The differential effects of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids on seizure frequency in patients with drug-resistant epilepsy – A Randomized, double-blind, placebo-controlled trial

Abstract The omega-3 (n-3) fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known to play an important role in maintenance and modulation of neuronal functions. There is evidence that omega-3 fatty acids may have anticonvulsant effects. The effect of DHA and EPA on seizure rate in patients with DRE was investigated. Methods: A double-blind, randomized, placebo-controlled clinical trial included ninety-nine (n=99) DRE patients, aged 5-16 (n=85) and 17-45 (n=14). After randomization, patients were given two, four or six capsules per day of DHA (417.8 mg DHA and 50.8 mg EPA/capsule, n=33), EPA (385.6 mg EPA and 81.2 mg DHA/capsule, n=33) or placebo (high oleic acid sunflower oil, n=33) for one year. The primary endpoint was the effect of treatment on rate of seizure. Random-effects negative binomial regression models were fitted to model the patients’ total count of seizures per month. The treatment effects on seizure incidence rate ratio was tested after controlling for the covariate effects of gender, age, rate of seizure per week at enrollment, type of seizure and number of AEDs combinations used at enrollment. Results: Fifty-nine patients (n=59) completed the study (59.6%).The average number of seizures per month were 9.7 ± 1.2 in the EPA group, 11.7 ± 1.5 in the DHA group, and 16.6 ± 1.5 in the placebo group. Age, gender and seizure type adjusted seizure incidence rate ratios (IRRs) of the EPA and DHA groups compared with the placebo were 0.61 (CI= 0.42-0.88, p=0.008, 42% reduction) and 0.67 (CI = 0.46-1.0, p= 0.04, 39% reduction), respectively. There was no difference in IRR between the EPA and DHA groups (p=0.56). Both treatment groups had a significantly higher number of seizure-free days compared to placebo (p<0.05). Significance: This study demonstrates that EPA and DHA are effective in reducing seizure frequency in patients with DRE

Effect of Glycine Betaine and Salicylic Acid on Growth and Productivity of Droughted Wheat Cultivars: Image Analysis for Measuring the Anatomical Features in Flag Leaf and Peduncle of the Main Shoot

The present study was planned to investigate the possible role displayed by water stress and application of GB, SA or their interaction on some anatomical features in flag leaf at anthesis (after 95 days from sowing) by measuring leaf thickness, ground tissue thickness, number of hairs, metaxylem vessel area, xylem vessel area, phloem tissue area, vascular bundle tissues area, number of motor cells as well as number of opened and closed stomata on both upper and lower epidermis and some anatomical features of peduncle (peduncle diameter, tracheids area, metaxylem vessel area, xylem area, phloem area, vascular area, number of vascular bundle as well as opened and closed stomata) of the two wheat cultivars. Water stress markedly affected the anatomical features in flag leaves of both wheat cultivars. It caused massive decreases (P< 0.05) in the leaf thickness, ground tissue thickness, number of hairs, metaxylem vessel area, xylem vessel area, phloem tissue area, vascular bundle area, number of motor cells as well as number of opened stomata on both upper and lower epidermis. On the other hand, water stress increased (P< 0.05) the number of hairs and closed stomata on both upper and lower epidermis in flag leaves of the two wheat cultivars. The magnitude of decrease in all anatomical features in flag leaf was more pronounced with the sensitive cultivar. Furthermore, water stress led to a marked decrease (P< 0.05) in peduncle diameter, tracheids area, metaxylem vessel area, xylem tissue area, phloem tissue area, vascular tissue area, number of vascular bundles as well as opened stomata but increased the number of hairs and closed stomata on the peduncle surface of the two wheat cultivars. In relation to wheat cultivar, the sensitive was more affected by water stress than the resistant one. The application of GB, SA or their interaction induced some modifications in the anatomical features of the flag leaf and peduncle of main shoot which appeared to be an adaptive response to drought stress

Volumetric Analysis of Allogenic and Xenogenic Bone Substitutes Used in Maxillary Sinus Augmentations Utilizing Cone Beam CT: A Prospective Randomized Pilot Study

PURPOSE The purpose of this prospective randomized clinical pilot study was to compare the three-dimensional changes of grafted maxillary sinuses when deproteinized bovine bone (DBB) or cortical mineralized allogeneic bone (MAB) was used. MATERIALS AND METHODS Seventeen patients were randomly assigned to receive either DBB or MAB for lateral-approach maxillary sinus augmentation. Cone beam computed tomography (CBCT) scans were performed preoperatively (T0), immediately after (T1), and at approximately 6 months posthoperatively (T2). Three-dimensional analysis of the radiographic volumetric changes was performed for DBB and MAB by measuring the difference in unoccupied sinus volumes at T1 and T2. RESULTS In the DBB group, a statistically significant increase in unoccupied sinus volume was found at T2 when compared to T1 (P = .001). It represents a mean resorption rate of 23.8% ± 15.9%. Similarly in the MAB group, a statistically significant increase in unoccupied sinus volume was found at T2 when compared to T1 (P = .007). The mean resorption rate in the MAB group was 19.5% ± 10.1%. There was no statistically significant difference between the contraction of DBB (23.8%) and MAB (19.5%) (P = .52). CONCLUSION Both DBB and MAB showed sufficient volume stability at T2 (mean 6.3 ± 1.6 months) postoperatively for 10- to 13-mm-implant placement without the need for additional grafting

The differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on seizure frequency in patients with drug-resistant epilepsy ? A randomized, double-blind, placebo-controlled trial

Objectives: The omega-3 (n ? 3) fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known to play an important role in maintenance and modulation of neuronal functions. There is evidence that omega-3 fatty acids may have anticonvulsant effects. The effect of DHA and EPA on seizure rate in patients with drug-resistant epilepsy (DRE) was investigated. Methods: A double-blind, randomized, placebo-controlled clinical trial included ninety-nine (n = 99) subjects with DRE, aged 5?16 years (n = 85) and 17?45 years (n = 14). After randomization, subjects were given two, four, or six capsules per day of DHA (417.8 mg DHA and 50.8 mg EPA/capsule, n = 33), EPA (385.6 mg EPA and 81.2 mg DHA/capsule, n = 33), or placebo (high oleic acid sunflower oil, n = 33) for one year. The primary endpoint was the effect of treatment on rate of seizure. Random-effects negative binomial regression models were fitted to model the patients? total count of seizures per month. The treatment effects on seizure incidence rate ratio (IRR) were tested after controlling for the covariate effects of gender, age, rate of seizure per week at enrollment, type of seizure, and number of antiepileptic drug (AED) combinations used at enrollment. Results: Fifty-nine subjects (n = 59) completed the study (59.6%). The average number of seizures per month were 9.7 ? 1.2 in the EPA group, 11.7 ? 1.5 in the DHA group, and 16.6 ? 1.5 in the placebo group. Age, gender, and seizure-type adjusted seizure IRRs of the EPA and DHA groups compared with the placebo group were 0.61 (CI = 0.42?0.88, p = 0.008, 42% reduction) and 0.67 (CI = 0.46?1.0, p = 0.04, 39% reduction), respectively. There was no difference in IRR between the EPA and DHA groups (p = 0.56). Both treatment groups had a significantly higher number of seizure-free days compared with the placebo group (p < 0.05). Significance: This study demonstrates that EPA and DHA are effective in reducing seizure frequency in patients with DRE

Preoperative predictive parameters for accurate detection of stage IV endometriosis

Abstract Background Surgery is the main line of treatment of endometriosis. Patients with stage IV endometriosis have more extensive adhesions, which make the surgery difficult. There are no accurate non-invasive predictive preoperative parameters of stage IV endometriosis and no consensus has been reached. Therefore, the aim of the present study was to evaluate and detect preoperative non-invasive parameters for the detection of stage IV endometriosis. Patients and methods In the present study, we included 150 females admitted for surgical removal of endometriosis. We scored and classified endometriosis into four stages according to the revised ASRM classification. We compared between baseline characteristics of patients with different stages of endometriosis, and then we selected the best combination of diagnostic and predictive parameters of stage IV endometriosis. Results Predictors of stage IV endometriosis and indicators for safety surgery were as follows: VAS ≥ 4 (p < 0.001), fixed uterus (p = 0.005), fixed ovarian cysts (p < 0.001), tender uterosacral ligament nodule (p < 0.001), tender rectovaginal septum nodule (p = 0.003), bilateral endometriosis (p < 0.001), and sum of sizes of endometriotic nodules (p < 0.001). Conclusion Fixed uterus, fixed ovarian cysts, tender uterosacral ligament nodule, tender rectovaginal septum nodule, bilateral endometriosis, and indications for surgery were significantly considered adequate predictive markers for stage IV endometriosis

Sex Differences in In-Hospital Outcomes of Transcatheter Mitral Valve Repair (from a National Database)

There is paucity of data on sex differences in outcomes of transcatheter mitral valve repair (TMVR). We queried the National Inpatient Sample database (2012-2016) to identify hospitalizations for TMVR. We conducted a propensity matching analysis to compare hospitalizations for TMVR in men versus women. Our analysis yielded 10,014 hospitalizations for TMVR. TMVR was increasingly performed in both sexes at similar rate. Compared with men, women undergoing TMVR had fewer major comorbidities. After matching, there was no difference in in-hospital mortality between men and women (3.0% vs 2.4%, p = 0.33). Also, there was no difference between men and women in cardiac arrest (2.1% vs 1.3%, p = 0.17), cardiogenic shock (3.9% vs 3.5%, p = 0.66), mechanical support devices (2.4% vs 2.9%, p = 0.45), acute kidney injury (17.8% vs 14.7%, p = 0.08), hemodialysis (1.7% vs 1.6%, p = 0.81), respiratory complications (1.7% vs 1.4%, p = 0.65), acute stroke (1.4% vs 1.3%, p = 0.82), discharges to nursing facilities (12.3% vs 15.2%, p = 0.09), tamponade (0.5% vs 0.4%, p = 0.69), acute myocardial infarction (2.1% vs 2.4%, p = 0.71), and mean length of stay (6.03 ± 8.153 vs 6.08 ± 8.858 days, p = 0.82). TMVR in men was associated with higher incidence of ventricular arrhythmias (7.2% vs 4.1%, p = 0.01) and lower incidence of pacemaker implantations (0.4% vs 1.7%, p = 0.01). In conclusion, this observational study showed that TMVR is increasingly performed in both sexes at similar rate. Despite that women had less comorbidities, there was no difference in in-hospital mortality and major complications for TMVR among women compared with men. Future studies comparing the differences between both sexes in long-term outcomes are encouraged

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN