Evaluación y manejo de primera crisis epiléptica / Assessment and management of the first epileptic seizure

RESUMEN Las crisis epilépticas son una causa frecuente de consulta en la emergencia y en la atención ambulatoria. La evaluación de una primera crisis epiléptica reviste gran trascendencia en este contexto, ya que la ocurrencia de ésta no implica necesariamente el diagnóstico de epilepsia (dos o más crisis no provocadas separadas por más de 24 horas; una crisis única con alto riesgo de recurrencia (>60%); o la evidencia de un síndrome epiléptico - definición de la Liga Internacional para la Lucha Contra la Epilepsia, ILAE) y el tratamiento subsecuente. Por otro lado, no todo paciente con primera crisis debe ser dejado en observación sin recibir el manejo apropiado. Esta decisión está en función del riesgo de recurrencia de crisis. Para ello, la Academia Americana de Neurología (AAN de sus siglas en inglés) recomienda la clasificación de la primera crisis epiléptica en cinco grupos y dependiendo del riesgo de recurrencia de crisis establecido para cada uno de ellos, se tendrá una guía para proceder o no con el tratamiento antiepiléptico. Los grupos son: pacientes con crisis epiléptica provocadas; pacientes con crisis sintomáticas agudas; pacientes con crisis sintomática remotas; primera crisis asociada a síndromes epilépticos; primera crisis de causa desconocida. La guía publicada por AAN en el 2015 para el manejo de primera crisis, sugiere que los pacientes con crisis sintomáticas remotas (lesiones cerebrales pasadas no evolutivas), pacientes con anormalidades epileptiformes interictales; pacientes con estudios de imagen anormales (RMN y TC); y pacientes con crisis nocturnas, tienen un riesgo elevado para recurrencia de crisis (>60%) por lo que deben ser tratadas. La evidencia disponible a la fecha sugiere también que no hay diferencia significativa en el inicio precoz o diferido del tratamiento antiepiléptico para el control de las crisis a largo plazo.

SUMMARY Epileptic seizures are a common cause of medical consultation in the emergency room and in outpatient settings. The evaluation of the first epileptic seizure is of upmost importance as not all patients presenting with seizures have epilepsy (two or more unprovoked crises separated more than 24 hours; one single crisis with a high risk of recurrence (>60%); or evidence of an epileptic syndrome needing treatment based on the definition by the International League against Epilepsy). On the other hand, not every patient with a first episode should be just observed not offering proper treatment. This decision is based on the risk of recurrence. For that purpose, the American Academy of Neurology (AAN) recommends classifying the first seizures into five groups depending on the risk of recurrence, these groups are: patients with provoked seizures; patients with acute symptomatic seizures; patients with remote symptomatic seizures; first seizure associated with an epileptic syndrome, and first seizure of unknown origin. The AAN guidelines for the management of the first seizure published in 2015 suggests that patients with symptomatic remote seizures (non-evolutive and old cerebral lesions), patients with interictal epileptiform abnormalities, patients with abnormal findings on MRI or CT scan, and patients with nocturnal seizures had a high risk for recurrence (>60%) and should be treated. Current evidence suggests that there is no difference in early or delay treatment for controlling seizures at the long-term.

Índice de redondez corporal como indicador antropométrico para identificar riesgo de síndrome metabólico en médicos del hospital San Francisco del IESS, en la ciudad de Quito / Body roundness index as an anthropometric indicator to identify risk of metabolic syndrome in physicians of the San Francisco hospital of the IESS, in the city of Quito

Contexto: las enfermedades crónicas no transmisibles revisten interés para la salud pública; algunas de ellas pueden detectarse y predecirse mediante estudios básicos como es la antropometría. El índice de masa corporal (IMC) valora, estratifica y clasifica el nivel de sobrepeso del individuo como factor de riesgo de síndrome metabólico (SM), sin discriminar entre masa muscular y adiposidad que puede dilucidarse mediante el índice de redondez corporal (IRC) y predecir tanto el porcentaje de grasa corporal y el estado de salud. Barazzoni y colaboradores relacionaron tanto al IRC e IMC con el síndrome metabólico; sobre esta relación existen contados estudios, algunos controversiales. Objetivo: demostrar la utilidad del IRC para identificar factores de riesgo de síndrome metabólico y correlacionarlo con el Índice de masa corporal para establecer la utilidad clínica como indicador de riesgo metabólico. Sujetos y métodos: estudio epidemiológico observacional descriptivo transversal de con- junto, en una muestra de 90 médicos del Hospital San Francisco de Quito. Perteneciente al Instituto Ecuatoriano de Seguridad Social. Mediciones principales: estado nutricional según peso, talla, circunferencia abdominal; diagnóstico de síndrome metabólico según «guía para el tratamiento de dislipidemias en adultos¼ (Adult Treatment Panel III). Resultados: el 16,67% (IC95% 10,37­25,69%) de sujetos fueron diagnosticados con SM de- mostrándose similar resultado usando IMC e IRC para establecer la condición de SM según criterios diagnósticos del ATPIII (p<0,05). La exactitud del IMC como predictor de riesgo de SM fue 62% y 30% de precisión; para IRC, la exactitud fue 42%, sensibilidad del 23% y 100% de valor predictivo negativo. Conclusión: la prevalencia de síndrome metabólico en médicos es alta. El IRC es útil para el diagnóstico de SM, sin embargo, su mayor aplicación es para descartar su diagnóstico, comparado con el IMC. Se recomienda nuevos estudios.

Contex: Chronic non-communicable diseases are of interest to public health; some of them can be detected and predicted through basic studies such as anthropometry. The body mass index (BMI) assesses, stratifies and classifies the individual's level of overweight as a risk factor for metabolic syndrome (MS), without discriminating between muscle mass and adiposi- ty that can be elucidated by means of the body roundness index (BRI) and predict both body fat percentage and health status. Barazzoni and collaborators related both IRC and BRI with metabolic syndrome; about this relationship there are few studies, some controversial. Objective: to demonstrate the usefulness of the BRI to identify risk factors for metabolic syndrome and correlate it with the body mass index to establish clinical utility as an indica tor of metabolic risk. Subjects and methods: Cross-sectional descriptive observational epidemiological study, in a sample of 90 doctors from the San Francisco Hostpital of Quito (Ecuadorian Social Security Institute). Main measurements: nutritional status according to weight, height, abdominal circumference; diagnosis of metabolic syndrome according to "guide for the treatment of dyslipidemias in adults" (Adult Treatment Panel III). Results: 16.67% (95% CI 10.37­25.69%) of subjects were diagnosed with MS demonstrating a similar result using BMI and BRI to establish the condition of MS according to diagnostic criteria of ATPIII (p <0.05). The accuracy of the BMI as a predictor of MS risk was 62% and 30% accuracy; for IRC, the accuracy was 42%, sensitivity 23% and 100% negative predictive value. Conclusions: The prevalence of metabolic syndrome in doctors is high. The BRI is useful for the diagnosis of MS, however, its greatest application is to rule out its diagnosis, compared to the BMI. New studies are recommended.

Biogenic porous silica and silicon sourced from Mexican Giant Horsetail (Equisetum myriochaetum) and their application as supports for enzyme immobilization.

Porous silica-based materials are attractive for biomedical applications due to their biocompatibility and biodegradable character. In addition, inorganic supports such as porous silicon are being developed due to integrated circuit chip compatibility and tunable properties leading to a wide range of multidisciplinary applications. In this contribution, biosilica extracted from a rarely studied plant material (Equisetum Myriochaetum), its conversion to silicon and the potential for both materials to be used as supports for enzyme immobilization are investigated. E. myriochaetum was subject to conventional acid digestion to extract biogenic silica with a% yield remarkably higher (up to 3 times) than for other Equisetum sp. (i.e. E. Arvense). The surface area of the isolated silica was ∼400 m2/g, suitable for biotechnological applications. Biogenic silicon was obtained by magnesiothermic reduction. The materials were characterized by SEM-EDX, XRD, FT-IR, ICP-OES, TGA and BET analysis and did not contain significant levels of class 1 heavy elements (such as Pb, Cd, Hg and As). Two commercial peroxidases, horseradish peroxidase (HRP) and Coprinus cinereus peroxidase (CiP) were immobilized onto the biogenic materials using three different functionalization routes: (A) carbodiimide, (B) amine + glutaraldehyde and (C) amine + carbodiimide. Although both biogenic silica and porous silicon could be used as supports differences in behaviour were observed for the two enzymes. For HRP, loading onto biogenic silica via the glutaraldehyde immobilization technique (route B) was most effective. The loading of CiP showed a much higher peroxidase activity onto porous silicon than silica functionalized by the carbodiimide method (route A). From the properties of the extracted materials obtained from Equisetum Myriochaetum and the immobilization results observed, these materials appear to be promising for industrial and biomedical applications.

Prevalencia de anticuerpos antifosfolípidos en pacientes con conectivopatías / Prevalence of antiphospholipid antibodies in patients with connective tissue diseases

Objetivos: Determinar la prevalencia de anticuerpos antifosfolípidos en pacientes con conectivopatías. Diseño: Estudio descriptivo transversal. Institución: Hospital Dos de Mayo e Instituto de Investigaciones Clínicas de la UNMSM, Lima, Perú. Participantes: Pacientes con diagnóstico de colagenopatía y sujetos sanos. Intervenciones: En 100 pacientes con diagnóstico de colagenopatía y 50 sujetos sanos, todos provenientes de Lima Metropolitana y atendidos entre enero y noviembre de 2008, se determinó fibrinógeno, tiempo de protrombina, tiempo parcial de tromboplastina activada, anticuerpos anticardiolipina y anticoagulante lúpico. Principales medidas de resultados: Presencia de anticuerpos anticardiolipina y anticoagulante lúpico. Resultados: Los pacientes con conectivopatías presentaron anticuerpos antifosfolípidos en 17 por ciento, anticoagulante lúpico en 13 por ciento y anticardiolipina IgG 4 por ciento. Al dividir el grupo por conectivopatías, en los 70 pacientes con lupus eritematoso sistémico 10 resultaron positivos para anticoagulante lúpico y 3 tuvieron anticardiolipina IgG; de los 30 pacientes con artritis reumatoide, 3 tuvieron anticoagulante lúpico positivo y 1 presentó anticardiolipina IgG. En el grupo de 50 personas sanas, solo se encontró un caso positivo para anticoagulante lúpico. Conclusiones: La prevalencia de anticuerpos antifosfolípidos en pacientes con conectivopatías fue 17 por ciento. La conectivopatía estudiada más frecuente fue el lupus eritematoso sistémico. El anticuerpo antifosfolípido más frecuente fue el anticoagulante lúpico.

Objectives: To determine the prevalence of antiphospholipid antibodies in patients with connective tissue diseases. Design: Descriptive transversal study. Setting: Dos de Mayo Hospital and Institute of Clinical Research, San Marcos University, Lima, Peru. Participants: Patients with diagnosis of collagen disease and healthy subjects. Interventions: In 100 patients with collagen disease and 50 healthy subjects, all from Metropolitan Lima and attended between January and November 2008, fibrinogen, prothrombin time, partial activated thromboplastin time, anticardiolipin antibody and lupus anticoagulant were determined. Main outcome measures: Presence of anticardiolipin antibodies and lupus anticoagulant. Results: Patients with collagen diseases presented antiphospholipid antibodies in 17 per cent, lupus anticoagulant in 13 per cent, and IgG anticardiolipin in 4 per cent. Individualizing connective tissue diseases, in 70 patients with systemic erythematous lupus 10 were positive for lupus anticoagulant and 3 had IgG anticardiolipin; of 30 patients with rheumatoid arthritis three were positive to lupus anticoagulant and one presented IgG anticardiolipin. In the group of 50 healthy individuals, only one was positive for lupus anticoagulant. Conclusions: The prevalence of antiphospholipid antibodies in patients with connective tissue was 17 per cent. The most frequent connective tissue disease studied was lupus erythematosus and the most frequent antiphospholipid antibody found was lupus anticoagulant.

Hospitales de la Comibol / Hospitals of the Comibol

La Corporación Minera de Bolivia, entidad estatal desde el año 1952 hasta 1986 y parcialmente en su funcionamiento hasta el presente, albergó en su seno, no solamente al trabajador minero sino también a diferentes profesionales, entre ellos los trabajadores de la salud minera en diferentes centros de salud.

Substance use among school-based youths in northern Mexico.

A small base of research suggests that adolescent substance use is a growing public health concern in Mexico. Employing confidential methods, the International Longitudinal Survey of Adolescent Health was administered to assess substance use among 1,238 students in northern Mexico. A large proportion of students indicated lifetime use of tobacco and alcohol. Gender differences in tobacco, alcohol, and marijuana were also evident. The current findings are congruent with the sparse extant data on youths' substance use in Mexico and highlight the need for early prevention interventions.

Substance use among school-based youths in Puerto Rico: differences between gender and grade levels.

The present study examined substance use rates among adolescents in Grades 7-12 in Puerto Rico. Nine hundred eighty-nine students completed the Spanish version of the International Survey of Adolescent Health. More than 50% of middle school youths and 75% of high-school youths reported lifetime alcohol use. Female gender was associated with tobacco use in middle school while male gender was associated with marijuana use in high school. High-school females reported lower rates of tobacco use and marijuana use than middle-school females. High-school males exhibited substantially higher drug-use rates than middle-school males for each substance. These findings may suggest that universal drug prevention interventions may be needed for females in Puerto Rico before they enter middle school, while targeted interventions aimed at high-risk females who continue to smoke tobacco or marijuana may be more effective during high school. In contrast, targeted drug prevention interventions for males probably need to begin in middle school and be maintained if not increased in intensity throughout the high-school years.

La medicina en el siglo XX / The medicine in the XX century

Al iniciar el siglo XXI es necesario un análisis retrospectivo del camino recorrido por la ciencia médica y tener mas o menos un criterio a priori de la medicina del futuro. Se descubrieron muchas substancias que dominan el organismo, asimismo los antibioticos, y aquellas que constituyen la esencia de los genes.La explosión demográfica dio lugar a las diferentes enfermedades sociales, como también tuvo que luchar contra las epidemias, en especial contra aquellas desconocidas. Nace la médicina ecológica como consecuencia de los cambios en el medio ambiente. Como consecuencia de los grandes avances de la medicina tecnologizada se plantean en el futuro próximo dificeles problemas de carácter bióetico.