Comparing the Efficacy and Safety of Levetiracetam Versus Phenytoin for Treating the Acute Phase of Neonatal Seizures

  Objectives Neonatal seizure is a significant problem in this life course, and its timely and effective treatment is crucial. In this study, we compared the efficacy of levetiracetam versus phenytoin for treating the acute phase of neonatal seizures. Materials & Methods In this single-blind case-control study, 60 consecutive children with neonatal seizures referred to the Children’s medical center in Tehran, Iran, in 2018 were studied. Those neonates who had at least 30 minutes of seizure after Phenobarbital treatment were assigned to receive either phenytoin (20 mg/kg) or levetiracetam (initial dose of 40-60 mg/kg) through block randomization. The efficacy and safety of the two drugs were compared between the groups. Results The response rate was 83.3% and 86.7% in phenytoin and Levetiracetam groups, respectively, which was not significantly different between groups (P=1.000). Adverse effects were nearly similar between groups (6.7% in the phenytoin group and 3.3% in the Levetiracetam group, P=1.000). ConclusionLevetiracetam and phenytoin are both practical and safe for treatingneonatal seizures

Right-side inguinal canal endometriosis at ultrasound: A case report

Background: The first case of inguinal endometriosis was described by Cullen. Endometriosis in the round ligament could be in the pelvic or inguinal area and is a rare disease occurring in 0.6% of women. Women with inguinal endometriosis have a painful inguinal mass during menstrual cycles and they mostly have a history of surgery. The right side is more commonly involved in inguinal endometriosis than the left side (90-94%). A history of gynecologic or abdominal surgery is common in women with inguinal endometriosis. Case presentation: In our case, a 39-yr-old virgin woman presented with localized pain in the right inguinal that had been present for 4 yr. She did not have any history of previous surgery, and abdominal ultrasonography showed a hypoechoic mass with minimal vascularity. Inguinal endometriosis was correctly diagnosed by two expert radiologists preoperatively, and she underwent laparoscopic surgery. Conclusion: Considering inguinal endometriosis in the differential diagnosis of women with inguinal masses is important, even if there is no history of gynecologic or abdominal surgery. Key words: Endometriosis, Inguinal, Ultrasound, Case report

A Comparative Study of EEG and aEEG in Seizure Diagnosis in Infants Admitted to the NICU

ObjectivesSeizure is a common sign in neonates hospitalized in the neonatal intensive care units (NICU) that may lead to morbidity and mortality. Most neonatal seizures are subclinical. Conventional EEG (cEEG) is the gold standard for detecting and monitoring seizures but is not widely available. Amplitude-integrated electroencephalography (aEEG) has been used for over a decade to evaluate infants with seizures. In this study, we tried to determine the efficacy of aEEG asa widely available diagnostic tool in diagnosing seizures.Materials & MethodsAll cases with seizures or suspicious seizures were admitted to the NICU of the Children’s Medical Center for one year. cEEG and aEEG were performed for these infants. aEEG was recorded for at least six hours with a description of the tracing. Clinical information, outcomes, and questionnaires (patient information) were recorded in detail. The obtained data were analyzed with the SPSS version 24 software.ResultsEleven out of twenty-five aEEG recordings were abnormal; other patients showed normal aEEGs. The most common clinical and neurological manifestations were seizure (68%) and hypotonia (28%); the mortality rate was 12%. No significant correlation was observed between aEEG findings and gender, age, familial relation, outcome, ultrasound result, type of seizure, and underlying disease

Placenta Percreta Invading Broad Ligament and Parametrium in a Woman with Two Previous Cesarean Sections: A Case Report

Introduction. The incidence of placenta accreta has dramatically increased due to increasing caesarean section rate all over the world. Placenta percreta is the most severe form of placenta accretes. It frequently results in maternal morbidity and mortality mainly caused by massive obstetric hemorrhage or emergency hysterectomy. Percreta invading into the broad ligament has rarely been previously reported. Case presenting. We presented a case of placenta percreta invading left broad ligament and parametrium in a woman with two previous cesarean sections, which led to massive intraoperative hemorrhage during hysterectomy and transient ischemic encephalopathy. Conclusion. In cases of parametrial involvement, it would be more difficult to decide whether to remove placenta or leave it in site. In surgical removal neither local excision of placental bed and uterine repair nor traditional hysterectomy is adequate if parametrium invaded by placenta. We suggest delayed elective hysterectomy in such cases. So, pregnancy-induced pelvic congestion would be decreased, we can gather an expert team of gynecologists, urologists, and vascular surgeons, we could get plenty of blood products, and we may have the chance to administer methotrexate

Evaluation of Cerebrospinal Fluid and Plasma Amino Acids Levels in Neonates with Refractory Seizures: A Prospective Cohort Study

Background: Altered concentrations of cerebrospinal fluid (CSF) and blood amino acids may be related to epilepsy or the severity of the seizure. In the present study, we assessed the concentrations of amino acids in CSF and plasma in neonates with refractory seizures. Methods: In this prospective cohort study, 27 neonates aged 1 to 56 days with refractory seizures were included. Blood and CSF samples were collected from each neonate within 24 hours after receiving 2nd antiseizure medications. All plasma and CSF samples were sent to the laboratory to measure amino acid concentrations. The associations between CSF and plasma amino acid levels with different variables were evaluated. Results: Except for leucine (P=0.15) and isoleucine (P=0.07), the levels of all amino acids were significantly higher in plasma than CSF. Significant associations were observed between types of seizure and plasma citrulline (P=0.008) and leucine concentrations (P=0.04). The mean of CSF glutamic acid was also statistically different among neonates with different EEG results (P=0.02). Conclusion: Our findings indicate that several plasma and CSF amino acids could be candidate biomarkers for neonatal refractory seizures. Further studies with larger sample size are to confirm our findings

In Vitro Assessment of the Anti-Proliferative and Anti-Viability Effects of Salivary Gland Extracts from Hyalomma ticks (Acari: Ixodidae) on Human Colorectal Cancer Cells

Background: The saliva and salivary glands of ticks possess a wide range of immuno-pharmacologically active mole­cules that effectively modulate the activity of enzymes, antibodies, and amines that have a role in different biological processes. Derived components from saliva and salivary glands of hard ticks Ixodidae have been characterized as poten­tial natural sources for discovering promising anti-cancer drug candidates. Methods: The anti-cancer activity of salivary gland extracts (SGEs) from Hyalomma anatolicum, Hyalomma drome­darii, Hyalomma marginatum, and Hyalomma schulzei was assessed. MTT assays and flow cytometry were done on the HT-29 colorectal cancer cell line to evaluate the anti-viability and proliferative inhibition. Results: Based on the MTT assay results, the SGEs from Hy. dromedarii had the highest and lowest substantial anti-viability effects on the HT-29 cancer cell and human foreskin fibroblast (HFF) normal cell, respectively. The cytometric assessment revealed a significant increase in the apoptosis and necrosis ratio of the HT-29 cancer cells after treatment with Hy. dromedarii SGEs. Conclusion: The results demonstrated that Hy. dromedarii SGEs have significant anti-proliferative, anti-viability, and apoptotic potential. The result of this study suggests that Hy. dromedarii SGEs is an appropriate candidate for further investigations to identify and purify the mechanisms and molecules involved in the anti-cancer activity of the SGEs

Physicians’ and nurses’ decision making to encounter neonates with poor prognosis in the neonatal intensive care unit

This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020. Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020.Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173acceptedVersio

Evaluations of vascular incasion, perineural invasion and serosal involvement in pathology slides of colorectal cancer

Background: Colorectal cancer (CRC) is one important cause of mortality in the world. In the common staging systems of CRC, many biological behaviors of the tumor that determine the prognosis are not defined. Risk stratification is becoming increasingly important in low-stage CRC, because these patients do not undergo adjuvant therapy unless poor prognostic factors such as vascular invasion (VI), perineural invasion (PI) and serosal involvement (SI) are present. Accurate evaluation of these factors in CRC specimens is still challenging. Methods: In this study, we evaluated the detection rate of VI, PI and SI in 180 patients of CRC who underwent surgical resection based on basic pathology reports, review of hematoxylin and eosin (H&E) slides with considering morphologic clues such as “protruding tongue” and “orphan artery” signs, and elastin stain for detection of VI. In addition, the stage of the disease, pT stage, tumor location, tumor type and grade were categorized, separately. We used the Fisher’s exact test for comparing variables between the two groups. P<0.05 was considered significant. All data analyzed using SPSS version 26. Results: Overall, the detection rate of VI was significantly increased in review of H&E slides with considering morphologic clues (P=0.019) and also using elastin stain (P<0.05) than basic pathology reports, but no significant differences observed in PI (P=0.118) and SI (P=1.00) between the first basic pathology reports and review of H&E slides. Also, significant differences observed in VI, PI and SI based on AJCC stage, pT stage and grade of tumor (P<0.05). Conclusion: Considering the prognostic importance of VI detection in the treatment of patients of CRC, Slide review with attention to the morphologic clues such as “protruding tongue” and “orphan artery” signs and elastin staining could be used for better detection of VI in patients of CRC in routine surgical specimens

Pediatric Mass Casualty Incident: A Real Crisis Mandating Inter-Disciplinary Coordination, Considering Ethical Issues

Interdisciplinary coordination of the director of crisis committee with emergency and other department's staff, financial support team, public relations, rehabilitation team,and police are required to successfully manage mass casualty incidents (MCIs). Prevention, staff training, equipment availability, clear-cut responsibilities and predicting all requirements are crucial aspects to be prepared (1). The task force for Mass Critical Care published guidance for adult MCI in 2008; For children, 17 experts of the Oak Ridge Institute for Science and Education developed recommendations for pediatric MCI (2). Certain guidelines have been suggested by the Centers for Disease Control and Prevention (CDC) and subsequently published in Pediatric Critical Care Medicine as a supplement as well as the more recent supplement in CHEST that updates the previous works (3, 4). Although the literature has provided sufficient evidence managing the situation, some major difficulties still exist in the stage of response to the crisis. Lack of equipment especially in international crises may lead to neglect moribund patients. This problem is more prominent for pediatric patients (5, 6). Personnel shortage mandates to accept the less-qualified staff contribution for pediatric car