An Atypical Seizure Onset and Re-Emergence in a Refugee with an Undiagnosed Sturge-Weber Syndrome: A Case Report from a Limited Setting

Awab H Saad,1,* Saeed Mohammed Omar,2,* Abeir Abbas Elgilli,2,* Ibtehal Abdalwahid Abdalmjeed Omer,2,* Morouj Hussein Jalaleldeen2,* 1Department of Internal Medicine, University of Medical Sciences and Technology, Khartoum, Khartoum State, Sudan; 2Department of Internal Medicine, University of Gadarif, Gadarif, Gadarif State, Sudan*These authors contributed equally to this workCorrespondence: Awab H Saad, Tel +249961162550 ; +966535911050, Email [email protected]: Sturge-Weber syndrome (SWS) is a complex rare genetic neuro-cutaneous disorder characterized by the presence of a port-wine stain, ophthalmic and intracranial angiomatosis leading to seizures, ocular, and oral abnormalities.Case Presentation: We report a 39-year-old, non-diabetic, non-hypertensive female refugee who presented initially with heart failure due to anemia for which she received blood transfusions. Later on admission, she developed multiple focal to bilateral seizures, severe irritability, aphasia, and right-sided hemiplegia, leading to admission to the ICU. A repeat medical history and examination revealed a faint left-sided ophthalmic port-wine stain that was initially unnoticed and a remote history of unprovoked seizures 20 years ago. Imaging revealed parietal calcifications and confirmed the diagnosis of SWS. Thus, a multidisciplinary approach was taken to fully understand the patient’s diagnosis and determine a treatment strategy, involving consultations with the neurology, ophthalmology, otolaryngology, and physiotherapy departments. Successful seizure control was achieved by administering IV phenytoin for 3 days and the up-titrating of oral carbamazepine to 1g daily through a nasogastric tube. Unfortunately, due to the unavailability of personnel or resources, other important assessments for patients with SWS, such as advanced neuroimaging, psychiatric, plastic and neuro-surgery evaluations, as well as dentistry reviews, could not be conducted.Conclusion: This case highlights the rare occurrence of adult-onset seizures in an undiagnosed SWS and their re-emergence after almost two decades without anti-seizure medications. It also highlights the importance of a comprehensive history and clinical examination, as this patient’s diagnosis of SWS could have been missed if she had not experienced seizures on admission. Our study also demonstrates the challenges associated with managing such a complex condition in settings with limited resources.Keywords: genetic, angioma, seizure, glaucoma, port-wine stai

Carbamazepine and the QTc interval: any association?

Abstract Objective: To determine whether carbamazepine monotherapy in epilepsy patients is or is not associated with prolongation of the QTc interval. Methods: This case-control study enrolled 100 consecutive patients with generalized tonic-clonic seizures. Fifty patients were already taking carbamazepine for a variable time, and the rest (n=50) were not on any antiepileptic drug. The QTc interval was calculated after doing a resting 12-lead ECG examination on a single occasion. Results: Of the 50 patients who had received carbamazepine, 11 patients displayed prolongation of their QTc interval, while 8 patients out of the 50 in the control group had QTc interval prolongation after correction for gender; p value =0.49, OR 1.36, 95% CI 0.54-3.29. Conclusion: This study demonstrated no statistically signifi cant association between carbamazepine monotherapy and prolongation of the QTc interval. Carbamazepine does not seem to prolong the QT interval when used as monotherapy for epilepsy. The presence of prolonged QTc interval in such patients should prompt a search for co-factors that prolong this interval, such as multiple medications, electrolytes disturbances, structural heart disease, and congenital long QT interval syndromes

The molecular characterisation of Escherichia coli K1 isolated from neonatal nasogastric feeding tubes

Background: The most common cause of Gram-negative bacterial neonatal meningitis is E. coli K1. It has a mortality rate of 10–15%, and neurological sequelae in 30– 50% of cases. Infections can be attributable to nosocomial sources, however the pre-colonisation of enteral feeding tubes has not been considered as a specific risk factor. Methods: Thirty E. coli strains, which had been isolated in an earlier study, from the residual lumen liquid and biofilms of neonatal nasogastric feeding tubes were genotyped using pulsed-field gel electrophoresis, and 7-loci multilocus sequence typing. Potential pathogenicity and biofilm associated traits were determined using specific PCR probes, genome analysis, and in vitro tissue culture assays. Results: The E. coli strains clustered into five pulsotypes, which were genotyped as sequence types (ST) 95, 73, 127, 394 and 2076 (Achman scheme). The extra-intestinal pathogenic E. coli (ExPEC) phylogenetic group B2 ST95 serotype O1:K1:NM strains had been isolated over a 2 week period from 11 neonates who were on different feeding regimes. The E. coli K1 ST95 strains encoded for various virulence traits associated with neonatal meningitis and extracellular matrix formation. These strains attached and invaded intestinal, and both human and rat brain cell lines, and persisted for 48 h in U937 macrophages. E. coli STs 73, 394 and 2076 also persisted in macrophages and invaded Caco-2 and human brain cells, but only ST394 invaded rat brain cells. E. coli ST127 was notable as it did not invade any cell lines. Conclusions: Routes by which E. coli K1 can be disseminated within a neonatal intensive care unit are uncertain, however the colonisation of neonatal enteral feeding tubes may be one reservoir source which could constitute a serious health risk to neonates following ingestion

Powering up microgrids: a comprehensive review of innovative and intelligent protection approaches for enhanced reliability

Microgrid protection schemes play a vital role in ensuring the reliability and efficiency of power distribution in urban and rural areas, especially as renewable distributed energy resources are increasingly integrated. This paper aims to provide a comprehensive analysis of existing microgrid protection schemes, discussing their advantages and limitations and highlighting key challenges and opportunities for future research. As microgrid systems become increasingly common, the management of power flow in small-community networks equipped with intelligent electronic devices, non-linear loads, and multiple distributed generation sources becomes more complicated. In order to address these challenges, coordination of protective schemes is required to prevent overload and damage to equipment. Firstly, the study discusses microgrid definitions and functional categories, highlighting their benefits and drawbacks. An analysis of microgrid protection literature includes adaptive protection systems as intelligent methods to address coordination challenges. Secondly, this review classifies microgrid protection techniques as modified, new knowledge-based and conventional schemes and provides a systematic analysis of optimization approaches. The study also examines the essential problems associated with the coordination of protective relays within microgrids. Finally, examining the current state of microgrid protection to identify the key research directions and opportunities for future development in this rapidly advancing field. The findings of this comprehensive analysis highlight the importance of effective microgrid protection in ensuring a stable and sustainable energy future

Application of the Jacobi Davidson method for spectral low-rank preconditioning in computational electromagnetics problems

[EN] We consider the numerical solution of linear systems arising from computational electromagnetics applications. For large scale problems the solution is usually obtained iteratively with a Krylov subspace method. It is well known that for ill conditioned problems the convergence of these methods can be very slow or even it may be impossible to obtain a satisfactory solution. To improve the convergence a preconditioner can be used, but in some cases additional strategies are needed. In this work we study the application of spectral lowrank updates (SLRU) to a previously computed sparse approximate inverse preconditioner.The updates are based on the computation of a small subset of the eigenpairs closest to the origin. Thus, the performance of the SLRU technique depends on the method available to compute the eigenpairs of interest. The SLRU method was first used using the IRA s method implemented in ARPACK. In this work we investigate the use of a Jacobi Davidson method, in particular its JDQR variant. The results of the numerical experiments show that the application of the JDQR method to obtain the spectral low-rank updates can be quite competitive compared with the IRA s method.Mas Marí, J.; Cerdán Soriano, JM.; Malla Martínez, N.; Marín Mateos-Aparicio, J. (2015). Application of the Jacobi Davidson method for spectral low-rank preconditioning in computational electromagnetics problems. Journal of the Spanish Society of Applied Mathematics. 67:39-50. doi:10.1007/s40324-014-0025-6S395067Bergamaschi, L., Pini, G., Sartoretto, F.: Computational experience with sequential, and parallel, preconditioned Jacobi–Davidson for large sparse symmetric matrices. J. Comput. Phys. 188(1), 318–331 (2003)Carpentieri, B.: Sparse preconditioners for dense linear systems from electromagnetics applications. PhD thesis, Institut National Polytechnique de Toulouse, CERFACS (2002)Carpentieri, B., Duff, I.S., Giraud, L.: Sparse pattern selection strategies for robust Frobenius-norm minimization preconditioners in electromagnetism. Numer. Linear Algebr. Appl. 7(7–8), 667–685 (2000)Carpentieri, B., Duff, I.S., Giraud, L.: A class of spectral two-level preconditioners. SIAM J. Sci. Comput. 25(2), 749–765 (2003)Carpentieri, B., Duff, I.S., Giraud, L., Magolu monga Made, M.: Sparse symmetric preconditioners for dense linear systems in electromagnetism. Numer. Linear Algebr. Appl. 11(8–9), 753–771 (2004)Carpentieri, B., Duff, I.S., Giraud, L., Sylvand, G.: Combining fast multipole techniques and an approximate inverse preconditioner for large electromagnetism calculations. SIAM J. Sci. Comput. 27(3), 774–792 (2005)Darve, E.: The fast multipole method I: error analysis and asymptotic complexity. SIAM J. Numer. Anal. 38(1), 98–128 (2000)Fokkema, D.R., Sleijpen, G.L., Van der Vorst, H.A.: Jacobi–Davidson style QR and QZ algorithms for the reduction of matrix pencils. SIAM J. Sci. Comput. 20(1), 94–125 (1998)Greengard, L., Rokhlin, V.: A fast algorithm for particle simulations. J. Comput. Phys. 73(3), 325–348 (1987)Grote, M., Huckle, T.: Parallel preconditioning with sparse approximate inverses. SIAM J. Sci. Comput. 18(3), 838–853 (1997)Harrington, R.: Origin and development of the method of moments for field computation. IEEE Antenna Propag. Mag. (1990)Kunz, K.S., Luebbers, R.J.: The finite difference time domain method for electromagnetics. SIAM J. Sci. Comput. 18(3), 838–853 (1997)Maxwell, J.C.: A dynamical theory of the electromagnetic field. Roy. S. Trans. CLV, (1864). Reprinted in Tricker, R. A. R. The Contributions of Faraday and Maxwell to Electrial Science, Pergamon Press (1966)Marín, J., Malla M.: Some experiments preconditioning via spectral low rank updates for electromagnetism applications. In: Proceedings of the international conference on preconditioning techniques for large sparse matrix problems in scientific and industrial applications (Preconditioning 2007), Toulouse (2007)Meijerink, J.A., van der Vorst, H.A.: An iterative solution method for linear systems of which the coefficient matrix is a symmetric M-matrix. Math. Comput. 31, 148–162 (1977)Sorensen, D.C., Lehoucq, R.B., Yang, C.: ARPACK users’ guide: solution of large-scale eigenvalue problems with implicitly restarted Arnoldi methods. SIAM, Philadelphia (1998)Rao, S.M., Wilton, D.R., Glisson, A.W.: Electromagnetic scattering by surfaces of arbitrary shape. IEEE Trans. Antenna Propag. 30, 409–418 (1982)Saad, Y.: Iterative methods for sparse linear systems. PWS Publishing Company, Boston (1996)Silvester, P.P., Ferrari, R.L.: Finite elements for electrical engineers. Cambridge University Press, Cambridge (1990)Sleijpen, S.L., van der Vorst, H.A.: A Jacobi–Davidson iteration method for linear eigenvalue problems. SIAM J. Matrix Anal. Appl. 17, 401–425 (1996)van der Vorst, H.A.: Bi-CGSTAB: a fast and smoothly converging variant of Bi-CG for the solution of non-symmetric linear systems. SIAM J. Sci. Stat. Comput. 12(6), 631–644 (1992

Dirac Equation with Spin Symmetry for the Modified P\"oschl-Teller Potential in DD-dimensions

We present solutions of the Dirac equation with spin symmetry for vector and scalar modified P\"oschl-Teller potential within framework of an approximation of the centrifugal term. The relativistic energy spectrum is obtained using the Nikiforov-Uvarov method and the two-component spinor wavefunctions are obtain are in terms of the Jacobi polynomials. It is found that there exist only positive-energy states for bound states under spin symmetry, and the energy levels increase with the dimension and the potential range parameter $\alpha$.Comment: 9 pages and 1tabl

Rare coding SNP in DZIP1 gene associated with late-onset sporadic Parkinson's disease

We present the first application of the hypothesis-rich mathematical theory to genome-wide association data. The Hamza et al. late-onset sporadic Parkinson's disease genome-wide association study dataset was analyzed. We found a rare, coding, non-synonymous SNP variant in the gene DZIP1 that confers increased susceptibility to Parkinson's disease. The association of DZIP1 with Parkinson's disease is consistent with a Parkinson's disease stem-cell ageing theory.Comment: 14 page

The non-coding landscape of head and neck squamous cell carcinoma

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Prevalence of Chlamydia trachomatis infection among women in a Middle Eastern community

BACKGROUND: Common vaginal infections that manifest in women are usually easily diagnosed. However, Chlamydia infection is often asymptomatic, leading to infertility before it is detected. If it occurs in pregnancy, it could lead to significant neonatal morbidity. It may also play a role with other viral infections for e.g. Human Papilloma Virus in the development of cervical cancer. The objective of this study was to determine the prevalence of Chlamydia infection in women undergoing screening for cervical abnormalities as a part of a research project in primary and secondary care institutions in the United Arab Emirates. METHODS: In this cross sectional study married women attending primary and secondary care participating in a large nationwide cervical abnormalities screening survey were offered Chlamydia testing using a commercially available test kit. This kit uses a rapid immunoassay for the direct detection of Chlamydia trachomatis antigen in endocervical swab specimens. As this study was performed in a traditional Islamic country, unmarried women were excluded from testing, as the management of any positive cases would create legal and social problems. All married women consenting to take part in the study were included irrespective of age. RESULTS: Of 1039 women approached over a period of eight months 919 (88.5%) agreed to participate. The number of women in the 16 to 19 years was small (0.01%) and 30% were aged over 40 years. The prevalence of Chlamydia infection in this study was 2.6% (95% confidence interval 1.2–3.3%), which was marginally higher in women screened in secondary care (p = 0.05). CONCLUSION: This is one of the few reports on the prevalence of Chlamydia infection in women from the Middle East. Due to cultural and social constraints this study excluded a large proportion of women aged less than 19 years of age. Hence no direct comparisons on prevalence could be made with studies from the West, which all included younger women at high risk of Chlamydia. However this study emphasizes the importance of cultural factors while interpreting results of studies from different cultures and communities

Effect of 12 months of testosterone replacement therapy on metabolic syndrome components in hypogonadal men: data from the Testim Registry in the US (TRiUS)

<p>Abstract</p> <p>Background</p> <p>Recent evidence suggests that there may be a bidirectional, physiological link between hypogonadism and metabolic syndrome (MetS), and testosterone replacement therapy (TRT) has been shown to improve some symptoms of MetS in small patient populations. We examined the effect of 12 months of TRT on MetS components in a large cohort of hypogonadal men.</p> <p>Methods</p> <p>Data were obtained from TRiUS (Testim^®Registry in the United States), a 12-month, multicenter, prospective observational registry (N = 849) of hypogonadal men prescribed Testim 1% testosterone gel (5-10 g/day). Data analyzed included age, total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), and MetS components: waist circumference, blood pressure, fasting blood glucose, plasma triglycerides, and HDL cholesterol.</p> <p>Results</p> <p>Of evaluable patients (581/849) at baseline, 37% were MetS+ (n = 213) and 63% were MetS- (n = 368). MetS+ patients had significantly lower TT (p < 0.0001) and SHBG (p = 0.01) levels. Patients with the lowest quartile TT levels (<206 ng/dL [<7.1 nmol/L]) had a significantly increased risk of MetS+ classification vs those with highest quartile TT levels (≥331 ng/dL [≥11.5 nmol/L]) (odds ratio 2.66; 95% CI, 1.60 to 4.43). After 12 months of TRT, TT levels significantly increased in all patients (p < 0.005). Despite having similar TT levels after TRT, only MetS+ patients demonstrated significant decreases in waist circumference, fasting blood glucose levels, and blood pressure; lowest TT quartile patients demonstrated significant decreases in waist circumference and fasting blood glucose. Neither HDL cholesterol nor triglyceride levels changed significantly in either patient population.</p> <p>Conclusion</p> <p>Hypogonadal MetS+ patients were more likely than their MetS- counterparts to have lower baseline TT levels and present with more comorbid conditions. MetS+ patients and those in the lowest TT quartile showed improvement in some metabolic syndrome components after 12 months of TRT. While it is currently unclear if further cardiometabolic benefit can be seen with longer TRT use in this population, testing for low testosterone may be warranted in MetS+ men with hypogonadal symptoms.</p