Tolerance and response to ketogenic therapy in neonates and infants younger than 4 months. Case series in a hospital center in Medellin, Colombia. / Tolerancia y respuesta a la terapia cetógena en neonatos y lactantes menores de 4 meses. Serie de casos en un centro hospitalario de Medellín, Colombia.

INTRODUCTION: Ketogenic therapy (KT) studies have focused in children older than 2 years and adults. Recently its efficacy in infants has been reported, but there are few studies in this age group. PATIENTS AND METHODS: We report a case series of nine newborn and children younger than 4 months of age with refractory epilepsy treated with KT. We retrospectively reviewed charts of children treated at our center between 2015-2021. RESULTS: Data was collected on seven patients. Six patients began having seizures on day one of life, one had seizures starting on day 45. Different epilepsy etiologies were found. KT was started as soon as 9 days of life. The average age at which ketogenic therapy was started was 24 days of life. Initially, the diet was started at 1:1 or 2:1 ratio, and was progressed to a 4:1 ratio. After one month of KT 5/7 patients experienced a significant reduction in seizure frequency (>50%) and 2/7 had complete seizure control. At six months, 4/7 patients achieve complete seizure freedom and 1/7 had >50% seizure reduction. Two patients were lost to follow-up. None of our patients reported gastrointestinal side effects that required diet adjustments. One patient had mild and one mild hypertriglyceridemia. CONCLUSION: Even though evidence about KT in young children are starting to emerge, our experience shows it can be successful in controlling seizure burden without considerable adverse effects. There is great research potential regarding KT in young children.

TITLE: Tolerancia y respuesta a la terapia cetógena en neonatos y lactantes menores de 4 meses. Serie de casos en un centro hospitalario de Medellín, Colombia.Introducción. Los estudios para terapia cetógena (TC) se han concentrado en niños mayores de 2 años y adultos. Su eficacia en lactantes se ha descrito, pero hay pocos estudios en este grupo de edad. Pacientes y métodos. Se describe una serie de casos de nueve neonatos y lactantes menores de 4 meses de edad con epilepsia refractaria que recibieron tratamiento con TC. Se evaluaron, retrospectivamente, los registros clínicos de niños tratados entre 2015 y 2021. Resultados. Se recolectaron datos de siete pacientes. Seis pacientes iniciaron con crisis epilépticas el primer día de vida, y uno, el día 45. La etiología de la epilepsia fue variada (metabólica, genética y estructural). La TC se inició tan temprano como a los 9 días de vida. La edad promedio de inicio fue los 24 días de vida. Se inició con una tasa cetógena de 1:1 o 1:2, y se progresó posteriormente a 4:1. Después de un mes de TC, 5/7 pacientes presentaron una reducción significativa en la frecuencia de las crisis (>50%) y 2/7 experimentaron un control completo. A los seis meses, 4/7 pacientes lograron un control completo y 1/7 un control >50%. Dos pacientes se perdieron en el seguimiento. No se notificaron efectos gastrointestinales que obligaran al ajuste o la suspensión de la dieta. Se notificaron hipoglucemia e hipertrigliceridemia. Conclusión. A pesar de que la evidencia en la TC en lactantes y neonatos apenas está empezando a aparecer, nuestra experiencia muestra que puede ser una buena opción terapéutica para el control de las crisis epilépticas, sin efectos adversos importantes. Existe un gran potencial de investigación en el área de la TC en lactantes y neonatos.

Tolerancia y respuesta a la terapia cetógena en neonatos y lactantes menores de 4 meses. Serie de casos en un centro hospitalario de Medellín, Colombia / Tolerance and response to ketogenic therapy in neonates and infants younger than 4 months. Case series in a hospital center in Medellín, Colombia

Introducción: Los estudios para terapia cetógena (TC) se han concentrado en niños mayores de 2 años y adultos. Su eficacia en lactantes se ha descrito, pero hay pocos estudios en este grupo de edad. Pacientes y métodos: Se describe una serie de casos de nueve neonatos y lactantes menores de 4 meses de edad con epilepsia refractaria que recibieron tratamiento con TC. Se evaluaron, retrospectivamente, los registros clínicos de niños tratados entre 2015 y 2021. Resultados: Se recolectaron datos de siete pacientes. Seis pacientes iniciaron con crisis epilépticas el primer día de vida, y uno, el día 45. La etiología de la epilepsia fue variada (metabólica, genética y estructural). La TC se inició tan temprano como a los 9 días de vida. La edad promedio de inicio fue los 24 días de vida. Se inició con una tasa cetógena de 1:1 o 1:2, y se progresó posteriormente a 4:1. Después de un mes de TC, 5/7 pacientes presentaron una reducción significativa en la frecuencia de las crisis (>50%) y 2/7 experimentaron un control completo. A los seis meses, 4/7 pacientes lograron un control completo y 1/7 un control >50%. Dos pacientes se perdieron en el seguimiento. No se notificaron efectos gastrointestinales que obligaran al ajuste o la suspensión de la dieta. Se notificaron hipoglucemia e hipertrigliceridemia. Conclusión: A pesar de que la evidencia en la TC en lactantes y neonatos apenas está empezando a aparecer, nuestra experiencia muestra que puede ser una buena opción terapéutica para el control de las crisis epilépticas, sin efectos adversos importantes. Existe un gran potencial de investigación en el área de la TC en lactantes y neonatos.(AU)

Introduction: Ketogenic therapy (KT) studies have focused in children older than 2 years and adults. Recently its efficacy in infants has been reported, but there are few studies in this age group. Patients and methods: We report a case series of nine newborn and children younger than 4 months of age with refractory epilepsy treated with KT. We retrospectively reviewed charts of children treated at our center between 2015-2021. Results: Data was collected on seven patients. Six patients began having seizures on day one of life, one had seizures starting on day 45. Different epilepsy etiologies were found. KT was started as soon as 9 days of life. The average age at which ketogenic therapy was started was 24 days of life. Initially, the diet was started at 1:1 or 2:1 ratio, and was progressed to a 4:1 ratio. After one month of KT 5/7 patients experienced a significant reduction in seizure frequency (>50%) and 2/7 had complete seizure control. At six months, 4/7 patients achieve complete seizure freedom and 1/7 had >50% seizure reduction. Two patients were lost to follow-up. None of our patients reported gastrointestinal side effects that required diet adjustments. One patient had mild and one mild hypertriglyceridemia. CONCLUSION. Even though evidence about KT in young children are starting to emerge, our experience shows it can be successful in controlling seizure burden without considerable adverse effects. There is great research potential regarding KT in young children.(AU)

Kinetics and mathematical model of killer/sensitive interaction under different physicochemical conditions of must/wine: a study from a biological point of view.

Fermentation of grape must to wine is carried out by a complex microbial mixture, which also involves spoilage yeasts of wine. The latter yeasts produce organoleptic changes that cause significant economic losses to the wine industry. SO2 is traditionally used to control this spoilage populations, but because of its harmful effects on human health, biocontrol has emerged as an alternative treatment. Although studies have been carried out to select biocontroller yeasts and examine their underlying mechanisms of action, reports on their application have not been published yet. To better understand the interaction and the successful application of biocontrol, the use of mathematical models, among other methods, is important, as they facilitate the prediction of success or failure of the antagonist. The objective of the present study was to use an existing mathematical model to obtain information about the yeast's interaction assayed and to validate its predictive use under different physicochemical conditions during the wine fermentation, and eventually predict biocontrol kinetics. The mathematical model was applied to the fermentation conditions and provided information on the kinetic parameters of the biocontrol interaction and allowed interpretations about other parameters. The model was applied in the different physicochemical conditions for the biocontrol and did not fit correctly to experimental data, and therefore an improvement was proposed which was successful and presented new hypotheses.

Sindrome de Ortner como causa de disfonía en paciente fumador / Ortner syndrome as the cause of dysphony in smokers

El síndrome de Ortner es una causa rara de parálisis del nervio recurrente laríngeo izquierdo debido a una etiología cardiovascular. Presentamos el caso clínico de un hombre de 70 años con historia de disfonía de un mes y medio de evolución diagnosticado de síndrome de Ortner por aneurisma del cayado aórtico (AU)

Ortner's syndrome is a rare cause of left recurrent laryngeal nerve paralysis due to a cardiovascular aetiology. We present a 70 years old man case with one and a half month history of dysphonia with Ortner’s syndrome caused by aortic arch aneurysm diagnosed (AU)

Enfisema subcutáneo como signo de perforación colónicatras diverticulitis aguda / Subcutaneous emphysema as sign of colonic perforation due to acute diverticulitis

Se presenta un caso de enfisema subcutáneo de localización cervical sin neumoperitoneo como signo clínico tras perforación de colon secundaria a una diverticulitis aguda de sigma. Se realiza una somera descripción de las distintas patologías que pueden causar enfisema subcutáneo así como de los mecanismos fisiopatológicos implicados en su formación. Se resalta igualmente la rareza del cuadro descrito así como el pronóstico sombrío que conlleva. The authors present a subcutaneous emphysema located at cervical level without pneumoperitoneo as clinical sign, after a colon perforation due to an acute sigma diverticulitis. We describe different pathologies that may present a subcutaneus emphysema an try to explain the phisiopathological mechanisms involved in this matter.We enphasize the oddness of the entity described and its awful prognosis (AU)

Prevención de riesgos para el personal de los servicios de emergencias extrahospitalarias / Risk prevention for non hospital emergency service staff

Los Servicios de Emergencias Extrahospitalarias (SEMEX) se han estado implantando en los países desarrollados, ofreciendo progresivamente cobertura sanitaria a zonas más amplias de población. Por las características intrínsecas de los mismos (actuaciones en entornos hostiles, rapidez en la toma de decisiones, desplazamientos con la ambulancia..) sus miembros están sometidos a unos riesgos, en ocasiones similares a los del personal sanitario hospitalario y en otras específicos de estos equipos. El presente trabajo describe los riesgos de este tipo de asistencia sanitaria y establece una serie de medidas para prevenirlos (AU)

Who will treat psychiatrically disturbed developmentally disabled patients? A health care nightmare.

The authors assess the impact of a policy adopted briefly in New York State to facilitate short-term hospitalization and long-term aftercare of psychiatrically disturbed, developmentally disabled patients. Denied admission to New York State facilities that provide long-term care for the psychiatrically disturbed or the developmentally disabled, these dually diagnosed patients have often languished in the emergency room of municipal hospitals or been inappropriately hospitalized in the acute-care psychiatric unit, sometimes for several months. The authors conclude that the policy expedited hospitalization but failed to facilitate patients' discharge because it did not address the underlying need for suitable aftercare facilities. Overlapping clinical and administrative issues and political exigencies that complicated the policymaking process are discussed.

Psychiatric catchment areas in an urban center: a policy in disarray.

This study of the catchment area policy in New York City's 10 municipal psychiatric inpatient units and emergency rooms showed that of a total of 52,170 emergency room visits and 18,558 admissions in 1982, 35% and 24%, respectively, were of patients from outside the hospitals' catchment areas. The authors discuss the factors associated with the relative ineffectiveness of the policy and the implications for municipal hospitals' funding and patient care. They suggest that policy makers consider a different model for acute-care hospitals and propose a network approach as a plausible alternative. The need for further research is also emphasized.

Muddling through mental health policies.

This study reports the process and outcome of a mental health policy change designed to relieve overcrowding in the 10 municipal adult psychiatric inpatient units in New York City. The authors describe the strategies used to achieve a limited change in admission policies and analyze the effect of this change on the municipal hospitals. Comparison of conditions before and after the policy change suggests its positive impact. Results are discussed in reference to the model of incrementalism in policy making, emphasizing the need for comprehensive rational planning, the training of mental health professionals in policy making, and further research on this important area of psychiatry.