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The classification of epilepsies and epileptic syndromes currently in use dates back to the eighties. Around thirty years later, it is now time to look for new approaches that are better adapted to the numerous advances that have taken place over the years in the different areas of research on epilepsy (genetics, neuroimaging, neurophysiology, etc.). In response to repeated calls by different authors to modify the classical approaches to epilepsy, in the year 2010 the Commission on Classification and Terminology of the International League Against Epilepsy (ILAE), led by Berg, published a terminological and conceptual revision of epileptic seizures and epilepsies with recommendations regarding the direction to be followed in their classification. This article, however, has received a great deal of criticism because it proposes a radical change with the elimination of classical concepts, without maintaining the useful elements and modifying only the parts that reflect obsolete concepts in the light of current scientific evidence. Unnecessary confusion has been generated by, for example, eliminating the division between focal and generalised epilepsies, but keeping the concept of focal and generalised epileptic seizures or by proposing a classification that mixes different approaches, electroclinical criteria, aetiology, and so on. Thus, the ILAE has before it the important task of striking a balance between the different opinions that have arisen and offering a new, more moderate proposal. At this point it would do well to recall the words of Seneca, who warned of the dangers of not proceeding in that way when he said: 'everything that exceeds the bounds of moderation has an unstable foundation'. Source

Montoya-Chinchilla R.,Hospital General Universitario Jm Morales Meseguer | Guirao-Pinera M.J.,Hospital General Universitario Virgen Of La Arrixaca | Nortes-Cano L.,Hospital General Universitario Virgen Of La Arrixaca
Anales de Pediatria | Year: 2014

Abstract Ureteral valves are a rare malformation, with an incidence of 1 in 5000-8000 live births. Urological malformations are associated with 50% of cases according to the current literature. We report 4 cases treated in our hospital from 2004 to 2012. Three of the patients had renal dysgenesis, one case associated with complete urethral duplication, and another case associated with a ureteral atresia. © 2012 Asociación Española de Pediatría. Source

This study addresses a number of general considerations on epilepsies and epileptic syndromes that develop in the neonatal period. The chronological limits of this stage of maturation are set out and the pathophysiology of the convulsive phenomenon during that period are briefly analysed. Furthermore, the differences that exist as a result of the incipient level of maturity of the newborn infant's central nervous system with regard to other ages, and obviously adults, are highlighted. Likewise, reference is made to the percentage values of this pathology, which even vary depending on the gestational age. The clinical expression has a personality that is very different from the other stages of maturation in children, with four predominant manifestations: subtle, tonic, clonic and myoclonic seizures, which have been universally accepted since they were first reported by Volpe. Epilepsies in the newborn infant are not sufficiently well differentiated in the different classifications of epilepsies and epileptic syndromes that have appeared in recent years, although they could well be, since they display enough significance and individuality for that to be so. Three clinical cases are reported, with the aid of video electroencephalographic findings, to illustrate some of the possible neonatal epileptic manifestations. Source

Rios-Risquez M.,Hospital General Universitario Morales Meseguer | Rios-Risquez M.,University of Murcia | Garcia-Izquierdo M.,University of Murcia | Alguacil E.L.,Hospital General Universitario Virgen Of La Arrixaca | And 3 more authors.
Emergencias | Year: 2013

Objective: The main aim of this study was to determine if hospitalized patients' satisfaction with emergency department nursing care differs between hospitals of greater or lesser complexity. Methods: Descriptive, cross-sectional, multicenter study of a random sample of 390 users of emergency services who were admitted to hospital. Data were collected with the La Monica-Oberst Patient Satisfaction Scale and a standardized questionnaire on personal and health-related patient details. Results: On a scale of 1 to 7 reflecting patient satisfaction with nursing care (1, very satisfied; 7, very disatisfied), the mean (SD) score overall was 2.34 (0.98). No significant differences in the overall satisfaction scores were found in relation to hospital complexity, but differences were detected for certain aspects of nursing: the chance to share feelings and ask questions (better in greater complexity hospitals) and participation in care planning, empathy and emotional communication, the chance to request information, and promptness in response to calls and kidness of nurses (better in bessen complexity hospitals). Higher user satisfaction was associated with a shorter emergency department stay. Conclusions: We found a medium to high level of patient satisfaction with emergency nursing care in this study. Overall satisfaction was unrelated to type of hospital (complexity). However, certain aspects of care did show differences between more and less complex hospitals. These aspects can be taken into account when planning ways to improve satisfaction with nursing care. Source

Sanchez-Migallon M.C.,University of Murcia | Nadal-Nicolas F.M.,Hospital General Universitario Virgen Of La Arrixaca | Nadal-Nicolas F.M.,University of Murcia | Jimenez-Lopez M.,University of Murcia | And 3 more authors.
Experimental Eye Research | Year: 2011

The transcription factor Brn3a has been reported to be a good marker for adult rat retinal ganglion cells in control and injured retinas. However, it is still unclear if Brn3a expression declines progressively by the injury itself or otherwise its expression is maintained in retinal ganglion cells that, though being injured, are still alive, as might occur when assessing neuroprotective therapies. Therefore, we have automatically quantified the whole population of surviving Brn3a positive retinal ganglion cells in retinas subjected to intraorbital optic nerve transection and treated with either brain derived neurotrophic factor or vehicle. Brain derived neurotrophic factor is known to delay retinal ganglion cell death after axotomy. Thus, comparison of both groups would inform of the suitability of Brn3a as a retinal ganglion cell marker when testing neuroprotective molecules. As internal control, retinal ganglion cells were, as well, identified in all retinas by retrogradely tracing them with fluorogold. Our data show that at all the analyzed times post-lesion, the numbers of Brn3a positive retinal ganglion cells and of fluorogold positive retinal ganglion cells are significantly higher in the brain derived neurotrophic factor-treated retinas compared to the vehicle-treated ones. Moreover, detailed isodensity maps of the surviving Brn3a positive retinal ganglion cells show that a single injection of brain derived neurotrophic factor protects retinal ganglion cells throughout the entire retina. In conclusion, Brn3a is a reliable retinal ganglion cell marker that can be used to accurately measure the potential effect of a given neuroprotective therapy. © 2011 Elsevier Ltd. Source

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