Real-time automated detection of clonic seizures in newborns

Objective: The aim of this study is to apply a real-time algorithm for clonic neonatal seizures detection, based on a low complexity image processing approach extracting the differential average luminance from videotaped body movements. Methods: 23 video-EEGs from 12 patients containing 78 electrographically confirmed neonatal seizures of clonic type were reviewed and all movements were divided into noise, random movements, clonic seizures or other seizure types. Six video-EEGs from 5 newborns without seizures were also reviewed. Videos were then separately analyzed using either single, double or triple windows (these latter with 50% overlap) each of a 10 s duration. Results: With a decision threshold set at 0.5, we obtained a sensitivity of 71% (corresponding specificity: 69%) with double-window processing for clonic seizures diagnosis. The discriminatory power, indicated by the Area Under the Curve (AUC), is higher with two interlaced windows (AUC = 0.796) than with single (AUC = 0.788) or triple-window (AUC = 0.728). Among subjects without neonatal seizures, our algorithm showed a specificity of 91% with double-window processing. Conclusions: Our algorithm reliably detects neonatal clonic seizures and differentiates them from either noise, random movements and other seizure types. Significance: It could represent a low-cost, low complexity, real-time automated screening tool for clonic neonatal seizures

Plasma Cystatin C based renal function assessment among adolescent and young adults failing antiretroviral treatment (ART) on a tenofovir based-ART in Harare, Zimbabwe :

Objective: To assess renal function using plasma CystatinC (CysC) among adolescent and young adult  PLWH failing a Tenofovir Disoproxil Fumarate (TDF)-containing Antiretroviral Therapy (ART) regimen with  no clinical signs of kidney disease.  Design: Retrospective cohort laboratory analysis.  Participants: Adolescents and young adults aged 10-24 years with VL>400 copies/ml enrolled in an adherence intervention cohort.  Setting: Parirenyatwa Hospital Family Care Centre & Harare City Health Clinics. Materials and Methods: The Human Cystatin-C Test CYSC2, (test ID 0‑ 139) kit was used for the  immunoturbidimetric quantification of CysC in human plasma on the COBAS INTEGRA400 system. Main Outcome Measures: Renal function status at week 36.Mild impaired renal function was defined by 2 2 eGFR<90mL/min/1.73 m with moderate to severe renal dysfunction defined by eGFR<60mL/min/1.73 m .  Results: We enrolled 139 participants; 86% completed follow-up of 36 weeks. Mean or Standard Deviation  (SD) age was 18.38 (2.99) years. Median duration on TDF-containing ART was 3.03 years (IQR 1.47-4.73).  Median or Interquartile Range (IQR) plasma CysC concentration was 0.78 (0.71-0.87) mg/L. There was no  significant correlation between plasma CysC with age (r=0.0785), weight (r=-0.1181), height (r=0.0310) and  2 BMI (r=-0.0977). About 67% had impaired renal function (eGFR<90 mL/min/1.73 m ) at endpoint, a  significant increase from 51% at enrolment (p=<0.0001).   Conclusions: There is a high burden of impaired renal function in adolescent and young adult patients on  tenofovir containing ART in Harare Zimbabwe with asymptomatic renal disease. The decline in renal  function over 36 weeks reported in this cohort was significant and concerning. Enhanced renal monitoring is  recommended for these patients. CysC is a reliable marker of renal function independent of age and anthropometric measurements.&nbsp

The transient effect of a peer support intervention to improve adherence among adolescents and young adults failing antiretroviral therapy in Harare, Zimbabwe: a randomized control trial

Abstract Background Adolescents and young adults living with HIV in sub Saharan Africa are at high risk of poor adherence to antiretroviral therapy (ART) and virologic failure (VF). Methods We conducted a randomized control trial among adolescents and young adults on ART with VF to assess the effectiveness of a community-based peer support intervention aimed at improving VF. Viral load (VL) levels were obtained at 12, 24 and 36 weeks. A subset of the participants had baseline HIV drug resistance (HIVDR) genotyped using Sanger sequencing. Results The participants’ median (interquartile range (IQR)) age was 18.1 (IQR: 15.1–20.0) years and half (50.5%, n = 107) were male. At week 24, the proportion of subjects with a detectable viremia was significantly lower in the intervention arm than in the standard of care (SOC) arm (76.0% (n = 79) vs. 89.0% (n = 96), p = 0.013). At Week 36, there remained a difference in the proportion of subjects with a detectable VL between the intervention arm (68.3%, n = 71) and SOC arm (79.6%, n = 86), which was trending towards statistical significance (p = 0.059). There was no difference in the probability of having a detectable VL over time between the intervention and SOC groups (adjusted odds ratio: 1.14, p = 0.439). Baseline HIVDR was observed in 44.0% of the participants in the intervention and 56.0% in the SOC group (p = 0.146). Conclusion A transient effect of the peer support intervention in improving VF was observed among adolescents and young people failing ART. Trial registration: This study is registered with www.clinicaltrials.gov under the reference number: NCT0283344

Real-time automated detection of clonic seizures in newborns

Objective: The aim of this study is to apply a real-time algorithm for clonic neonatal seizures detection, based on a low complexity image processing approach extracting the differential average luminance from videotaped body movements. Methods: 23 video-EEGs from 12 patients containing 78 electrographically confirmed neonatal seizures of clonic type were reviewed and all movements were divided into noise, random movements, clonic seizures or other seizure types. Six video-EEGs from 5 newborns without seizures were also reviewed. Videos were then separately analyzed using either single, double or triple windows (these latter with 50% overlap) each of a 10. s duration. Results: With a decision threshold set at 0.5, we obtained a sensitivity of 71% (corresponding specificity: 69%) with double-window processing for clonic seizures diagnosis. The discriminatory power, indicated by the Area Under the Curve (AUC), is higher with two interlaced windows (AUC. = 0.796) than with single (AUC. = 0.788) or triple-window (AUC. = 0.728). Among subjects without neonatal seizures, our algorithm showed a specificity of 91% with double-window processing. Conclusions: Our algorithm reliably detects neonatal clonic seizures and differentiates them from either noise, random movements and other seizure types. Significance: It could represent a low-cost, low complexity, real-time automated screening tool for clonic neonatal seizures. © 2014 International Federation of Clinical Neurophysiology