This study aimed at defining clinical predictors of drug resistance in adults with genetic generalized epilepsy (GGE) who were treated with a broad spectrum of antiepileptic drugs. Of a cohort of 137 unselected adult GGE patients with long-term follow up, clinical and demographic data, putative prognostic factors (e.g., psychiatric comorbidities, electroencephalography [EEG]), treatment response, and data indicative of social status were collected. Fifty-eight patients had seizures within the past year. Thirty-three patients met the definition of "drug-resistant epilepsy" according to the International League Against Epilepsy (ILAE) definition. Psychiatric comorbidities, age at first diagnosis, and absences were associated with worse seizure control, whereas focal changes in EEG remained without prognostic impact. Resistance to valproic acid was the most important prognostic factor for refractory seizures. Resistance to valproic acid had a specificity of 100% to identify patients with drug resistance and correlated strongly with bad social outcome and seizure burden. Conversely, 21.2% of all patients with refractory seizures according to the ILAE definition later became seizure free (mainly with valproic acid). Our data suggest that "drug resistant GGE" must not be declared unless patients were adequately treated with valproic acid, and advocate resistance to valproic acid as a new clinical biomarker for drug-resistant GGE. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
The economic history of Latin America offers an unusual paradox. For much of the twentieth century, nationalist governments have fostered the growth of state enterprise, but for the most part the proponents of such policies have received little attention. The Argentine petroleum industry is a case in point. While the state oil company Yacimientos Petrolíferos Fiscales (or YPF) grew from relatively modest origins into the largest firm in the country, its most important architect, General Enrique Mosconi, has remained a little-known figure. In this article, however, Dr. Solberg takes note of Mosconi's career. He examines the forces that shaped it and that shaped his policies as the Director General of YPF. Mosconi's story, however, is not that of just another nationalist-turned-public servant, for his ideas and policies had far-reaching ramifications not only in the political economy of Argentina but also in that of other nations of Latin America.
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Writing in 1904, the Chilean intellectual Nicolás Palacios bitterly complained that his fellow-countrymen inhabiting the southern frontier provinces were “orphans” in their own land. The simile was appropriate. Since the 1870's, the government, through its land policy, systematically and deliberately had excluded Chile's wage-labor class from property ownership in the frontier. As a direct result, many Chilean laborers fell to peonage while European immigrants and wealthy Chileans acquired ownership of much of the public domain. Shortly before World War I, social and political pressures in Chile forced the government to end this discriminatory policy and to begin distributing the remainder of the public domain to nativeborn settlers.
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