Estimulación cerebral profunda en enfermedad de Parkinson / Deep brain stimulation in Parkinson disease

RESUMEN Introducción: la enfermedad de Parkinson es considerada la segunda causa de enfermedad neurodegenerativa, en la que se destacan signos y síntomas motores como temblor, bradicinesia, rigidez e inestabilidad postural, acompañados de síntomas no motores como alteraciones del sueño, autonómicas, cognitivas, gastrointestinales, entre otras. El tratamiento farmacológico de la enfermedad al inicio suele ser útil, pero cuando los síntomas persisten, el tratamiento falla o no se toleran sus reacciones adversas, es necesario considerar alternativas como la estimulación cerebral profunda. Metodología: revisión narrativa con énfasis en los aspectos clínicos de la terapia con estimulación cerebral profunda en los pacientes con enfermedad de Parkinson. Discusión: la estimulación cerebral profunda es una técnica quirúrgica en la que se implantan electrodos en regiones cerebrales específicas, generalmente el núcleo subtalámico, globo pálido interno o núcleo ventral intermedio del tálamo, y se conectan a un marcapasos subcutáneo desde donde se modula eléctricamente la actividad de estas áreas. Esta terapia ha mostrado ser costo-efectiva, aporta beneficios considerables en la mejoría de los síntomas de la enfermedad de Parkinson y cuenta con evidencia clínica en los pacientes que han sido seleccionados correctamente.

SUMMARY Introduction: Parkinson's disease is considered the second cause of neurodegenerative disease, in which motor signs and symptoms such as tremor, bradykinesia, rigidity and postural instability are highlighted, accompanied by non-motor symptoms such as sleep, autonomic, cognitive, gastrointestinal among others disturbances. The pharmacological treatment of the disease at the beginning is usually useful, but when the symptoms persist, the treatment fails or its adverse reactions are not tolerated, it is necessary to consider alternatives such as deep brain stimulation. Methodology: This is a narrative review with emphasis on the clinical aspects of deep brain stimulation therapy in patients with Parkinson's disease. Discussion: Deep brain stimulation is a surgical technique in which electrodes are implanted in specific brain regions, usually the subthalamic nucleus, globus pallidus interna or ventral intermediate nucleus of the thalamus, and are connected to a subcutaneous pacemaker from which the activity of these areas is modulated electrically. This therapy has been shown to be cost-effective, provides considerable benefits in improving the symptoms of Parkinson's disease and has clinical evidence in patients who have been correctly selected.

Predictores de lesiones asociadas a crisis epilépticas en pacientes adultos con epilepsia en Colombia: estudio de casos y controles / Predictors of seizure related injuries in adult patients with epilepsy in Colombia: a case-control study

Objetivo. Identificar los predictores de lesiones asociadas con crisis epilépticas en adultos con epilepsia en Colombia. Sujetos y métodos. Estudio de casos y controles. Se incluyó a los pacientes con diagnóstico de epilepsia mayores de 16 años que fueron atendidos por una especialista en epilepsia que acudieron a Neurocentro en el período comprendido entre 2013 y 2016. Se definió como aso a los pacientes que habían presentado lesiones asociadas con crisis epilépticas, y como grupo control, a los que no las habían presentado. Se calcularon odds ratios e intervalos de confianza al 95%. Se realizó una regresión logística. Resultados. Se identificaron 101 (28,5%) casos y 253 (71,5%) controles. Los pacientes con lesiones asociadas con crisis epilépticas fueron significativamente más jóvenes que los controles a la edad de inicio de la epilepsia (9 frente a 12 años; p = 0,017). Las variables significativas en el análisis bivariado fueron: algún grado de deterioro cognitivo, epilepsia resistente a medicamentos, examen neurológico anormal y crisis asociadas a cambios en las fases lunares. No se identificaron factores protectores. En el análisis multivariado, dos variables permanecieron significativas: epilepsia resistente a medicamentos y algún grado de deterioro cognitivo. Conclusión. Se observó que la epilepsia resistente a medicamentos y el deterioro cognitivo son predictores de lesiones asociadas con crisis epilépticas en pacientes adultos con epilepsia. Un adecuado control farmacológico de las crisis epilépticas y unas recomendaciones de prevención pueden disminuir el riesgo de dichas lesiones en estos pacientes (AU)

Aim. To identify predictors of seizure related injuries in adult patients with epilepsy in Colombia. Subjects and methods. Case-control study. Patients with a diagnosis of epilepsy aged 16 years and older who attended the Neurocentro epilepsy center between 2013-2016 and were attended by a specialist in epilepsy were included. Patients with seizure related injuries were defined as the case. The control group was conformed by those without seizure related injuries. Odds ratios and 95% confidence intervals were calculated. A logistic regression was performed. Results. A total of 101 (28.5%) patients were cases and 253 (71.5%) were controls. Patients with seizure related injuries were significantly younger than controls at the age of onset of epilepsy (9 vs 12 years; p = 0.017). The significant variables in the bivariate analysis were: some degree of cognitive impairment, drug resistant epilepsy, abnormal neurological examination, and seizures related with changes in the lunar phases. No protective factors were identified. In the multivariate analysis, two variables remained significant: drug resistant epilepsy and some degree of cognitive impairment. Conclusion. Drug-resistant epilepsy and cognitive impairment were predictors of seizure related injuries in adult patients with epilepsy. Adequate pharmacological control of epileptic seizures and prevention recommendations may reduce the risk of seizure related injuries in these patients (AU)

Is Legionellosis Present and Important in Colombia? An Analyses of Cases from 2009 to 2013.

Infection due to Legionella pneumophila has been not studied in Colombia, although it is present. The observational, retrospective study in which the incidence of legionellosis in Colombia, 2009-2013, was estimated based on data extracted from the personal health records system (Registro Individual de Prestación de Servicios, RIPS) using the ICD-10 codes A48.1 (Legionnaires' disease) and A48.2 (Pontiac Fever). Using official population estimates of the National Administrative Department of Statistics (DANE), crude and adjusted incidence rates were estimated (cases / 100,000 pop). During the period, 206 cases were reported (mean of 41.2 per year) for the cumulated national rate of 0.45 cases / 100,000 pop. The clinical form of legionellosis with the highest incidence rates was the non-pneumonic Legionnaires' disease (0.39 cases / 100,000 pop) with women being the main affected (0.42 cases / 100,000 pop). The territory with the highest incidence rate was Bolivar department (1.94 cases / 100,000 pop), followed by La Guajira (1.7 cases / 100,000 pop). Finally, age groups with the highest morbidity were 0-9.999 years old (1.16 cases / 100,000 pop) and system of identification for social subsidies beneficiaries (SISBEN) category with the highest number of total cases was level one (88 cases). According to these results, we can show that legionellosis in Colombia is more common than it could be thought. Nevertheless, cross-sectional and prospective studies should be conducted in our country in order to improve the knowledge of incidence, prevalence, and burden of disease.

Opioid Prescribing Patterns and Costs in a Large Group of Patients in Colombia.

The potential for development of tolerance and dependence and the risk of side effects of opioids make it necessary to monitor their prescribing patterns in order to decrease the morbidity and mortality associated with their continued use. The objective of this study was to determine prescription patterns of opioid medication in a group of patients through a cross-sectional study on a population database of 3.5 million people. Patients with three months of continuous opioid use were identified. Pharmacological, co-medication and cost variables were analyzed. We conducted a multivariate analysis. A total of 7,457 patients were included; 72.1% were women, the mean age was 65.1 years, and 3.8% had a diagnosis of cancer. 10.2% of the patients received opioids in combination therapy. The most prescribed opioids were codeine (57.7%), tramadol (30.9%), and hydrocodone (10.4%). The great majority of patients (91.8%) received pharmacological co-medication with antihypertensive agents (54.4%), statins (38.2%) and acetaminophen (35.4%). The use of other analgesics such as acetaminophen (OR: 1.45, 95% CI: 1.22 -1.75) or nonsteroidal anti-inflammatory drugs (OR: 1.98, 95% CI: 1.60 -2.44) was associated with increased risk of receiving opioids in combination therapy. Prescribing habits of weak agonists and short-acting opioids predominate, mainly in monotherapy and at lower than recommended doses.

Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia.

OBJECTIVE: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. METHODS: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. RESULTS: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). CONCLUSIONS: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre).