Efficacy of clobazam as add-on therapy in brain tumor-related epilepsy

Journal of Neuro-Oncology - Brain tumor-related epilepsy (TRE) is often resistant to currently available antiepileptic medications (AEDs). Clobazam was initially approved as adjunctive AED for...     

Hemicrania Continua Responsive to Intravenous Methyl Prednisolone

Hemicrania continua (HC) is a strictly unilateral, continuous primary headache disorder with periodic exacerbations, usually accompanied by cranial autonomic disturbances. Exquisite and persistent effect of indomethacin is a fundamental property of HC. We report 2 patients of HC in which attacks were successfully eliminated by repeated infusion of methyl prednisolone.     

Juguloarterial Endothelin-1 Gradients After Severe Traumatic Brain Injury

Background  

Endothelin-1 (ET-1) is a potent vasoconstrictor and is thought to be responsible for secondary ischemia and vasogenic edema after traumatic brain injury (TBI). Both CSF and plasma concentrations have been shown to be increased after TBI, but there is little evidence to confirm an intracranial site of production.     

Immune markers measured before treatment predict outcome of intensive phase tuberculosis therapy

The development of a statistical model based on simple immunological markers which could predict the response to tuberculosis treatment would facilitate clinical trials of new anti-tuberculosis drugs. We have examined the ability of immunological biomarkers, measured at diagnosis and after 4 weeks of treatment, to predict sputum smear status at week 8. Eighteen tuberculosis patients with positive Ziehl-Nielsen (ZN)-stained sputum smears 8 weeks after initiation of treatment (slow response) were matched for age, gender, sputum smear grade and extent of disease on chest radiograph to 18 patients with negative sputum smears at week 8 (fast response). In addition to total white blood cell (WBC) counts and absolute lymphocyte, monocyte and neutrophil numbers, concentrations of six serum markers were measured by enzyme-linked immunosorbent assay (ELISA) in all patients (soluble interleukin-2 receptor alpha (sIL-2Ralpha), granzyme B, soluble tumour necrosis factor alpha receptors 1 and 2 (sTNF-R1 and -2), nitrotyrosine and interferon-gamma (IFN-gamma). At diagnosis, 4 biomarkers (sTNF-R1, total WBC, absolute monocyte and absolute neutrophil numbers) were significantly higher in slow response patients. At week 4, total WBC count and absolute monocyte and neutrophil numbers remained significantly higher in slow responders. Discriminant analysis of the diagnosis and week 4 data provided models for classification of slow response patients with 67% and 83% predictive accuracy. We suggest that treatment response phenotypes can be determined before the start of treatment. Reliable predictive models would allow targeted interventions for patients at risk for slow treatment response to standard tuberculosis therapy.     

Constitutional tetrasomy 18p

We present here the first case of constitutional tetrasomy 18p from India. A 3 year old female with developmental delay and dysmorphic features revealed 47,XX,+mar karyotype. The small meta-centric marker chromosome was identified as i(18p) with m-FISH followed by m-BAND. Parents and a normal sibling of the proband revealed normal karyotype. There was history of mental retardation and dysmorphic features in four cases on paternal side; however, their karyotype was also normal.     

Changes in the kinetics of intracellular IFN-gamma production in TB patients during treatment

The role of T lymphocyte cytokine responses in tuberculosis (TB) still needs clarification. This study aimed to define interferon-gamma (IFN-gamma) responses longitudinally in HIV-negative TB patients during treatment, compared to those of healthy volunteers. Flow cytometric intracellular IFN-gamma determinations after CD3 stimulation were done in parallel with lymphocyte proliferation assays in response to mycobacterial antigen. Percentages of IFN-gamma-producing CD8 and CD4 T lymphocytes in patients at diagnosis were significantly higher than in controls but normalized during treatment. Additional kinetic studies suggested accelerated IFN-gamma production in patients at diagnosis, compared to controls and treated patients. Lymphocyte proliferation was below normal in patients at diagnosis and increased rapidly with decreasing bacterial load during treatment. We conclude that T cell IFN-gamma response kinetics in TB patients suggest a pre-activated state at diagnosis, which changes during treatment. At diagnosis intracellular IFN-gamma or lymphocyte proliferation was not an indicator for treatment response.     

Association of HIV and malaria with mother-to-child transmission, birth outcomes, and child mortality

OBJECTIVE: To assess the impact of HIV and malaria coinfection on mother-to-child HIV transmission (MTCT) and adverse birth outcomes. METHODS: One hundred nine HIV-positive mother-infant pairs with a malaria diagnosis were identified in a community cohort and followed up postpartum. Maternal malaria was diagnosed by a rapid immunochromatographic test (ICT) on sera and histopathologic examination of placenta. Infant HIV was diagnosed within 6 weeks of birth using polymerase chain reaction (PCR) to capture in-utero and intrapartum HIV transmission. Log binomial models were used to assess the relative risk of MTCT, low birth weight, and preterm birth associated with malaria. RESULTS: Approximately 17.4% of infants were HIV positive at or around birth, and the prevalence of serologic and placental malaria were 31% and 32%, respectively. HIV-positive mothers with serological ICT malaria were significantly more likely to have low-birth-weight infants, and low-birth-weight infants had significantly higher risk of MTCT compared with infants of normal birth weight. Although placental and serologic ICT malaria were significantly associated with MTCT, after adjusting for maternal HIV viral load, the risk of MTCT was significantly increased only for mothers coinfected with placental malaria (relative risk [RR] = 7.9, P = 0.025). CONCLUSIONS: Placental malaria increases the risk of MTCT after adjustment for viral load. Programs should focus on enhanced malaria prevention during pregnancy to decrease the risk of adverse birth outcomes and MTCT.     

Long-term outcomes of laparoscopic totally extraperitoneal inguinal hernia repairs performed by supervised surgical trainees

Background

Long-term outcomes of laparoscopic totally extraperitoneal (TEP) inguinal hernia repairs performed by supervised surgical trainees are absent.

Methods

Retrospective review of TEP inguinal hernioplasties performed by trainees at our institution.

Results

From 1995 to 2009, a total of 1,479 inguinal hernia repairs on 976 patients were performed by supervised surgical trainees. The mean patient age was 54 years (range 5–86). Men (97%), direct defects (51%), and bilateral repairs (52%) predominated. Recurrent hernias compromised 17%. Four (.4%) patients were converted to open surgery because of scarring. Postoperative complications consisted of urinary retention (8%), seroma (3%), and hematoma (2%). Trainee participation included interns (46%), PGY-2s (10%), PGY-3s (2%), PGY-4s (3%), and PGY-5s (39%). With a mean follow-up of 6.1 years, recurrence and bothersome groin pain rates were 2.6% and 1.5%, respectively.

Conclusions

With adequate supervision, surgical trainees can safely perform the TEP repair with good long-term outcomes.