Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross-sectional study.

OBJECTIVE: To describe the sociodemographic and clinical characteristics of imprisoned patients with epilepsy seen at Samaritana University Hospital (HUS) in Bogotá D.C., between January 2017 and November 2020. METHODS: Cross-sectional cohort study of inmate patients over 18 years of age seen at HUS between January 2017 and November 2020, with a discharge diagnosis of epilepsy. A descriptive univariate analysis of patient sociodemographic and clinical characteristics was carried out. RESULTS: Overall, 92 patients were included, 95.7% were males with a median age of 32 years (IQR: 26-44); 65% were assessed in the outpatient clinic; median hospital length of stay was 2 days (IQR: 0) and 7.6% required admission to the intensive care unit; 75% had focal onset epilepsy, 63.04% with undetermined etiology 31.52% with structural causes. Polytherapy was found in 53.3%, valproic acid being the most frequently used antiseizure medication in 59.78%; lack of adherence was reported in 15.22% and inadequate seizure control in 81.52%; status epilepticus occurred in 5.34%. A total of 31 EEG recordings and 53 brain images were performed, of which, 29% and 39.62%, respectively, were abnormal. Non-epileptic paroxysmal events were diagnosed in 5.34%, while organic or psychiatric comorbidities were found in 25%, and the use of psychoactive substances was documented in 17.39%. Upon discharge, 93.47% had no disability, and only 45.65% returned for outpatient follow-up. SIGNIFICANCE: The clinical profile was of men in the fourth decade of life with focal onset epilepsy characterized by high seizure frequency, most of whom were receiving antiseizure medication, with a high proportion of polytherapy. The results are a point of departure for prospective studies designed to identify points to intervene and improve healthcare for inmates with epilepsy. PLAIN LANGUAGE SUMMARY: Inmates are a vulnerable proportion of persons with epilepsy. In this group there are significant differences compared to the general population, especially with greater psychiatric comorbidity and worse control of epileptic seizures due to difficulties in accessing medical care, antiseizure medication and diagnostic tests. We found that the most characteristic population is made up of men in the fourth decade of life with a high frequency of seizures, most of whom were receiving multiple antiseizure medication This study is the first of its kind in Latin America and it is an initial approach to epilepsy in inmates.

Complejo teniasis/cisticercosis / Teniasis / Cysticercosis complex

RESUMEN La neurocisticercosis, como parte del complejo teniasis/cisticercosis, es la helmintiasis que compromete con mayor frecuencia el sistema nervioso central, particularmente en países en vías de desarrollo, en los cuales su transmisión es endémica. Sus manifestaciones clínicas son variables, de acuerdo con su localización en el sistema nervioso central, y resalta la epilepsia como una de sus principales formas de presentación clínica. Los avances en el uso de métodos diagnósticos inmunológicos, así como las neuroimágenes y la introducción hace dos años de nuevos criterios diagnósticos, han mejorado la certeza diagnóstica. La implementación del tratamiento anticestocida asociado con el uso de corticoides y, en algunos casos particulares, la intervención quirúrgica brindan no solo una opción terapéutica, sino también un mejor pronóstico a los pacientes afectados por esta condición. Hoy el reto se centra en implementar medidas de salud pública sobre en el ciclo biológico del CTC para lograr su erradicación.

SUMMARY Neurocysticercosis, as part of the Teniasis / Cysticercosis complex, is helminthiasis that more frequently involves the central nervous system, particularly in countries undergoing development where its transmission is endemic; its clinical manifestations are variable, according to its location in the central nervous system, highlighting epilepsy as one of its main forms of clinical presentation. Advances in the use of diagnostic methods immunological tests, as well as neuroimaging and the introduction two years ago of new criteria diagnoses have improved the diagnostic certainty, with the implementation of anti-treatment cestocide associated with the use of corticosteroids and, in some particular cases, the intervention surgical treatment provides not only a therapeutic option but also a better prognosis for patients affected by this condition. The challenge today is focused on implementing measures of public health on the biological cycle of the CTC to achieve its eradication.

Linfoma/leucemia t pediátrico con expresión del receptor Tyð / Pediatric t-lymphoma / leukemia with Tyð receptor expression

Los linfomas/leucemias Tyδ son poco frecuentes en la población pediátrica. Reportamos el caso de un niño de 5 años que presentó adenomegalias cervicales, supraclaviculares, axilares e inguinales induradas no dolorosas de 15 días de evolución. Hemograma de ingreso: Hto:44%; Hb:15.4g%; Leucocitos: 5900/mm3; Plaquetas: 262.000/mm3, Eritrosedimentación: 7mm. Serología negativa para Epstein-Barr, HIV, HCV, HBC. Radiografía de Tórax normal. La biopsia por anatomía patológica del ganglio mostró una infiltración por Linfoma Linfoblástico /Leucemia Linfoblástica Aguda T y por citometría de flujo una población de linfocitos TCR ɣδ+, con expresión de CD7++, CD3+, CD5+, CD2+, CD45+, CD4-, CD8-, CD38++, HLA-DR+ heter, CD71+. Además, se evaluaron las regiones variables δ del TCR por CF sugiriendo monoclonalidad para la Vδ3. La médula ósea mostró una infiltración del 30% de blastos con las mismas características inmunofenotípicas. El paciente recibió tratamiento para Leucemia Linfoblástica Aguda protocolo ALLIC BFM 2002. El día 15 del tratamiento presentó 5% de blastos en la médula ósea. Actualmente se encuentra en buen estado general y bajo tratamiento. Se presenta el caso por la baja frecuencia de la patología y el compromiso de médula ósea en un paciente con hemograma normal.

Tyδ lymphomas/leukemias are rare in infant population. Here we report the case of a 5 year old boy who presented cervical, supraclavicular, axillary, and inguinal indurated non-painful adenomegalias with a 15 day evolution. Blood count at admission: HCT: 44%; Hb:15.4g %; White Blood Cells: 5,900/ mm3; Platelets: 262,000/mm3, Eritrosedimentation: 7mm. Negative serology for Epstein-Barr, HIV, HCV, HBC. Normal chest X-ray. Biopsy by pathological anatomy of the node revealed infiltration by Lymphoblastic Lymphoma / Acute Lymphoblas- tic Leukemia T and by flow cyto- metry a population of TCR ɣδ+ lymphocytes, with CD7++, CD3+, CD5+, CD2+, CD45+, CD4-, CD8-, CD38++, HLA-DR+ heter, CD71+ expression. In addition, the variable regions δ of TCR where assessed by flow cytometry suggesting monoclonality for Vδ3. The bone marrow showed a 30% infiltration of blasts with the same immunophenotypical characteristics. The patient underwent treatment for Acute Lymphoblastic Leukemia protocol ALLIC BFM 2002. On the fifteenth day of treatment the patient presented 5% of blasts in his bone marrow. At present, his general condition is good and he is under treatment. This case is presented due to the rare occurrence of the pathology and the bone marrow involvement in a patient with normal blood count.

Leucemia promielocitica aguda: utilidad de la citometría de flujo en el diagnóstico / Acute promyelocytic leukemia: usefulness of flow cytometry in diagnosis

La Leucemia Promielocítica Aguda (LPA) requiere una rápida identificación ya que deben tomarse decisiones terapéuticas tempranas. Habitualmente el estudio morfológico es suficiente, pero la existencia de falsos positivos y negativos hace necesario buscar métodos más objetivos y rápidos que la confirmación molecular de la t(15;17) (PMLRARα) patognomónica. Objetivo: Evaluar la utilidad del inmunofenotipo por Citometría de Flujo (CF) como método diagnóstico temprano a LPA ya que presenta un patrón fenotípico aberrante característico. Materiales y Métodos: Se evaluaron 85 pacientes con diagnóstico presuntivo de Leucemia Mieloide Aguda, de los cuales 10 presentaron perfil inmunofenotipico de LPA. Procedimientos diagnósticos en el aspirado medular: 1) observación microscópica e histoquímica para mieloperoxidasa; 2) análisis multiparamétrico con anticuerpos monoclonales por CF, que cubrió el espectro de los distintos linajes. Los datos se adquirieron y analizaron en un FACScalibur (Becton Dickinson). Los parámetros hemostáticos evaluados fueron: Tiempo de Protrombina y Tiempo de Tromboplastina Parcial Activado, Fibrinógeno, Dímero D y Productos de Degradación del Fibrinógeno. Resultados: Las características fenotípicas de probable LPA M3 t(15,17) la presentaron 10 de los pacientes. El perfil inmunofenotípico tuvo correlación con la morfología en 6 casos; en 2 pacientes, la morfología no fue suficiente para clasificarlos como portadores de LMA M2 o M3. Pacientes (n=2), que presentaban inicialmente morfología monocítica, el diagnóstico definitivo fue M3v hipogranular. Patrón inmunofenotípico: única población de blastos, autofluorescencia, CD33++ homogéneo, expresión heterogénea de CD13, ausencia de expresión de HLA DR, patrón CD15/ CD34 definido. Conclusiones: el inmunofenotipo aporta gran valor para un screening rápido de LPA con rearreglo PML/RARα.

Acute Promyelocytic Leukemia (APL) requires rapid identification since early therapeutic decisions should be made. In general, morphological screening is enough. However, the existence of false positive and false negative results requires a search for methods that are more objective and rapid than molecular confirmation of pathognomonic t(15;17) (PMLRARa+). The objective of this study was to assess the usefulness of immu- nophenotype by means of Flow Cytometry (FC) as an early diag- nosis method for APL since it presents a characteristically aberrant phenotypical pattern. The study consisted in the assessment of 85 patients presu- mably with a diagnosis for Acute Myeloid Leukemia (AML). Among these patients, 10 presented an APL immunophenotypical profi- le. The diagnostic procedures performed in the medullar aspi- ration were the following: 1) microscopic and histochemical observation for myeloperoxidase; 2) multi-parameter analysis with monoclonal antibodies by means of FC, that covered the spectrum for the different strains. Data were acquired and analyzed in a FACScalibur (Becton Dickinson). The hemostatic parameters assessed were the following: Prothrombine Time and Partially Activated Thromboplastine Time, Fibrinogen, D Dimer, and Fibrinogen Degradation Products. The following results were obtained: 10 of the patients showed phenotypical characteristics of probable APL M3 t(15,17). The immunophenotypical profile showed correlation with the morphology in 6 cases; in 2 patients, the morphology was not enough to classify them as AML M2 or M3 carriers. For those patients (n=2), presenting monocytic morphology at the on-set, the final diagnosis was hypogranular M3v. The immunophenotypical pattern found was only one blast population, auto-fluorescence, homogeneous CD33++, heterogeneous CD13 expression, lack of expression of HLA DR, defined CD15/CD34 pattern. In conclusion, the immunophenotype is very useful for rapid screening of APL with PML/RAR rearrangement.

Estudio comparativo del EEG con privación de sueño y el EEG convencional seriado en pacientes con diagnóstico de epilepsia / Comparative study of EEG with sleep deprivation and a conventional serial EEG in patients with epilepsy

El diagnóstico de epilepsia se hace con base en la información de la historia clínica. Un EEG, único puede ser normal en 35.50/100 de los pacientes con epilepsia; y por ello se realizan EEG seriados, o se utilizan métodos que buscan activar el EEG como la privación de sueño y los de registros continuos. El objetivo del estudio fue evaluar la utilidad, del electroencefalograma con privación de sueño frente al convencional seriado de vigilia en el diagnóstico de la epilepsia. El estudio concluye que el electroencefalograma con privación de sueño y el tercer EEG seriado de vigilia duplican la sensibilidad del segundo EEG de vigilia, el primerotiene una especificidad similar a la de un tercer EEG seriado de vigilia y probabilidades muy superiores de evidenciar la actividad epileptiforme interictal con una menor tasa de falsos positivos, y mejores VPP, VP, PPP