclear. People with epilepsy (PWE) can experience sudden unexpected death in epilepsy (SUDEP) and one reason can be dysautonomia. If dysautonomia can be detected in PWE before a severe event, then it could complement and redirect patient treatment and monitoring. OBJECTIVE: To map the available literature on dysautonomia in PWE and describe patients' characteristics and methods used to evaluate dysautonomia. METHODS: We performed a scoping literature review. We searched PubMed, Scopus, Embase, and hand searched starting from the first registry in the literature until August 2019. Studies were independently assessed by three authors and two epileptologists. We present data in tables and summarize information according to the following structure: population, concepts, and context. RESULTS: Thirty-five studies were included in the analysis with epidemiological designs including case reports (23), cross-sectional studies (4), case‒controls (7), and cohort studies (1). A total of 618 patients were enrolled. Heart rate variability, arrhythmia, blood pressure, the tilt-table test, polysomnography, respiratory function, and magnetic resonance imaging were the methods most commonly used to assess dysautonomia in PWE. A detailed description of the heart rate variability assessment is presented. CONCLUSIONS: This review provides a broad description of the available literature identifying clinical findings, the most frequently reported assessment measurements of dysautonomia, in temporal lobe epilepsy and extratemporal epilepsies.

Assessment of sexual dysfunction in patients with multiple sclerosis: a perspective from neurologist.

BACKGROUND: Sexual dysfunction (SD) is a common comorbidity in people with multiple sclerosis (pwMS). It affects the quality of life and remains an overlooked condition. The objective of this study was to describe how Colombian neurologists assess and treat SD and explore the barriers during sexual function evaluation. METHODS: In this observational cross-sectional study we developed a questionnaire for neurologists with 4 sections (demographic data, evaluation and treatment of SD, and possible reasons for not discussing sexual dysfunction.) It was sent via email to 326 Colombian neurologists. We grouped the answers according to the type of consultation (neurologists from a MS program or no MS program). We described through absolute frequencies and proportions. RESULTS: Fifty neurologists answered the survey. 64% stated that they usually study sexual dysfunction in neurological disorders. The main methods employed were private reading (86%) and attending conferences (14%). 5/50 participants have never attend pwMS; the Sect. 2-4 was not answered by them. 29% work in a MS program, all of them asked their patients about sexual function, but 18.75% of physicians working outside an MS program have never asked about it. Main reasons for not talking about sexual dysfunction were lack of knowledge (65.1%), presence of a companion (65.1%) and lack of time (55.8%). 91% of the neurologists reported that their patients usually and frequently ask about sexual function. Neurologists use informal questions to assess sexual function (80%), although 64.4% said that they are aware of SD questionnaires. When sexual dysfunction is detected, 91% of neurologists refer patients to another specialist and 87% do not start any treatment. CONCLUSIONS: Colombian neurologists are concerned with sexual function in pwMS, however it remains an underdiagnosed an undertreated condition. It is necessary to strengthen knowledge about the diagnosis and treatment of sexual dysfunction in pwMS, for neurologists and patients. It is also imperative to eliminate barriers around the topic and include sexual function evaluation and treatment as the routine care of pwMS.

Gender and Polysomnographic Profiles Findings in Obstructive Sleep Apnea Syndrome Patients Living in High Altitude.

PURPOSE: Obstructive sleep apnea (OSA) is a common sleep disorder which prevalence is 22% in men and 17% in women. It is well described that females presented different clinical and polysomnographic characteristics compared with men. Those studies were performed in plain areas. We described the analysis by gender and clinical profiles of a sample of patients with diagnostic of OSA and living at high altitude. PATIENTS AND METHODS: It is an observational study that describes differences between clinical and polysomnographic characteristics by gender in patients with OSA. Additionally, an unsupervised cluster algorithm was used to find groups of patients with similar clinical and polysomnographic characteristics. RESULTS: We included 709 patients, 51.6% were females and 48.3% were males with mean age of 64 and 62 years old, respectively, in which 90.97% presented OSA. Men presented a higher apnea and hypopnea index than women (p=0.002), besides presented more sleep polysomnographic alterations. Meanwhile, women evidenced better sleep quality based on parameters. Additionally, in the sample of patients, we found four separated clinical profiles characterized mainly by differences in the severity of polysomnographic parameters. CONCLUSION: The patients were more obese, older, and had lower SpO2 values than most of those previously reported. Men had greater severity in most of the parameters measured by polysomnography. Polysomnographic variables were different both in the OSA patient profiles and in the gender comparison. However, the REM sleep apnea hypopnea index did not differ between sexes, indicating the importance of this variable in the evaluation of OSA severity in women. In contrast to previous reports, clinical and demographic characteristics showed few differences in both analyses. This result suggests that the behavior of OSA at high altitudes may have particularities with respect to low altitudes.

Asociación entre polifarmacia y prescripción inapropiada según la clase social en adultos mayores de Bucaramanga / Association between polypharmacy and inappropriate prescription according to social class in older adults in Bucaramanga

Resumen Introducción: La polifarmacia y la prescripción inapropiada (PI) se han visto relacionadas con múltiples variables, incluidas las de aspecto socioeconómico, sin embargo, la evidencia en esta asociación es escasa y heterogénea. Objetivo: Evaluar la asociación entre la polifarmacia y la prescripción inapropiada de medicamentos en adultos mayores de 60 años según su clase social. Material y métodos: Estudio piloto de diseño descriptivo, corte transversal realizada en la ciudad de Bucaramanga-Colombia, con una muestra de 135 adultos mayores de 60 años. Se realizó una encuesta donde se registraron datos sociodemográficos, estado de salud en el último mes, comorbilidades, medicamentos de uso crónico y escalas de funcionalidad. Resultados: No se encontró asociación estadísticamente significativa entre prescripción inapropiada y polifarmacia con la clase social y el nivel educativo (P=0,639). Sin embargo, el tener una filiación al sistema de seguridad social de tipo subsidiado estuvo significativamente asociada a la infra prescripción (P<0,029). La presencia de ingresos mensuales estuvo asociada con la presencia de polifarmacia (P<0,029) y prescripción inadecuada (P<0,033). Conclusiones: Existe una asociación entre algunas variables socioeconómicas, el número de médicos tratantes y algunas especialidades médicas con presentar polifarmacia y prescripción inapropiada de medicamentos.

Abstract Introduction: Polypharmacy and inappropriate prescribing have been related to multiple variables, including sociodemographic, however the evidence is limited and heterogeneous. Objective: To evaluate the association between polypharmacy and inappropriate prescribing in adults over 60 years old according to their social class. Material and methods: A pilot cross-sectional population-based study in the city of Bucaramanga, Colombia, with a sample of 135 adults over 60 years old. A survey was conducted where sociodemographics, health status in the last month, comorbidities, drugs of chronic use and functionality according to scales were registered. Results: No statistical association was found between inappropriate prescribing and Polypharmacy amongst social class and education level (P=0.639). Nevertheless, having an affiliation with a subsidized social security system was significantly associated with infra prescription (P <0.029). The existence of monthly income was associated with the presence of polypharmacy (P <0.029) and inadequate prescribing (P <0.033). Conclusions: There exists an association between some socioeconomic variables, the number of practicing physicians and some medical specialties with polypharmacy and inadequate prescription of drugs.

Estudio bibliométrico: 45 años de literatura biomédica en trasplante de células madre hematopoyéticas / A Bibliometric Study: 45 Years of Biomedical Literature in Hematopoietic Stem Cell Transplantation / Estudo bibliométrico: 45 anos de literatura biomédica em transplante de células-tronco hematopoiéticas

Introducción: La bibliometría mide variables de la literatura científica que se describen de forma cuantitativa por medio de análisis estadístico; con esta herramienta se busca evidenciar el impacto de los trasplantes de células madre hematopoyéticas en la literatura de los últimos 45 años. Objetivo: Descripción de la literatura médica indexada en MEDLINE desde 1970 hasta 2015 sobre trasplantes de células madre hematopoyéticas. Metodología: Se realizó una búsqueda en la base de datos MEDLINE a través de GoPubMed y Fabumed. La estrategia de búsqueda fue: "Hematopoietic Stem Cell Transplantation" [Majr] AND "1970:2015"[dp]. Las variables analizadas fueron el número de publicaciones por año, revistas, países y porcentaje de publicaciones sobre trasplantes de células madre hematopoyéticas. Resultados: Se recuperaron 23,295 referencias sobre trasplantes de células madre hematopoyéticas. Se identificaron 1,844 revistas diferentes, el mayor número de publicaciones se encontró en Bone Marrow Transplantation con 2,443 publicaciones, seguida de Blood con 1,375 y Biology of Bone Marrow Transplantation con 1,319 referencias. Estados Unidos fue el país con mayor número de publicaciones con 7,491 (32.15%); en Latinoamérica fueron publicados 324 (1.39%). Los descriptores de la literatura más investigados relacionados con el tema fueron: Trasplante de células madre hematopoyéticas con 23,345 publicaciones, humanos con 22,019 y células madre con 17,564. Conclusiones: Las publicaciones sobre trasplantes de células madre hematopoyéticas han incrementado de forma progresiva durante los 45 años estudiados. Los países desarrollados son los que han realizado mayor investigación del tema, en contraste con el número de publicaciones en total. [Ríos-Moreno JV, Bueno-Flórez SJ, Conde-Hurtado DI, Tarazona N, Sossa-Melo Claudia Lucía. Estudio bibliométrico: 45 años de literatura biomédica en trasplante de células madre hematopoyéticas. MedUNAB 2017-2018; 20(3): 319-326].

Introduction: Bibliometric measures variables from the scientific literature that are described quantitatively by means of statistical analysis; this tool seeks to demonstrate the impact of hematopoietic stem cell transplants in the literature throughout the last 45 years. Objective: To describe the indexed medical literature in MEDLINE from 1970 to 2015 on hematopoietic stem cell transplants. Methodology: A search of the MEDLINE database through GoPubMed and Fabumed was performed. The search strategy was: Hematopoietic Stem Cell Transplantation [Majr] and 1970:2015 [dp]. The variables analyzed were the number of publications per year, journals, countries and percentage of publications on hematopoietic stem cell transplants. Results: 23,295 references were recovered on hematopoietic stem cell transplants. 1,844 different journals were identified, the largest number of publications was found in Bone Marrow Transplantation with 2,443 publications, followed by Blood with 1,375 and Biology of Bone Marrow Transplantation with 1,319 references. The United States was the country with the highest number of publications with 7,491 (32.15%), in Latin America 324 (1.39%) were published. The most researched descriptors of literature related to the topic were: Transplantation of hematopoietic stem cells with 23,345 publications, humans with 22,019 and stem cells with 17,564. Conclusions: The publications on hematopoietic stem cell transplants have increased progressively during the 45 years studied. The developed countries are the ones that have done more research on the subject, in contrast to the number of publications in total. [Ríos-Moreno JV, Bueno-Flórez SJ, Conde-Hurtado DI, Tarazona N, Sossa-Melo Claudia Lucía. A Bibliometric Study: 45 Years of Biomedical Literature in Hematopoietic Stem Cell Transplantation. MedUNAB 2017-2018; 20(3): 319-326].

Introdução: A bibliometria mede variáveis da literatura científica que são descritas quantitativamente por meio de análise estatística; esta ferramenta procura demonstrar o impacto dos transplantes de células estaminais hematopoiéticas na literatura dos últimos 45 anos. Objetivo: Descrição da literatura médica indexada em MEDLINE de 1970 a 2015 em transplantes de células-tronco hematopoiéticas. Metodologia: uma pesquisa do banco de dados MEDLINE foi realizada através do GoPubMed e Fabumed. Aestratégia de busca foi: "Transplante de células estaminais hematopoiéticas" [Majr] AND "1970: 2015" [dp]. As variáveis analisadas foram o número de publicações por ano, periódicos, países e porcentagem de publicações sobre transplantes de células estaminais hematopoiéticas. Resultados: Foram recuperadas 23,295 referências, em transplantes de células estaminais hematopoiéticas. Identificamos 1,844 periódicos diferentes; o maior número de publicações foi encontrado no Transplante de medula óssea com 2,443 publicações, seguido de sangue com 1,375 e Biologia do transplante de medula óssea com 1,319 referências. Os Estados Unidos foi o país com maior número de publicações com 7,491 (32.15%); na América Latina, foram publicados 324 (1.39%). Os textos mais pesquisados da literatura relacionados com o tema foram: Transplante de células-tronco hematopoiéticas com 23,345 publicações, humanos com 22,019 e células-tronco com 17,564. Conclusões: As publicações sobre transplantes de células estaminais hematopoiéticas aumentaram progressivamente durante os 45 anos estudados. Os países desenvolvidos são os que fizeram mais pesquisas sobre o assunto, em contraste com o número de publicações no total. [Ríos-Moreno JV, Bueno-Flórez SJ, Conde-Hurtado DI, Tarazona N, Sossa-Melo Claudia Lucía. Estudo bibliométrico: 45 anos de literatura biomédica em transplante de células-tronco hematopoiéticas. MedUNAB 2017-2018; 20(3): 319-326].