Neuromonitoring and Emergency EEG

Intraoperative and Intensive Care Unit (ICU) EEG monitoring is very useful in cases of possible brain damage, for example, during carotid endarterectomy, cardiac surgery and neurosurgery, or when subclinical seizures are suspected. Continuous EEG (cEEG) monitoring during surgery is a valid and sensitive instrument for recognizing and/or preventing perioperative ischemic insults or any epileptiform activity responsible for convulsive or nonconvulsive symptoms. Furthermore, it allows brain functions monitoring for anesthetic drug administration, to determine the depth of anesthesia and for adjusting drug levels to achieve a predefined neural effect, such as burst suppression. In ICU, cEEG monitoring is essential to identify electrical discharges that occur frequently in critically ill patients and that are often clinically undetected, but potentially harmful if the diagnosis and the treatment are delayed. In the last years, cEEG monitoring has become a widespread practice, especially because of the use of new digital equipments, which are extremely compact and easy to use, not requiring a constant connection to the power grid and thus avoiding artifacts. EEG tracings can be visualized in real-time or analyzed after acquisition, either online or offline, with qualitative and/or quantitative methods. Finally, it is worth remembering that EEGs can be recorded bedside from a peripheral recording unit and then sent to the central unit, so that neurophysiologists can examine the recordings from distance and process them without interfering with the patients’ management

TDF and quantitative ultrasound bone quality in African patients on second line ART, ANRS 12169 2LADY sub-study.

Bone demineralization, which leads to osteoporosis and increased fracture risk, is a common metabolic disorder in HIV-infected individuals. In this study, we aimed to assess the change in bone quality using quantitative ultrasound (QUS) over 96 weeks of follow-up after initiation of second-line treatment, and to identify factors associated with change in bone quality.In a randomized trial (ANRS 12169), TDF and PI-naïve participants failing standard first-line treatment, from Burkina Faso, Cameroon, and Senegal were randomized to receive either TDF/FTC/LPVr, ABC/ddI/LPVr or TDF/FTC/DRVr. Their bone quality was assessed using calcaneal QUS at baseline and every 24 weeks until week 96. Stiffness index (SI) was used to measure bone quality. Out of 228 participants, 168 (74%) were women. At baseline, median age was 37 years (IQR: 33-46 years) and median T-CD4 count was 199 cells/μl (IQR: 113-319 cells/μl). The median duration of first-line antiretroviral treatment (ART) was 52 months (IQR: 36-72 months) and the median baseline SI was 101 (IQR: 87-116). In multivariable analysis, factors associated with baseline SI were sex (β = -10.8 [-18.1,-3.5] for women), age (β = -8.7 [-12.4,-5.1] per 10 years), body mass index (BMI) (β = +0.8 [0.1,1.5] per unit of BMI), and study site (β = +12.8 [6.5,19.1] for Cameroon). After 96 weeks of second-line therapy, a reduction of 7.1% in mean SI was observed, as compared with baseline. Factors associated with SI during the follow-up were similar to those found at baseline. Exposure to TDF was not associated with a greater loss of bone quality over time.Bone quality decreased after second-line ART initiation in African patients independently of TDF exposure. Factors associated with bone quality include age, sex, baseline BMI, study site, and duration of follow-up