Assessment of dialysis adequacy guidelines implementation in a developing country

Dialysis adequacy has been shown to have a significant impact on patient survival, but there are few data concerning the adequacy of the delivered hemodialysis dose in developing countries. To describe the level of implementation of dialysis practice guidelines in a dialysis center in Morocco, we retrospectively reviewed our 1-year experience of managing chronic hemodialysis patients (CHP), from May 2009 to May 2010. Demographic and biochemical data were collected, and the percentage of patients achieving targets recommended by the NKF-KDOQI guidelines were calculated. Our data suggests that dialysis units in a developing country can achieve current guidelines targets for dialysis adequacy, however, our results are not generalizable to all dialysis centers in Morocco.     

Myocardial infarction as complication of acute pancreatitis

We report a case of an acute pancreatitis complicated by myocardial infarction with normal coronary arteries on angiography. This observation presents a double interest. First, it illustrates unusual forms of coronary disease represented by the non-atherosclerotic infarction. On the other hand, it shows that the multiple visceral damage associated with acute pancreatitis can include myocardial infarction which complications aggravate prognosis.     

Assessment of hairline EEG as a screening tool for nonconvulsive status epilepticus

PURPOSE: Because of the high incidence of nonconvulsive status epilepticus (NCSE), the attraction of a "quick and easy" screening electroencephalogram (EEG) is obvious. Previous studies have shown utility of hairline EEG in diagnosing epilepsy. However, this technique has not been evaluated as a screening tool for NCSE. We wanted to provide proof of principle that a screening hairline EEG has sufficient sensitivity to use as a screening tool for diagnosing NCSE. METHODS: A total of 120, 2- to 3-min EEG samples of normal and various abnormal digital EEG studies were reformatted in three six-channel montages (A, longitudinal bipolar; B, referential to ipsilateral ear; C, referential to contralateral ear) that mimicked a hairline recording and were interpreted by five neurophysiologists. The test data interpretation was compared with the original EEG interpretation. RESULTS: Performance was best with montages A and B; 71% and 70.5% of the samples were interpreted correctly by using these montages. Only 65% of the samples were correctly interpreted by using montage C. With the best montage (A), the sensitivities ranged from 91% for normal EEG to 54% for periodic lateralized epileptiform discharges (PLEDs). The sensitivity for seizures was only 72%. Seizures were frequently misinterpreted as more benign patterns such as normal and diffuse slowing. CONCLUSIONS: EEG data reformatted to resemble a hairline EEG had low sensitivity for detecting seizures. As a result, we do not recommend further pursuit of hairline EEG as a "quick and easy" screening tool for NCSE.     

Posterior-reversible encephalopathy in hemodialysis

Posterior-reversible encephalopathy syndrome (PRES) is a recently clinicoradiologic entity caused by numerous medical conditions and characterized by acute-neurologic disorders, such as headaches, confusion, seizures associated with arterial hypertension. MRI characteristics are typical. The rapid diagnosis is of capital importance due to a potential reversibility.     

Weight loss in narcolepsy patients treated with sodium oxybate

IntroductionNarcolepsy is often associated with increased body weight. Sodium oxybate has efficacy in many narcolepsy symptoms. The purpose of this study was to evaluate the effects of sodium oxybate on weight in patients with narcolepsy.MethodsCharts from three centers of all patients with narcolepsy who had been using sodium oxybate for at least 3 months were reviewed. Patients in whom anti-cataplexy medications were added or withdrawn or wake-promoting medications added after the start of sodium oxybate were excluded from further analysis. In the remainder, pre-sodium oxybate and, most recently, on-sodium oxybate weights were compared using Student’s t-tests. Sodium oxybate dose and duration of therapy were also noted.ResultsA total of 54 patients meeting inclusion criteria were identified. Of these 54, 33 (61%) were women; the mean age was 48.3 years. The mean dose of sodium oxybate was 6.9 g/night and the duration of therapy was 25 months. The mean pre-sodium oxybate weight was 78.3 (±15.7) kg. The most recent on-sodium oxybate weight was 74.9 (±15.1, p = 0.003). The average weight loss was 3.4 kg, whereas the maximum was 30.9 kg.ConclusionsThis study suggests that treatment of patients with narcolepsy with sodium oxybate can result in weight loss.     

Long-term safety and efficacy in patients with uncontrolled partial-onset seizures treated with adjunctive lacosamide: results from a Phase III open-label extension trial

Purpose: To evaluate the long‐term (up to 5 years exposure) safety and efficacy of lacosamide as adjunctive therapy in patients with uncontrolled partial‐onset seizures taking one to three concomitant antiepileptic drugs (AEDs) in open‐label extension trial SP756 (NCT00522275). Methods: Patients who completed the double‐blind trial SP754 (NCT00136019) were eligible to participate in this open‐label extension trial (SP756). At the conclusion of trial SP754, patients had transitioned to lacosamide 200 mg/day. Subsequent dosage adjustments of lacosamide (100–800 mg/day) and/or concomitant AEDs were allowed to optimize tolerability and seizure reduction. Treatment‐emergent adverse events (TEAEs), vital signs, body weight, clinical laboratory data, electrocardiography studies, and seizure frequency were evaluated. Key Findings: A total of 308 patients received open‐label lacosamide and 138 patients (44.8%) completed the long‐term trial. The median modal dose (defined as the daily lacosamide dose a patient received for the longest duration during the treatment period) was 500 mg/day. The percentages of patients with lacosamide exposure >1, >2, >3, or >4 years were 75%, 63%, 54%, and 29%, respectively. Primary reasons for discontinuation were lack of efficacy (26%) and adverse events (11%). Common TEAEs (≥15%) were dizziness, headache, contusion, nausea, convulsion, nasopharyngitis, fall, vomiting, and diplopia. TEAEs that led to discontinuation in ≥1.0% of patients were dizziness (1.6%) and convulsion (1.0%). The median percent reductions from baseline of trial SP754 in 28‐day seizure frequency were 53.4%, 55.2%, 58.1%, and 62.5%, respectively, for 1‐, 2‐, 3‐, and 4‐year completers. The ≥50% responder rates were 52.8%, 56.5%, 58.7%, and 62.5% for 1‐, 2‐, 3‐, and 4‐year completers, respectively. Seven of eight patients on lacosamide monotherapy for ≥12 months were deemed 50% responders. Of patients exposed to lacosamide ≥2 years, 3.1% remained seizure‐free for a period ≥2 years. Significance: Long‐term (up to 5 years) lacosamide treatment was generally well tolerated. The safety profile of lacosamide observed in this trial is consistent with that established in previous double‐blind, placebo‐controlled trials. Although the open‐label trial design limits the analysis of efficacy, long‐term reduction in seizure frequency and maintenance of efficacy was observed.     

Cardiac localization of non Hodgkin's lymphoma: a study on four cases

INTRODUCTION: Cardiac localization of non-Hodgkin's lymphoma is rare and usually seen in the latest phase of the disease. However, its frequency is certainly under-estimated because 20% of patients who die of lymphoma have a heart involvement at autopsy. EXEGESIS: We report four cases of cardiac involvement of non-Hodgkin's lymphoma with various revelation modalities. Features of cardiac lymphoma are multiple and not specific. Echocardiography can be helpful in finding cardiac localizations, which can involve every cardiac structure. Histological proof of such an involvement is sometimes difficult to obtain. CONCLUSION: Prognosis of cardiac lymphoma remains poor despite the real progress in the treatment of lymphomas.