Status Epilepticus: Etiology, Outcome and Predictors of Mortality

ObjectiveThis study was designed to determine the etiology of status epilepticus (SE) andits relation to mortality.Materials and MethodsThis descriptive study was carried out based on the medical records of 40 patients with diagnosis of SE discharged from pediatric hospital of Bandar Abbas between March 2002 and March 2004. Multivariant analysis was pereformed to determine the prevalence of the disorder and the relation between SE and other factors such as gender, age, response to treatment, and mortality. We classified the etiology according to international league against epilepsy (ILAE) classification and also uses another classification regarding underlying causes such as fever (non-CNS infection), central nervous system infection, hypoxia, and metabolic causes.ResultsStatus epilepticus was responsible for 0.3% of all hospital  dmissions during the study period. Based on the ILAE classification, frequencies for acute symptomatic, febrile, progressive encephalopathic, remote, and cryptogenic SE were 42.5%, 32.5%, 10%, 7.5%, and 7.5%, respectively.The most common underlying causes resulting in SE were fever (45%), metabolic disorders (15%), CNS infection (12.5%), chronic neurologic diseases (7.5%), idiopathic (7.5%), hypoxia (5%), drug withdrawal (2.5%), CNS hemorrhage (2.5%), neurodegenerative disease (2.5%), brain abscess (2.5%), and post DPT (Diphteria,Pertusis,Tetanus) vaccination (2.5%). Mortality rate was 25% (80% in the patients younger than 5 years and 40% in those aged less than 1 year). Occurrence of SE and its mortality was found to be related to age (p< 0.05).ConclusionFor SE, if seizures continue for more than 5 minutes, treatment must beinitiated. The outcome is determined by etiology, age, seizure duration and management; however, all we can do is enhance the management and increase its effectiveness

99mTc-MIBI Lung Scintigraphy in the Assessment of Pulmonary Involvement in Interstitial Lung Disease and Its Comparison With Pulmonary Function Tests and High-Resolution Computed Tomography: A Preliminary Study

The differentiation of active inflammatory processes from an inactive form of the disease is of great value in the management of interstitial lung disease (ILD). The aim of this investigation was to assess the efficacy of 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scans in distinguishing the severity of the disease compared to radiological and clinical parameters.In total, 19 known cases of ILD were included in this study and were followed up for 1 year. Five patients without lung disease were considered as the control group. The patients underwent pulmonary function tests (PFTs) and high-resolution computed tomography scans, followed by 99mTc-MIBI scanning. The 99mTc-MIBI scans were analyzed either qualitatively (subjectively) or semiquantitatively.All 19 ILD patients demonstrated a strong increase in 99mTc-MIBI uptake in the lungs compared to the control group. The 99mTc-MIBI scan scores were higher in the patient group in both the early phase (0.240.19-0.31 vs 0.110.10-0.15, P 0.14). The 99mTc-MIBI scan scores were not significantly correlated with the PFT findings (P > 0.05). In total, 5 patients died and 14 patients were still alive over the 1-year follow-up period. There was also a significant difference between the uptake intensity of 99mTc-MIBI and the outcome in the early phase (dead: 0.320.29-0.43 vs alive: 0.210.18-0.24, P < 0.05) and delayed phase (dead: 0.270.22-0.28 vs alive: 0.100.07-0.19, P < 0.05).The washout rate was ~40 min starting from 20 min up to 60 min and this rate was significantly different in our 2 study groups (ILD: 46.6115.61-50.39 vs NL: 70.9127.09-116.36, P = 0.04).The present study demonstrated that 99mTc-MIBI lung scans might distinguish the severity of pulmonary involvement in early views, which were well correlated with HRCT findings. These results also revealed that 99mTc-MIBI lung scans might be used as a complement to other diagnostic and clinical examinations in terms of functional information in ILD; however, further investigations are strongly required

The effect of fractal-like mechanical ventilation on vital signs in a rat model of acute-on-chronic liver failure

OBJECTIVE: The network of interactions between different organs is impaired in liver cirrhosis. Liver cirrhosis is associated with multi-system involvement, which eventually leads to multiple organ failure. This process is accelerated by a precipitating factor such as bacterial infection, which leads to respiratory distress, circulatory shock, neural dysfunction and very high mortality. Cirrhotic patients often have blunted respiratory sinus arrhythmia and impaired cardio-respiratory variability. Fractal-like mechanical ventilation is reported to enhance respiratory sinus arrhythmia and attenuate respiratory distress in experimental models. In the present study we hypothesise that fractal-like mechanical ventilation may improve the outcome of cirrhotic rats with multiple organ failure. APPROACH: Cirrhosis was induced by chronic biliary obstruction in rats. Acute multiple organ failure was induced by intraperitoneal injection of bacterial endotoxin in cirrhotic rats. The effect of conventional mechanical ventilation (with constant tidal volume and respiratory rate) or fractal-like ventilation (with the same average but variable tidal volume and respiratory rate) were assessed on vital signs, oxygen saturation and plasma alanine aminotransferase in anaesthetised cirrhotic rats. MAIN RESULTS: We demonstrated that fractal-like mechanical ventilation was accompanied by improved oxygen saturation, reduced heart rate and decreased liver injury following injection of bacterial endotoxin. Moreover, variable mechanical ventilation in cirrhotic rats reduced mortality and prevented a fall in short-term heart rate variability following endotoxin challenge in comparison with rats with constant mechanical ventilation. Significance: We suggest further investigations into the beneficial effects of fractal-like ventilation strategy in critically ill patients with liver failure requiring organ support and mechanical ventilation

Free volume variation with molecular weight of polymers

Free volume measurements were made in several molecular weight fractions of two different geometries of poly(arylene ether ketone)s. Free volumes were measured using positron lifetime spectroscopy. It has been observed that the free volume cell size V(sub f) varies with the molecular weight M of the test samples according to an equation of the form V(sub f) = AM(B), where A and B are constants. The molecular weights computed from the free volume cell sizes are in good agreement with the values measured by gel permeation chromatography

Anti-melanocortin-4 receptor autoantibodies in obesity

Background: The melanocortin-4 receptor (MC4R) is part of an important pathway regulating energy balance. Here we report the existence of autoantibodies (autoAbs) against the MC4R in sera of obese patients. Methods: The autoAbs were detected after screening of 216 patients' sera by using direct and inhibition ELISA with an N-terminal sequence of the MC4R. Binding to the native MC4R was evaluated by flow cytometry and pharmacological effects by measuring adenylyl cyclase activity. Results: Positive results in all tests were obtained in patients with overweight or obesity (prevalence: 3.6%) but not in normal weight patients. The selective binding properties of anti-MC4R autoAbs were confirmed by surface plasmon resonance and by immunoprecipitation with the native MC4R. Finally it was demonstrated that these autoAbs increased food intake in rats after passive transfer via intracerebroventricular injection. Conclusion: These observations suggest that inhibitory anti-MC4R autoAbs might contribute to the development of obesity in a small subpopulation of patients

Neonatal Sepsis Alters the Excitability of Regular Spiking Cells in the Nucleus of the Solitary Tract in Rats

OBJECTIVE: Sepsis is a leading cause of mortality and morbidity in infants. Although the measures of autonomic dysfunction (e.g. reduced heart rate variability) predict mortality in sepsis, the mechanism of sepsis-induced autonomic dysfunction has remained elusive. The nucleus of the solitary tract hjh(NTS) is a vital structure for the integrated autonomic response to physiological challenges. In the present study we hypothesized that sepsis alters the excitability of NTS neurons in a rat model of neonatal sepsis (14-day old rats). METHODS AND RESULTS: Sepsis was induced by intraperitoneal injection of cecal slurry (CS) in rat neonates. The presence of autonomic dysfunction was confirmed by observing a significant reduction in both short-term and long-term heart rate variably following CS injection. We investigated the effect of polymicrobial sepsis on the electrophysiological properties of the medial NTS neurons using a whole cell patch clamp recording. Our results showed that the resting membrane potential in regular spiking neurons was significantly less polarized in the septic group (-37.6 ± 1.76 mv) when compared with the control group (-54.7 ± 1.73 mv, P < 0.001). The number of spontaneous action potentials in the septic group, was also significantly higher than the control group (P < 0.05). In addition, the frequency and amplitude of the spontaneous excitatory post synaptic potentials (EPSPs) was significantly higher in neurons recorded in the septic group (P < 0.001). Interestingly, regular spiking cells in the CS group exhibited a rebound action potential following hyperpolarization. Injection of depolarizing currents was associated with lower first spike latency and changes in rise slope of action potential (P < 0.001). CONCLUSIONS: We showed that polymicrobial sepsis increases the excitability of regular spiking cells in the medial NTS. These alterations can potentially affect neural coding and thus may contribute to an abnormal homeostatic or allostatic physiological response to sepsis and systemic inflammation

In vitro propagation of four Iranian grape varieties: Influence of genotype and pretreatment with arbuscular mycorrhiza

There is a great demand for table grape saplings, mainly for commercial varieties indicating that micropropagation could be an effective method for their mass propagation. Internal contamination in woody plant species is an important problematic issue and arbuscular mycorrhizal fungi (AMF) have been known as potential plant biological protectors. In the present study, the glasshouse grown mother plants of four grape varieties ('Asgari', 'Khalili', 'Keshmeshi', and 'Shahroudi') were inoculated with AMF as pre-treatment. The fungi strains were Glomus mosseae, G. fasciculatum, G. intraradices and a mixture of all three species. The comparative in vitro performance of these genotypes was evaluated following optimization of in vitro growth conditions for each genotype. Furthermore, the positive effect of AMF inoculation of stock plant on micropropagation process was studied. Changes in biochemical features (total chlorophylls, total phenols and total sugars), growth parameters (root length and total leaf area) and in vitro behavior of AMF pretreated as well as control explants were recorded. The mycorrhizal association with grapevine roots was confirmed following root staining and evaluation of colonization rate. The results revealed a distinct difference and clear genotypic effect on various in vitro parameters of studied grape genotypes. The utilized inocula were found to have the capability of mycorrhizal association with grapevine roots, leading to enhancing phenolics as a defense mechanism, increasing sugars and chlorophyll and finally growth of whole plant corresponding to the grape variety and AMF strain. These results confirmed that health and physiological conditions of the stock plants are important parameters for in vitro grape culture establishment and suggest the integration of mycorrhizal technology with tissue culture to accomplish better results