Use of phenobarbitone for treating childhood epilepsy in resource-poor countries

Should the continued use of phenobarbitone for childhood epilepsy in resource-poor countries be considered a form of discrimination? Phenobarbitone was recommended by the World Health Organization (WHO) as the first-line agent for the control of seizures,1 but this has been contested on the grounds that it is biased against resource-poor countries.2 It was first used as an anticonvulsant in 1912, but now has little role to play in First-World countries where the newer generation agents are readily accessible. Phenobarbitone monotherapy has equivalent efficacy to the newer anticonvulsants (phenytoin, sodium valproate and carbamazepine) in children with partial-onset and generalised tonic-clonic seizures.3 Phenobarbitone is cheap, readily available, and easy to use and store. However, it has definite cognitive and behavioural side-effects in many children. It can exacerbate seizures in about 35% of children, and extreme caution should be taken with children who have a pre-morbid state of behavioural problems or attention deficit hyperactivity disorder (ADHD)

Child with tuberculous meningitis and COVID-19 coinfection complicated by extensive cerebral sinus venous thrombosis

CITATION: Essajee Farida et al. 2020. Child with tuberculous meningitis and COVID-19 coinfection complicated by extensive cerebral sinus venous thrombosis. BMJ Case Reports, 2020:13, doi:10.1136/bcr-2020-238597.The original publication is available at: https://casereports.bmj.comWe herein report a case of a child with tuberculous meningitis and COVID-19 coinfection complicated by hydrocephalus, arterial ischaemic stroke and extensive cerebral sinus venous thrombosis. Both conditions induce a proinflammatory cytokine drive resulting, among others, in a prothrombotic state. The disruption of the coagulation system in this case was supported by elevated D-dimers, fibrinogen and ferritin levels, consistent with thrombotic complications reported in some adult patients infected with COVID-19. The child also exhibited prolonged viral shedding that suggests severe disease.Publisher's versio

Withdrawal of parenteral phenobarbitone - implications for resource-poor countries

Parenteral phenobarbitone is an integral part of the management of status epilepticus, especially in the context of resource-poor countries. It is highly effective at controlling seizures. It is safe, cheap, can be given by rapid intravenous push or intramuscular route, boluses can be repeated, and it is recommended as part of the Advanced Paediatric Life Support guidelines. The proposed alternatives lack efficacy, practicality and/or place the child in status epilepticus at risk of respiratory compromise. The impact of the loss of parenteral phenobarbitone would be increased cardiac complications, lack of early seizure control, prolonged seizures resulting in brain damage and systemic complications. Increased numbers of patients will require artificial ventilation in centres without facilities, and centres with facilities will be unable to cope with the load of ventilated patients because of lack of safe transport systems and bed space

The characteristics of juvenile myasthenia gravis among South Africans

Objectives. To report the characteristics of juvenile-onset

Management of intracranial tuberculous mass lesions : how long should we treat for? [version 3; peer review: 3 approved]

CITATION: Marais, S., et al. 2019. Management of intracranial tuberculous mass lesions : how long should we treat for? [version 3; peer review: 3 approved]. Wellcome Open Research, 4:158, doi:10.12688/wellcomeopenres.15501.3.The original publication is available at https://wellcomeopenresearch.orgTuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis (M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.https://wellcomeopenresearch.org/articles/4-158Publisher's versio

Standardized Methods for Enhanced Quality and Comparability of Tuberculous Meningitis Studies

Tuberculous meningitis (TBM) remains a major cause of death and disability in tuberculosis-endemic areas, especially in young children and immunocompromised adults. Research aimed at improving outcomes is hampered by poor standardization, which limits study comparison and the generalizability of results. We propose standardized methods for the conduct of TBM clinical research that were drafted at an international tuberculous meningitis research meeting organized by the Oxford University Clinical Research Unit in Vietnam. We propose a core dataset including demographic and clinical information to be collected at study enrollment, important aspects related to patient management and monitoring, and standardized reporting of patient outcomes. The criteria proposed for the conduct of observational and intervention TBM studies should improve the quality of future research outputs, can facilitate multicenter studies and meta-analyses of pooled data, and could provide the foundation for a global TBM data repository

iSchools and archival studies

Whispers and rumors about the iSchool movement lead some to fear that this represents yet another shift away from the valued traditions of library schools, threatening something far different than what library science pioneers ever envisioned. Predating the iSchool movement, however, were other programmatic shifts such as those that led to the formalization of graduate archival education. This essay argues that such evolution is essential to our future, as iSchools tackle the increasingly complex issues confronting a digital society. We consider the mission and history of iSchools and of archival studies, the basic elements and concepts of archival studies that are critical to iSchools, and the relationship between iSchools and the changing nature of personal and institutional archives. © 2009 Springer Science+Business Media B.V