Predictive factors of drug-resistant epilepsy in children presenting under 2 years of age: experience of a tertiary center in Turkey

Population-based studies report that children with epilepsy have relatively better prognosis than those with an onset at infancy, though studies about this period are limited. We aimed to evaluate the etiology in infant epilepsy less than 2 years of age and foreseeable risk factors for anti-epileptic drug resistance. We evaluated the patients who were presented to the division of pediatric neurology in our university hospital with seizures when they were between 1 and 24 months of age and diagnosed as epilepsy. Two hundred and twenty-nine patients (110 male and 119 female) who were diagnosed between the ages of 1–24 months were included in the study. The etiologies were structural (n = 55;24%), genetic (n = 29;12.7%), metabolic (n = 27;11.7%), and infectious (n = 8;3.5%), and it was unknown in 110 patients (48%). One-hundred and forty (61%) patients met the criteria for drug-resistant epilepsy (DRE). Multivariate logistic regression analysis showed that developmental delay at onset (OR 3.9, 95% CI 1.22, 12.47, p = 0.021), multifocal epileptiform discharges (OR 2.8, 95% CI 1.1, 7.44, p = 0.031), and history of status epilepticus (OR 32.9, 95% CI 3.8, 285.35, p = 0.001) were strong predictive factors for DRE. The epilepsy in children under 2 years of age is highly resistant to the anti-epileptic drugs, which could be related to the history of status epilepticus, developmental delay at onset, and multifocal epileptiform discharges.     

Surgical strategies for severely atherosclerotic (porcelain) aorta during coronary artery bypass grafting

Porcelain aorta (PA) is an asymptomatic atherosclerotic disease, characterized by circumferential calcification throughout the whole perimeter of the aorta. It is seen in 2% to 9.3% of patients undergoing elective coronary artery bypass grafting (CABG) and makes manipulation of the ascending aorta impossible. It has been clearly shown that most emboli seen and detected during the CABG procedure occur during aortic cross-clamping and aortic side-clamping. Manipulation of porcelain or a severely atherosclerotic aorta increases the risk of perioperative stroke. The incidence of stroke after CABG is between 0.48% and 2.9%, and the risk is correlated with the extent and severity of the atherosclerotic disease. A conventional CABG procedure involves successive steps that include cannulation of the ascending aorta, application of a cross-clamp to the aorta, and partial clamping of the aorta to create the proximal anastomosis. Therefore in procedures that involve cannulation, clamping, or proximal anastomosis, and where aortic manipulation is inevitable, preassessment of the atherosclerotic aortic plaques is crucial. Although many surgeons still rely on intraoperative manual aortic palpation, this approach has very low sensitivity and underestimates the severity of the atherosclerotic illness. Imaging methods including preoperative computed tomography or intraoperative epiaortic ultrasonography enable modification of the surgical technique according to the severity of atherosclerosis. Various surgical techniques have been described to reduce the risk of atheroembolism that may lead to cerebrovascular events in patients with severely atherosclerotic ascending aorta. Anaortic or “no-touch” techniques that do not utilize aortic manipulation may significantly decrease the development of neurological complications by avoiding aortic maneuvers known to cause emboli. In cases where severe atherosclerotic disease or other factors preclude safe use of the ascending aorta, modifications in the surgical techniques, such as switching to different cannulation sites including the axillary/subclavian, femoral and innominate arteries, or using hypothermic ventricular fibrillation and in-situ pedicled arterial grafts, or performing proximal anastomoses at alternative anatomical locations will enable CABG operations to be performed safely with low morbidity and mortality rates in patients with porcelain aortas.     

Evaluation of 100 brain examinations using a 3 Tesla MR-compatible incubator—safety, handling, and image quality

Introduction

Several studies have revealed the importance of brain imaging in term and preterm infants. The aim of this retrospective study was to review safety, handling, and image quality of MR brain imaging using a new 3 Tesla MR-compatible incubator.

Methods

Between 02/2011 and 05/2012 100 brain MRIs (84 infants, mean gestational age 32.2?±?4.7 weeks, mean postmenstrual age at imaging 40.6?±?3.4 weeks) were performed using a 3 Tesla MR-compatible incubator with dedicated, compatible head coil. Seventeen examinations (13 infants, mean gestational age 35.1?±?5.4 weeks, mean postmenstrual age at imaging 47.8?±?7.4 weeks) with a standard head coil served as a control. Image analysis was performed by a neuroradiologist and a pediatric radiologist in consensus.

Results

All but two patients with known apnea were transferred to the MR unit and scanned without problems. Handling was easier and faster with the incubator; relevant motion artifacts (5.9 vs. 10.8 %) and the need for repetitive sedation (43.0 vs. 86.7 %) were reduced. Considering only images not impaired by motion artifacts, image quality (4.8?±?0.4 vs. 4.3?±?0.8, p?=?0.047) and spatial resolution (4.7?±?0.4 vs. 4.2?±?0.6, p?=?0.011) of T2-weighted images were scored significantly higher in patients imaged with the incubator. SNR increased significantly (171.6?±?54.5 vs. 80.5?±?19.8, p?<?0.001) with the use of the incubator.

Conclusion

Infants can benefit from the use of a 3 Tesla MR-compatible incubator because of its safety, easier, and faster handling (compared to standard imaging) and possibility to obtain high-quality MR images even in unstable patients.     

HHV-8 positive Kaposi sarcoma in a patient with end-stage renal disease undergoing hemodialysis: no regressive effect of captopril

Human herpesvirus 8 (HHV-8) has been associated with Kaposi sarcoma (KS) in renal transplant recipients. On the other hand, there are only a few reported cases of KS in patients with end stage renal failure receiving hemodialysis. Here, we report a case of HHV-8 positive, disseminated KS, in a 70-year-old man with renal failure, receiving hemodialysis for 7 months. The KS lesions had begun to develop almost at the same time with the onset of dialysis. The patient had been on captopril therapy since the diagnosis of renal failure. Captopril has been reported to inhibit angiogenesis, and by this way, to reduce tumor growth. However, in our patient, the lesions had developed under the treatment of captopril, and showed no evidence of regression after withdrawal of the drug.     

Prevalence of psychiatric disorders, depression, and suicidal behavior in child and adolescent with thalassemia major

PURPOSE: To study the rate of psychiatric disorder and suicidal behavior in children with thalassemia major. METHOD: One hundred ten subjects with thalassemia major were interviewed according to the K-SADS Farsi version by face-to-face interview. RESULT: The most common psychiatric disorders were major depressive disorder and separation anxiety disorder. The rate of oppositional defiant disorder, attention-deficit hyperactivity disorder, and bipolar mood disorder were 3.6%, 1.8%, and 0.9%, respectively. About 49% suffered from depressed mood and 62.7% suffered from irritability and anger. More than 43% of them had recurrent thought of death and 27.3% considered suicide in the last year. CONCLUSIONS: The rate of psychiatric disorders was very low than that in the prior studies and the most common was major depressive disorder. However, the rate of psychiatric symptoms was very common. The rate of suicidal behavior was not more than that in the general population.     

Depression among unaccompanied minor refugees: the relative contribution of general and acculturation-specific daily hassles

Objectives. This study is designed to provide an empirical conceptualization of daily hassles among unaccompanied refugees, and whether they might affect mental health of young refugees after resettlement. First, we examined the underlying structure of daily hassles conceptualized as measuring general and acculturation-specific hassles. Second, we examined whether these two distinct categories of daily hassles significantly contribute to depression above and beyond the impact of premigration trauma.

Design. The study was based on self-report questionnaire data collected from 895 unaccompanied refugees who had been granted residence in Norway.

Results. Using structural equation modeling, the results confirmed the grouping of hassles in two general categories, which explained 43% of the variance in depression.

Conclusion. The findings underscore the importance of current life conditions for unaccompanied refugees' mental health.