The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: a case-control study

The present study aimed to assess the impact of the ketogenic diet on arterial morphology and endothelial function of the big vessels of the neck and on cardiac diastolic function, in a cohort of epileptic children and young adults treated with the ketogenic diet

Nasotracheal Prolonged Safe Extubation Reduces the Need of Tracheotomy in Patients with Acute Respiratory Failure following Thyroidectomy

Objectives: Acute respiratory failure (ARF) is a complication following thyroid surgery; its incidence is reported as high as 0.9%. Through an illustrative case series, we present an alternative treatment of this peculiar ARF: the nasotracheal Prolonged Safe Extubation (PSE). Methods: Patients treated at our Intensive Care Unit for ARF following thyroid surgery from January 2004 to December 2009, were reviewed. Demographic data including gender, age, clinical presentation, laryngoscopic findings, management and outcome during a 24-months follow-up after treatment were collected and evaluated. The strategy for prolonged nasotracheal safe extubation is presented. Results: Twelve out of the 1713 patients scheduled for thyroid surgery (0.7%) at our university hospital, developed post-operative ARF. All of them were treated by nasotracheal prolonged safe extubation. The success rate in avoiding highly invasive treatment was of 83.3%, since only 2 patients needed tracheotomy (16.7%). Conclusions: The prolonged safe extubation reduced the amount of expected tracheotomies in patients with ARF following thyroid surgery. Thanks to its minimal invasiveness, and to the high degree of comfort, it was well tolerate

Predictive factors of Status Epilepticus and its recurrence in patients with adult-onset seizures: A multicenter, long follow-up cohort study

Purpose: Status epilepticus (SE) is associated with high morbidity and mortality. This multicenter retrospective cohort study aims to identify the factors associated with the occurrence of SE and the predictors of its recurrence in patients with adult-onset seizures. Methods: We retrospectively analyzed data of 1115 patients with seizure onset>18 years, observed from 1983 to 2020 in 7 Italian Centers (median follow-up 2.1 years). Data were collected from the databases of the Centers. Patients with SE were consecutively recruited, and patients without SE history were randomly selected in a 2:1 ratio. To assess determinants of SE, different clinical-demographic variables were evaluated and included in univariate and multivariate logistic regression model. Results: Three hundred forty-seven patients had a SE history, whereas the remaining 768 patients had either isolated seizures or epilepsy without SE history. The occurrence of SE was independently associated with increasing age at onset of disease (OR 1.02, 95% CI 1.01--1.03, p<0.001), female sex (OR 1.39, 95% CI 1.05--1.83, p=0.02) and known etiology (OR 3.58, 95% CI 2.61--4.93, p<0.001). SE recurred in 21% of patients with adult-onset SE and recurrence was associated with increasing number of anti-seizure medications taken at last follow-up (OR 1.88, 95% CI 1.31--2.71, p<0.001). Conclusions: In patients with adult-onset seizures, SE occurrence is associated with known etiologies, advanced age , female sex. Patients with recurrent SE are likely to have a refractory epilepsy, deserving careful treat-ment to prevent potentially fatal events