Manejo y factores de riesgo de mortalidad del estatus epiléptico: estudio retrospectivo / Status epilepticus management and mortality risk factors: A retrospective study

Introducción: El estatus epiléptico (SE, por sus siglas en inglés) es una urgencia neurológica con altas tasas de mortalidad. En este estudio analizamos el manejo del SE e identificamos factores de riesgo de mortalidad en los que realizar intervenciones de mejora o modificaciones en los protocolos de actuación hospitalarios. Métodos: Retrospectivamente se analizaron los datos demográficos de tratamiento y pronóstico de 65 pacientes (59 [44,5-77] años, 53,8% mujeres) que ingresaron en un hospital terciario cumpliendo los criterios de SE de la ILAE 2015, durante un periodo de 18 meses. Resultados: Treinta (46,2%) pacientes tenían antecedentes de epilepsia. Las causas más frecuentes de SE fueron enfermedad cerebrovascular (27,7%) e infección sistémica (16,9%). Se registraron desviaciones respecto al tratamiento habitual: la administración de las benzodiazepinas como primer fármaco solo en 33 (50,8%) pacientes, la combinación de 2 benzodiazepinas en 7 (10,8%) pacientes y el uso off-label de lacosamida en 5 (7,7%) pacientes. El electroencefalograma (EEG) fue realizado únicamente en 26 (40%) pacientes y solo 5 EEG (7,7% de pacientes) en las primeras 12 h. La tasa de mortalidad fue del 21,5%. Ictus agudo y complicaciones cerebrovasculares se asociaron con mortalidad, mientras que epilepsia previa e ingreso en la unidad de cuidados intensivos (UCI) fueron factores de buen pronóstico (p < 0,05). Conclusiones: Para mejorar el manejo del SE y reducir la tasa de mortalidad, sería recomendable implementar actividades formativas dirigidas a los profesionales del departamento de urgencias, así como el ingreso electivo en la UCI para pacientes con factores de riesgo (primera crisis epiléptica, con ictus agudo o complicaciones cardiovasculares). (AU)

Introduction: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. Methods: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. Results: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). Conclusions: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications). (AU)

Status epilepticus management and mortality risk factors: a retrospective study.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <  .05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).

Status epilepticus management and mortality risk factors: A retrospective study. / Manejo y factores de riesgo de mortalidad del estatus epiléptico: estudio retrospectivo.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).

Diabetes mellitus tipo 1: Características clínicas y demográficas en pacientes del servicio de endocrinología del Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela

Objetivo: Conocer las características clínicas y demográficas de los pacientes con Diabetes Mellitus tipo 1 (DM1) en relación a la aparición, evolución y situación actual en el Instituto Autónomo Hospital Universitario de los Andes (IAHULA), Mérida, Venezuela. Métodos: Estudio observacional, retrospectivo y descriptivo, con revisión de historias clínicas de 105 pacientes con DM1, del 2000 al 2010. Se recolectaron al ingreso y en su última consulta edad, sexo, tipo de debut, procedencia, antecedentes familiares-personales, examen físico, tratamiento, control metabólico, complicaciones agudas y crónicas. Resultados: Edad promedio 11,57±6,52 años al ingreso, en la última evaluación 17,86±8,3. La mayoría debutó en hiperglucemia, con índice de masa corporal (IMC) y tensión arterial (TA) normal. El 81% tenía antecedentes familiares de diabetes. Las insulinas más usadas fueron NPH y cristalina. El 66,2% estaba en mal control metabólico. Hubo 80 episodios de cetoacidosis diabética y 38 de hipoglucemia moderada a severa. Los pacientes en tratamiento con análogos de insulina tuvieron significativamente mejor control y menos hipoglucemias. El 26,8% de los pacientes presentaron complicaciones crónicas, las cuales estuvieron asociadas a mayor edad y mayor duración de la diabetes. Conclusión: El debut de DM1 fue más frecuente en menores de 10 años de edad. Existe un alto porcentaje de pacientes en mal control metabólico. Las complicaciones crónicas fueron más frecuentes en mayores de 19 años y con más de 5 años de evolución. El uso de análogos de insulina mostró mejores beneficios. El registro de datos en las historias clínicas es deficiente. Se deben mejorar las estrategias tanto de educación diabetológica como de diagnóstico precoz y tratamiento de la DM1.

Objective: To know the clinical and demographic characteristics of patients with type 1 diabetes mellitus (T1DM) in relation to the onset, evolution and current situation in the Autonomous Institute Hospital Universitario de los Andes (IAHULA), Mérida, Venezuela. Methods: Observational, retrospective and descriptive study with review of medical records of 105 patients with T1DM, from 2000 to 2010. The age, sex, type of debut, origin, family and personal history, physical examination, treatment, metabolic control, acute and chronic complications, were collected, at admission and at their last consultation. Results: Mean age 11.57 ± 6.52 years at admission, 17.86 ± 8.3 years at last assessment. The majority debuted in hyperglycemia, with normal body mass index and blood pressure. The 81% had a family history of diabetes. The NPH and crystalline insulin were the most used. The 66.2% were in poor metabolic control. There were 80 episodes of diabetic ketoacidosis and 38 moderate to severe hypoglycemia. Patients treated with insulin analogues had significantly better control and less hypoglycemia. The 26.8% of the patients had chronic complications, which were associated with older age and longer duration of diabetes. Conclusion: The debut of T1DM was more common in children under 10 years of age. There were a high percentage of patients in poor metabolic control. Chronic complications were more common in patients over 19 years and more than 5 years of evolution. The use of insulin analogues showed better benefits. Registration data in medical records is poor. The strategies of diabetes education and early diagnosis and treatment of DM1 should be improved.

Características clínico epidemiológicas de las complicaciones agudas de la diabetes en el servicio de urgencias del Hospital General de Atizapán / Clinical-epidemiological features of diabetes acute complications in the emergency ward at Atizapan General Hospital

Antecedentes: La epidemia de la diabetes mellitus es reconocida por la Organización Mundial de la Salud (OMS) como una creciente amenaza mundial. Se calcula que en el mundo existen más de 180 millones de personas con diabetes y es probable que esta cifra aumente a más del doble para 2030. En México la diabetes ocupa el primer lugar en número de defunciones por encima de otros padecimientos crónicos, enfermedades infectocontagiosas o accidentes. Las complicaciones agudas de diabetes representan casi el 30% de las hospitalizaciones en la sala de urgencias y de ellos hasta el 10% de la mortalidad en dicho servicio. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes ingresados por complicaciones agudas de la diabetes mellitus al servicio de urgencias del Hospital General de Atizapán, un suburbio de la ciudad de México. Materiales y métodos: Se realizó un estudio prospectivo, transversal, descriptivo y observacional. El universo estuvo conformado por 1417 pacientes diabéticos que ingresaron al servicio de urgencias del Hospital General de Atizapán del 1 de julio de 2010 al 31 de junio del 2011. Resultados: Cien pacientes (7% del total) ingresaron con diagnóstico de complicaciones agudas de diabetes. La más frecuente fue la hipoglucemia, que se observó en 48% de los pacientes. En menor cantidad, 33% con cetoacidosis diabética, 17% con estado hiperosmolar y 2% con acidosis láctica. Presentando principalmente manifestaciones neurológicas y digestivas, la mayoría de ellos provenientes de nivel socioeconómico bajo. Conclusiones: La identificación oportuna de las características clínicas de las complicaciones agudas de la diabetes nos permite brindar atención rápida y eficaz, con lo que se evita mayor gravedad. Los factores sociales, culturales o educacionales pueden favorecer su aparición por lo que la educación para la salud será esencial en materia de prevención.

Background: The epidemic of diabetes mellitus is recognized by the World Health Organization as an increasing world menace. It has been estimated that there are more than 180 million diabetic patients in the world. This amount can double by the year 2030. In Mexico, diabetes is the first cause of mortality over other problems such as chronic or infectious diseases or accidents. Acute complications of diabetes account for almost 30% of the hospitalized patients in the emergency room, from which the mortality rate reaches 10%. Objective: To identify clinical and epidemiological features of the patients presenting acute complications of diabetes mellitus admitted to the emergency ward at Atizapan General Hospital, a suburb of Mexico City. Material and Methods: Prospective, transversal, descriptive, observational study with 1417 diabetic patients admitted to the emergency ward at Atizapan General Hospital from July the first, 2010 until June 31, 2011. Results: A hundred patients (7%) were admitted with a diagnosis of acute complications of diabetes. Hypoglycemia (48%) was the most frequent complication followed by diabetic ketoacidosis (33%), hyperosmolar hyperglycemic state (17%) and finally lactic acidosis (2%). Neurological and digestive were the main symptoms and most patients came from low socioeconomic level. Conclusions: Timely identification of the clinical manifestations of acute complications of diabetes allows better and faster attention avoiding severe complications. Social, economic and cultural and/or educational factors may foster complications; therefore, health education is essential to prevent such conditions.

Tumores primarios del estroma gastrointestinal (GIST) localizados en yeyuno e íleon: reporte de un caso / Primary gastrointestinal stromal tumors (GIST) presenting in jejunum and ileum: a case report

Introduction. Multiple primary gastrointestinal stromal tumors (GIST) are an infrequent finding in patients without known risk factors for this condition, such as type I neurofibromatosis or Carney’s triad. Benign and malignant tumors might coexist in the same patient. We discuss one case of a benign jejunal GIST and a malignant ileal GIST coexisting in the same patient. Case Report. A 46-years-old male patient presented with a distal ileum perforated GIST and a small non-complicated proximal jejunum GIST diagnosed by computerized tomography. The patient was submitted to surgery and both tumors were managed without incidents. Discussion. Radiological and pathological characteristics of GIST are clearly established, this clinical case highlights those characteristics and illustrates an uncommon clinical scenario in patients without known risk factors for multiple GIST.

Introducción: Los tumores múltiples del estroma gastrointestinal (GIST), son un hallazgo infrecuente en pacientes sin factores de riesgo como neurofibromatosis tipo I o tríada de Carney. En estos casos pueden coexistir GIST benignos y malignos en un mismo paciente. El presente reporte discute el caso de un paciente que se presenta con un GIST maligno perforado de íleon distal y con un GIST benigno de yeyuno proximal. Reporte de caso: Paciente masculino de 46 años de edad que se presentó con un GIST de íleon distal perforado y un pequeño GIST no complicado de yeyuno proximal diagnosticados mediante tomografía abdominal. Ambos tumores se resolvieron quirúrgicamente sin incidentes. Discusión: Las características anatomopatológicas y radiológicas de los GIST se encuentran actualmente claramente establecidas, el presente caso remarca estas características e ilustra una situación clínica poco habitual en pacientes sin factores de riesgo para GIST múltiples.