Effect of the Duration of Withdrawal of Antiepileptic Drugs on the Risk of Seizure Recurrence in Childhood Epilepsy

ABSTRACT Background: There is no consensus on how long the duration of antiepileptic drugs (AEDs) withdrawal after seizure control should be. Some centers recommend very rapid withdrawal while others recommend prolonged tapering. Objective: This study was designed to identify the risk of seizure recurrence after rapid or slow discontinuation of AEDs in epileptic children who are in remission and to assess variables that may modify the risk of recurrence in rapid or slow withdrawal. Methods: One hundred and six epileptic children in remission were included: sixty one of them were subjected to AEDs withdrawal over six months while the remaining forty five patients underwent withdrawal of drugs over three months. All patients were followed up for one year for any new seizure occurs. Results: No significant statistical difference was found between both groups regarding the rate of seizure relapse in one year follow up (P=0.81). It is found that gender, presence of family history of epilepsy, type of seizures, seizure free duration, number of drugs used and type of drugs have no effect on the relapse rate irrespective to the duration of tapering; However, abnormal EEG at withdrawal of therapy was associated with significantly higher relapse rate in the group of three months (rapid) withdrawal. Conclusion: It was concluded that seizure relapse in epileptic children undergoing AEDs withdrawal is not affected by the duration of tapering of treatment apart from children with abnormal EEG in remission who may experience less recurrence rate if 6 months withdrawal is adopted

Unique prokaryotic consortia in geochemically distinct sediments from Red Sea Atlantis II and Discovery Deep brine pools

© The Author(s), 2012. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in PLoS ONE 7 (2012): e42872, doi:10.1371/journal.pone.0042872.The seafloor is a unique environment, which allows insights into how geochemical processes affect the diversity of biological life. Among its diverse ecosystems are deep-sea brine pools - water bodies characterized by a unique combination of extreme conditions. The ‘polyextremophiles’ that constitute the microbial assemblage of these deep hot brines have not been comprehensively studied. We report a comparative taxonomic analysis of the prokaryotic communities of the sediments directly below the Red Sea brine pools, namely, Atlantis II, Discovery, Chain Deep, and an adjacent brine-influenced site. Analyses of sediment samples and high-throughput pyrosequencing of PCR-amplified environmental 16S ribosomal RNA genes (16S rDNA) revealed that one sulfur (S)-rich Atlantis II and one nitrogen (N)-rich Discovery Deep section contained distinct microbial populations that differed from those found in the other sediment samples examined. Proteobacteria, Actinobacteria, Cyanobacteria, Deferribacteres, and Euryarchaeota were the most abundant bacterial and archaeal phyla in both the S- and N-rich sections. Relative abundance-based hierarchical clustering of the 16S rDNA pyrotags assigned to major taxonomic groups allowed us to categorize the archaeal and bacterial communities into three major and distinct groups; group I was unique to the S-rich Atlantis II section (ATII-1), group II was characteristic for the N-rich Discovery sample (DD-1), and group III reflected the composition of the remaining sediments. Many of the groups detected in the S-rich Atlantis II section are likely to play a dominant role in the cycling of methane and sulfur due to their phylogenetic affiliations with bacteria and archaea involved in anaerobic methane oxidation and sulfate reduction.This work was supported by King Abdullah University for Science and Technology Global Collaborative Partners (GCR) program

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe

Nutritional Status in Children with un-operated Congenital Heart Diseases:An Egyptian Center Experience

Background: Malnutrition is a common cause of morbidity and mortality in children with congenital heart disease (CHD).This study aimed to identify prevalence and predictors of malnutrition in Egyptian children with symptomatic CHD.Methods: This case-control study included 100 children with symptomatic CHD (76 acyanotic and 24 cyanotic) and 100 age and sex-matched healthy children as a control group. Clinical Evaluation and Laboratory Assessment of Nutritional Status were done. Anthropometric measurements were recorded and Z scores for weight for age (WAZ), weight for height (WHZ) and height for age (HAZ) were calculated. Malnutrition was defined as weight, height and weight/ height z-score ≤ –2.Results: The overall prevalence of malnutrition was 84.0% in patients with CHD and 20% in controls. Severe malnutrition was diagnosed in 71.4% of cases. All anthropometric measurements and levels of biochemical markers of nutritional state were significantly lower in the patients group compared to controls. In patients with acyanotic CHD, stunting was proportionately higher (57.89%) than in cyanotic CHD, while wasting was predominant (45.83%) in the latter. Malnutrition correlated significantly with low hemoglobin level, low arterial oxygen saturation, heart failure, pulmonary hypertension and poor dietary history. Conclusion: Malnutrition is a very common problem in children with symptomatic CHD and predicted by the presence of low hemoglobin level, low arterial oxygen saturation, heart failure, poor dietary history and pulmonary hypertension

Cluster dendrogram illustrating the relationship of the (4a) archaeal and (4b) bacterial communities in the Red Sea to those in other oceanic systems.

<p>The dendrogram shows the complete linkage hierarchical clustering of the different sediment sections based on the relative abundance of the OTUs in each section. The height indicates the relative distances between the datasets. The data of other oceanic systems from the Guaymas Methane Seep (ICM GMS) project included <i>Estuarine bulk water, North Atlantic Ocean</i> (ICM GMS 1–2): oxic sediment from the White Oak River; <i>Cold Seep¹ Gulf of Mexico</i> (ICM GMS 3–4): microbial mat; <i>Cold Seep^2,3 Gulf of Mexico</i> (ICM GMS 5–8): sediments from anoxic deep-sea hydrocarbon seeps in the Gulf of Mexico; <i>Continental shelf, Norwegian Sea</i> (ICM GMS 13–14): an oxic microbial mat from the continental shelf at the Storegga seep enrichment in the Norwegian Sea; <i>Carbonate reef Black Sea</i> (ICM GMS 15–16): an anoxic microbial mat from the Black Sea; <i>Marine hydrothermal vent^1–2, Gulf of California</i> (ICM GMS 17–20): microbial mat from the Gulf of California, oxic hydrothermal vent from Guaymas Basin.</p

Taxonomic assignment of OTUs to major archaeal and bacterial groups.

<p>Water Col.¹: Average OTU in the water column</p><p>Water Col.²: Highest OTU in the water column</p

Pyrotag 16S rDNA data sets.

<p>Pyrotag 16S rDNA data sets.</p

Taxonomic assignment and abundance of archaeal communities in ATII, DD, CD and BI sediment samples.

<p>Maximum-likelihood phylogenetic tree showing the taxonomic diversity and relative abundance of archaeal OTUs in all sediment samples. Bootstrap support values greater than 50% are indicated by the size of the circle on each branch. The taxonomically assigned OTUs are represented in ST-1.</p