Introducción: El Síndrome de Janz o Epilepsia Mioclónica Juvenil se inicia generalmente en la pubertad o adolescencia, tiene una etiología idiopática-hereditaria que presenta sacudidas mioclónicas, crisis generalizadas tónico-clónicas que se producen por la privación del sueño, la ingesta de alcohol entre otras . Se han reportado pocos casos a nivel internacional dando un estimado de 1 caso por cada 1000-2000 personas, actualmente no hay casos reportados en Ecuador, esto debido a que en muchos casos esta enfermedad es infra diagnosticada. El tratamiento de elección es el Ácido Valpróico aunque se ha evidenciado que el tratamiento con Levetiracetam ha dado buenos resultados. Objetivo: Describir un caso clínico de una paciente joven, que presenta Epilepsia Mioclónica Juvenil analizando las características clínico-electroencefalográficas y enfatizar en la necesidad de un diagnóstico y tratamiento adecuado. Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico. Resultados: Se presenta un caso clínico de una paciente femenina de 24 años con antecedentes patológicos de Mioclonias esenciales de los brazos desde los 16 años de aparición esporádica la cual acude a médico particular quien prescribe Ácido Valpróico 500 mg vía oral 2 veces al día con aparente mejoría, a los 4 años posteriores, aparece un episodio de convulsión tónico clónica generalizada, este mismo episodio se repite por 9 ocasiones durante 2 años, actualmente en tratamiento con Levetiracetam 2000 mg vía oral cada día. Conclusiones: Se puede concluir que el Síndrome de Janz es una patología de difícil diagnóstico, que es importante realizar una adecuada historia clínica que permita orientar un tratamiento adecuado logrando una adecuada calidad de vida y evitando complicaciones innecesarias en los pacientes.
Introduction: arterial ischemia defined as stenosis or occlusion of the aorta either of distant arteries from the heart, is a vascular emergency with a high risk of loss of a limb and associated morbidity and mortality [1]. Clinical Case: A 79-year-old male patient with a clinical history of psoriasis and chronic pain in the lower limbs followed by rheumatology, with a previous 60-year smoking habit of 10 units daily, who attended the emergency department with severe pain in the right lower limb with paresthesias that make it impossible to walk for 6 hours after lifting weights at home. On physical examination the right lower extremity, intense pain on palpation, cold, femoral pulse, popliteal present, anterior and posterior tibial absent, decreased mobility, absent foot sensation. Discussion: In this particular case, it is noteworthy that the only risk factor that the patient presented for developing critical ischemia with threatened viability was smoking and as a salvage measure, fibrinolysis with ateplase was performed, monitoring the distal circulation with a positive response of arterial reperfusion distal. Conclution: It should be noted that as a salvage measure evaluating the patient's risk-benefit, fibrinolysis with ateplase can be performed. It is essential to establish an early diagnosis that allows timely therapy to be established and has a positive impact on the prognosis of these individuals, since they present a high rate of morbidity and mortality [4].
This document describes the challenges associated with integrating and implementing Industry 4.0 technologies. A systematic review was conducted, considering scientific articles in occupational safety and health. Several factors contributed to a challenge to be resolved for those responsible for the well-being of workers in the industry. The use of technology, its dependence, its needs, and other aspects related to the dependence on the use of technology contribute to occupational safety and health risks that are psychosocial and have a direct impact on the performance of the company, so that workplace risk plans must be restructured taking into account these new challenges.
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