NEUROCYSTICERCOSIS IN CHILDREN PRESENTING WITH AFEBRILE SEIZURE: CLINICAL PROFILE, IMAGING AND SERODIAGNOSIS

Neurocysticercosis (NCC) is one of the major causes of childhood seizures in developing countries including India and Latin America. In this study neurological pediatric cases presenting with afebrile seizures were screened for anti-Cysticercus antibodies (IgG) in their sera in order to estimate the possible burden of cysticercal etiology. The study included a total of 61 pediatric afebrile seizure subjects (aged one to 15 years old); there was a male predominance. All the sera were tested using a pre-evaluated commercially procured IgG-ELISA kit (UB-Magiwell Cysticercosis Kit ™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%) cases. The majority of cases with a positive ELISA test presented with generalized seizure (52.17%), followed by complex partial seizure (26.08%), and simple partial seizure (21.73%). Headaches were the major complaint (73.91%). Other presentations were vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscle weakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this study one child without any significant findings on imaging was also found to be positive by serology. There was a statistically significant association found between the cases with multiple lesions on the brain and the ELISA-positivity (p = 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology. Hence, neurocysticercosis should be suspected in every child presenting with afebrile seizure especially with a radio-imaging supportive diagnosis in tropical developing countries or areas endemic for taeniasis/cysticercosis

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

EEG Correlates of Active Stopping and Preparation for Stopping in Chronic Tic Disorder

Motor inhibition is an important cognitive process involved in tic suppression. As the right frontal lobe contains important inhibitory network nodes, we characterized right superior, middle, and inferior frontal gyral (RSFG, RMFG, RIFG) event-related oscillations during motor inhibition in youth with chronic tic disorders (CTD) versus controls. Fourteen children with CTD and 13 controls (10–17 years old) completed an anticipated-response stop signal task while dense-array electroencephalography was recorded. Between-group differences in spectral power changes (3–50 Hz) were explored after source localization and multiple comparisons correction. Two epochs within the stop signal task were studied: (1) preparatory phase early in the trial before motor execution/inhibition and (2) active inhibition phase after stop signal presentation. Correlation analyses between electrophysiologic data and clinical rating scales for tic, obsessive-compulsive symptoms, and inattention/hyperactivity were performed. There were no behavioral or electrophysiological differences during active stopping. During stop preparation, CTD participants showed greater event-related desynchronization (ERD) in the RSFG (γ-band), RMFG (β, γ-bands), and RIFG (θ, α, β, γ-bands). Higher RSFG γ-ERD correlated with lower tic severity (r = 0.66, p = 0.04). Our findings suggest RSFG γ-ERD may represent a mechanism that allows CTD patients to keep tics under control and achieve behavioral performance similar to peers

Infecciones, autoinmunidad e inmunodeficiencias son las principales etiologías de las bronquiectasias no asociadas a fibrosis quística en adultos del suroccidente colombiano

Introduction: Non-cystic fibrosis bronchiectasis (NCFB) is a complex medical condition with multiple etiologies, characterized by chronic productive cough and radiologic evidence of airway lumen dilation and wall thickening. Associated exacerbations and declining lung function contribute to increased disability and mortality. There are no data in the Colombian population on the prevalence of NCFB etiologies.Objective: To investigate the etiology and clinical characteristics of NCF-Bronchiectasis in adults evaluated in the Southwest of Colombia.Materials and methods: Cross-sectional, non-interventional study. Subjects diagnosed with non-cystic fibrosis bronchiectasis referred from their healthcare providers were enrolled between October 2018 and April 2021. Medical records and radiological studies were evaluated. Participants underwent laboratory tests including CBC and serum immunoglobulin levels or additional tests in some cases.Results: 161 subjects were included. Average age was 50 years old, with 59% females. Bronchiectasis etiology was identified in 84,6% of cases. Post-infectious (34,6%) and Immune Disorders (25,3%) represented by autoimmunity (13,6%) and Immunodeficiency (11,7%) were the leading causes. Gender differences were noted in autoimmune (females 18.8% vs. males 6,1%, P=0.021) and immunodeficiency-related bronchiectasis (males 21,2% vs. females 5,2%, P=0,002). Immunodeficiencies-associated bronchiectasis was more prevalent in subjects under 50 years of age, while COPD-associated bronchiectasis was common in subjects over 50 years of age.Discussion: The etiologies of NCFB in Colombia are diverse, exhibiting notable differences compared to other global regions. Serum immunoglobulins levels and a clinical immunologist evaluation should be prioritized in the diagnostic workup of patients with unclear bronchiectasis etiology, particularly those with recurrent sinopulmonary infections.Introducción. Las bronquiectasias no relacionadas con fibrosis quística (BQ no-FQ) son una condición médica compleja con múltiples etiologías, caracterizada por tos crónica productiva y evidencia radiológica de dilatación del lumen de las vías respiratorias y engrosamiento de la pared. Las exacerbaciones asociadas y el deterioro de la función pulmonar contribuyen a un aumento de la discapacidad y la mortalidad. No existen datos en la población colombiana sobre la prevalencia de las etiologías de BQ no-FQ.Objetivo. Investigar la etiología y características clínicas de las BQ no-FQ en adultos evaluados en el suroccidente colombiano.Materiales y métodos. Es un estudio transversal y no intervencionista. Se incluyeron sujetos diagnosticados con BQ no-FQ entre octubre de 2018 y abril de 2021, remitidos por sus médicos tratantes. La historia clínica y los estudios radiológicos fueron evaluados. A todos los participantes se le realizaron estudios de laboratorio incluyendo hemograma y niveles séricos de inmunoglobulinas entre otros estudios complementarios.Resultados. Fueron incluidos 161 sujetos. La mediana de edad fue de 50 años, con un 59% de mujeres. La etiología de las bronquiectasias se identificó en el 84,6% de los casos, siendo post-infecciosa (34,6%) y trastornos inmunológicos (25,3%) representados por autoinmunidad (13,6%) e inmunodeficiencia (11,7%) las principales causas. Se observaron diferencias de género en bronquiectasias atribuidas a autoinmunidad (mujeres 18,8% vs. Hombres 6,1%, P = 0.021) y en bronquiectasias atribuidas a inmunodeficiencias (hombres 21,2% vs. Mujeres 5,2%, P=0,002). Éstas últimas fueron más prevalentes en sujetos menores de 50 años, mientras que las bronquiectasias asociadas a EPOC fueron comunes en sujetos mayores de 50 años.Discusión. Las etiologías de las bronquiectasias no fibrosis quística en Colombia son diversas y presentan diferencias notables en comparación con otras regiones del mundo. Los niveles de inmunoglobulinas séricas y la evaluación de un inmunólogo clínico deben priorizarse en el estudio diagnóstico de pacientes con etiología no clara, particularmente aquellos con infecciones sino pulmonares recurrentes