Heat-related side-effects of neurological and non-neurological medication may increase heatwave fatalities

Background: During the 2003 French heatwave 15 000 excess deaths were registered. One fifths died from the combination of dehydration, heatstroke, and hyperthermia and one tenth from dehydration, despite abundant water. Methods and Results: We hypothesized that physiologic adaptation to heat was not effective in the victims attributable to side-effects of drugs (impaired thermoregulation, suppressed thirst) many of these patients were taking. This could explain why many victims died of dehydration despite availability of water. As a consequence of the global climate change heatwaves may occur more frequently and may be more intense, with a strong impact on the future selection of drugs in elderly patients. Conclusion: Insufficient water intake, impaired thermoregulation, and resulting death may be directly linked to the use of certain drugs, implying an immediate need for public awareness during heatwaves and for long-term strategies to mitigate the expected increase in future heatwave-related fatalities

Multivariate analysis-based prediction rule for pulmonary embolism

The diagnosis of pulmonary embolism (PE) is still an unresolved problem. The aim of this prospective observational study was to derive and validate a prediction rule (PEscore) by which PE can be diagnosed by easily obtainable and rapidly available investigations. Included were consecutive patients with a clinical suspicion of PE admitted to a community hospital. Risk factors and clinical and instrumental investigations were registered. PE was diagnosed by angiography, scintigraphy, or autopsy. In 168 patients, PE was either diagnosed (angiography, n=28; autopsy, n=18) or excluded (angiography, n=12; scintigraphy, n=99; autopsy, n=11). Based on the results of clinical and instrumental findings, a PEscore was derived by a multiple regression analysis, calculated as: [0.29 x proven leg vein thrombosis (0=no, 1=yes)] + [0.25 x ECG right heart strain (0=no, 1=yes)] + [0.22 x neck vein distension (0=no, 1=yes)] + [0.20 x dyspnoea (0=no, 1=yes)] + [0.13 x suspicious chest X-ray (0=no, 1=yes)] - [0.17 (constant)]. The PEscore was tested further in 139 subsequent cases. In these patients, the PEscore was 0.65 +- 0.17 (diagnosed PE, n=47) and 0.1810.17 (excluded PE, n=92), respectively (p=0.0001). Depending on a given PEscore, the level of probability of PE can be assessed. Calculation of the PEscore can be helpful in clinical decisions when PE is suspected

Do pets reduce the likelihood of sudden unexplained death in epilepsy?

Purpose: To assess the relationship between the presence of pets in homes of epilepsy patients and the occurrence of sudden unexpected death in epilepsy (SUDEP). Methods: Parents or relatives of SUDEP patients collected over a ten-year period (2000-2009) in a large epilepsy unit were asked if the patient lived together with any domestic pet at the time of death or not. Patients who did not experience SUDEP served as controls. Results and conclusions: Eleven out of the 1092 included patients (1%) experienced SUDEP, all with refractory symptomatic epilepsy, but none of them had pets in their homes at the time of death. In contrast, the frequency of pet-ownership in the control group (n = 1081) was 61%. According to previous studies there are some indications that human health is directly related to companionship with animals in a way that domestic animals prevent illness and facilitate recovery of patients. Companion animals can buffer reactivity against acute stress, diminish stress perception and improve physical health. These factors may reduce cardiac arrhythmias and seizure frequency, factors related to SUDEP. Companion animals may have a positive effect on well-being, thus irnproving epilepsy outcome. (c) 2012 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.FAPESPFAPESPCInAPCeFAPESPCInAPCe-FAPESPCNPqCNPqINCT/MCTINCT/MC