Profilaxis antibiótica en cirugía espinal: Una revisión sistemática

Treball Final de Grau en Medicina. Codi: MD1158. Curs acadèmic: 2016-2017Una de las complicaciones de la cirugía espinal es la infección de la herida quirúrgica, y se calcula que la sufrirán en torno al 1-15% de los pacientes intervenidos, la profilaxis antibiótica es un método para evitarla. El objetivo de esta revisión es conocer cuales son los antibióticos más efectivos, así como, su dosis, momento de aplicación y su duración. Se realiza una búsqueda en las bases de datos PubMed, Scopus, Cochrane y google académico; la calidad de los artículos obtenidos ha sido evaluada con los criterios de Oxford. Se describen las cefalosporinas de 1º - 2º generación como el antibiótico de elección en profilaxis antibiótica, a una dosis de 1-2 gramos, los 60 minutos previos a la intervención, y manteniéndolo durante 1 día tras la intervención. Al igual que en cirugía ortopédica se observa que las cefalosporinas son el antibiótico de elección para la profilaxis debido a los agentes infecciosos que actúan. Surge un método nuevo con el fin de cubrir los agentes resistentes, vancomicina en polvo. Para prevenir la infección de la herida quirúrgica, el uso de cefalosporinas, como método profiláctico resulta eficazOne of the complications of spinal surgery is surgical wound infection, and it is estimated that about 1-15% of patients will undergo antibiotic prophylaxis as a method to prevent it. The objective of this review is to know which are the most effective antibiotics, as well as their dose, timing and duration. Material and methods: A research in PubMed, Scopus, Cochrane and academic google databases was made; the quality of the articles obtained has been evaluated with the Oxford criteria. First - generation cephalosporins are described as the antibiotic chosen in prophylaxis, at a dose of 1-2 grams, 60 minutes before the intervention, and maintained for 1 day after the intervention. As in orthopedic surgery it is observed that cephalosporins are the antibiotic chosen for prophylaxis due to the infectious agents that ac. A new method emerges in order to cover the resistant agents, vancomycin powder. To prevent infection of the surgical wound, the use of cephalosporins as a prophylactic method is effective

Morphological Description of Frontal EEG Interictal and Ictal Discharges in an Adult Cohort of 175 Patients

EEG morphology; Electroencephalography; Frontal lobe seizuresMorfología EEG; Electroencefalografía; Convulsiones del lóbulo frontalMorfologia EEG; Electroencefalografia; Convulsions del lòbul frontalClinical and electroencephalogram (EEG) features in frontal lobe epilepsy (FLE) vary considerably among patients, making the diagnosis a challenge. The objective of this study was to describe interictal and ictal EEG activity, identifying variables that could help to differentiate and diagnose frontal lobe epilepsy cases. A prospective cross-sectional study from patients with frontal interictal epileptiform discharges (IED) referred to the Vall d’Hebron University Hospital (Barcelona, Spain) after a clinical event compatible with epileptic seizures was designed. The interictal and ictal activity were analyzed to provide a detailed EEG description of the cases, using different statistical analyses. The morphological seizure pattern at the ictal onset remained globally unchanged over time in seizures arising from the frontal lobe for each patient. Isolated sharp waves were the most frequent waveforms in the expression of IED. Frontal lobe seizures are frequently short and sometimes appear grouped in clusters within the same recording. Often the ictal expression of the electrical activity in frontal lobe seizure is subtle and challenging to interpret. A description of the main findings is summarized to identify seizures arising from the frontal lobe and avoid false negatives findings in EEG interpretations.This research received no external funding

Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol

Super-refractory status epilepticus (SRSE) represents a neurological emergency that is characterized by a lack of response to the third line of antiepileptic treatment, including intravenous general anesthetics. It is a medical challenge with high morbidity and mortality. Electroconvulsive therapy (ECT) has been recommended as a nonpharmacologic option of treatment after other alternatives are unsuccessful. Its effect on the cessation of SRSE has been minimally investigated. The objective of this article is to analyze the effect of ECT on SRSE. For this purpose, a multidisciplinary team created a protocol based on clinical guidelines similar to those described previously by Ray et al. (2017). ECT was applied to six patients with SRSE after the failure of antiepileptic treatment and pharmacologic coma.The objective of each ECT session was to elicit a motor seizure for at least 20 s. SRSE was resolved in all patients after several days of treatment, including ECT as a therapy, without relevant adverse effects. Thus, ECT is an effective and feasible option in the treatment of SRSE, and its place in the algorithm in treatment should be studied due to the uncommon adverse effects and the noninvasive character of the therapy

Modelo para predicción de resultado de la neurografía en el síndrome del túnel carpiano

Neuropathy of the median nervecaused bytheentrapment of this nerveasit passesthrough the carpal tunnel is very common. Its symptoms and signs are known as carpal tunnel syndrome (CTS), whose diagnosticand therapeutic approach consumes important health resources as it is a highly prevalent pathology. Electroneurography (ENG) or neurographyisconsidered the gold standard in its evaluation, as it allows for quantifying the nerve injury degree, but the generalization of its use sometimes results in its performance even before a careful clinical evaluation and conservative treatment. A sensory and motor involvement of the nerve is usually a criterion for considering a surgical approach, leading to conservative treatment in the rest of the cases. We present a cohort of 816 patients referred to our service for ENG for suspected CTS. A clinical reassessment was carried out, classifying the symptoms as typical or atypical for CTS according to criteria, and ENG was performed in all cases. The correlation of a series of demographic and clinical characteristics of patients with a degree of sensory and motor involvement (≥ 3 on our scale) was studied and a statistical model was generated to predict the degree of neuropathy before ENG. Presenting typicalclinicalsymptoms, male gender,age over 50 years, bilateralsymptoms, or presenting them in the dominant hand, as well as positivity of Tinel’s sign and Phalen’s hand correlated with a higher degree of neuropathy.La neuropatía del nervio mediano ocasionada por el atrapamiento de este nervio a su paso por el túnel carpiano es muy frecuente. Sus síntomas y signos se conocen como síndrome del túnel carpiano (STC), cuyo abordaje diagnóstico y terapéutico consume importantes recursos sanitarios al tratarse de una patología muy prevalente. La electroneurografía (ENG) o neurografía se considera el patrón oro en su evaluación, pues permite cuantificar el grado de lesión del nervio, pero la generalización de su uso deriva, en ocasiones, a su realización previa, incluso, de una cuidadosa evaluación clínica y tratamiento conservador. Una afectación sensitiva y motora del nervio suele ser criterio para plantear abordaje quirúrgico, optando por el tratamiento conservador en el resto de los casos. Presentamos una cohorte de 816 pacientes remitidos a nuestro servicio para la realización de ENG por sospecha de STC. Se llevó a cabo una reevaluación clínica, clasificando los síntomas en típicos o atípicos para STC acorde a unos criterios, y se realizó ENG en todos los casos. Se estudió la correlación de una serie de características demográficas y clínicas de los pacientes con un grado de afectación sensitiva y motora (≥ 3 de nuestra escala) y se generó un modelo estadístico con la finalidad de poder predecir el resultado de la ENG antes de su realización. Presentar una sintomatología clínica típica, el género masculino, la edad superior a 50 años, la bilateralidad de los síntomas, o presentarlos en la mano dominante, así como la positividad del signo de Tinel y la manobra de Phalen, se correlacionaron con mayor grado de neuropatía

Morphological Description of Frontal EEG Interictal and Ictal Discharges in an Adult Cohort of 175 Patients

Clinical and electroencephalogram (EEG) features in frontal lobe epilepsy (FLE) vary considerably among patients, making the diagnosis a challenge. The objective of this study was to describe interictal and ictal EEG activity, identifying variables that could help to differentiate and diagnose frontal lobe epilepsy cases. A prospective cross-sectional study from patients with frontal interictal epileptiform discharges (IED) referred to the Vall d’Hebron University Hospital (Barcelona, Spain) after a clinical event compatible with epileptic seizures was designed. The interictal and ictal activity were analyzed to provide a detailed EEG description of the cases, using different statistical analyses. The morphological seizure pattern at the ictal onset remained globally unchanged over time in seizures arising from the frontal lobe for each patient. Isolated sharp waves were the most frequent waveforms in the expression of IED. Frontal lobe seizures are frequently short and sometimes appear grouped in clusters within the same recording. Often the ictal expression of the electrical activity in frontal lobe seizure is subtle and challenging to interpret. A description of the main findings is summarized to identify seizures arising from the frontal lobe and avoid false negatives findings in EEG interpretations