Alteration of the threshold stimulus for intraoperative brain mapping via use of antiepileptic medications

Intraoperative seizures during awake craniotomy with cortical and subcortical mapping are a common occurrence. Patients are routinely treated preoperatively with anti-convulsive medications to reduce seizure occurrence. Historically these drugs have not been believed to significantly affect awake craniotomy procedures. We report a patient undergoing intraoperative mapping with differential response and seizure occurrence based upon antiepileptic drug usage. A 43 year old female presented with history of seizures, right sided hemiparesis, electrical sensations, and difficulty with language function. She was determined to have a mass lesion involving the left frontal and temporal lobes and subsequently elected to undergo resection by awake craniotomy with intraoperative mapping. A first attempt at lesion resection was performed after a missed dose of anti-convulsant medication (levetiracetam) and was subsequently aborted because of repeated seizure activity. The threshold for seizure generation (1.75 mA) was observed to be significantly lower than expected. Therapy was begun with both levetiracetam and phenytoin prior to a second attempted resection one week later. Thresholds for cortical motor response in the second operation were significantly higher than expected (> 9.0 mA), and no intraoperative seizure activity was observed. To our knowledge this is the first quantitative example of antiepileptic drugs affecting the current required for intraoperative mapping. This case highlights the potential for higher current requirements in patients preoperatively treated with high doses of antiepileptic drugs, as well as the importance of confirming adequate dosage of antiepileptic drugs in patients at an increased risk of seizure generation

The carbonate-evaporite lagoon of Al Dakhirah (Qatar): an example of a modern depositional model controlled by longshore transport

The southern coast of the Arabian Gulf is considered a good example of an arid carbonate depositional system. The objective of this field investigation is to better elucidate the dynamic controls on the character and pattern of the depositional belts in a carbonate-evaporite lagoonal setting. The interpretation of this lagoon is based on combined field examination and laboratory analyses of surface samples, and this has resulted in an updated depositional model for carbonate-evaporite lagoonal settings. This study highlights the effects of sediment transport by longshore currents, with the formation of sand spits that gradually closed the lagoon during their southwards migration. The associated narrow and elongated back-barrier settings consist of tidal-dominated muddy sediments affected by a network of tidal channels. This wave-dominated high-energy system has generated several carbonate barrier and back-barrier units that migrated southwards and seawards during the last few thousands of years. This updated depositional model significantly differs from shoreline-parallel facies tracts of the classical Trucial Coast model, where the dominant wind is orientated perpendicular to the coastline. Conversely to the sediment belts of the Trucial Coast, the Al Dakhirah lagoon displays a strongly asymmetrical pattern of the sediment belts, marked by a southwards and seawards migratio

Comparative study of preterm infants fed new and existing human milk fortifiers showed favourable markers of gastrointestinal status

AIM: This study examined the influence of different human milk fortifiers on biomarkers of gastrointestinal immaturity and inflammation in preterm infants. METHODS: We report secondary outcomes from a controlled, double-blind, randomised, parallel group study conducted from 2011 to 2014 in neonatal intensive care units at 11 metropolitan hospitals in France, Belgium, Germany, Switzerland and Italy. Preterm infants born at up to 32 weeks or weighing up to 1500 g were randomised to a new powdered human milk fortifier (n = 77) or a control fortifier (n = 76) for a minimum of 21 days. We analysed faecal markers of gut inflammation, namely alpha-1 antitrypsin and calprotectin, and maturity, namely elastase-1. RESULTS: Faecal alpha-1 antitrypsin was slightly lower in the new than control fortifier group after 21 days of full enteral feeding, with a geometric mean and standard deviation of 1.52 +/- 1.32 vs 1.82 +/- 1.44 mg/g stools (P = .01). There was no significant difference in faecal calprotectin (median [Q1-Q3] of 296 [136-565] mug/g stools in both groups combined at study day 21). Faecal elastase-1 was lower in the new fortifier than control fortifier group (202.5 +/- 1.6 vs 257.7 +/- 1.5 mug/g stools, P = .016). CONCLUSION: Mean values for each parameter were within the ranges in healthy term infants, indicating favourable markers of gastrointestinal status in both groups. In addition, for faecal calprotectin, the relatively high concentration observed in preterm infants fed fortified human milk suggests that the threshold level for detecting necrotising enterocolitis should be revised

Analysis of dietary patterns and nutritional adequacy in lactating women: A multicentre European cohort (ATLAS study)

Eating habits of lactating women can influence the nutrient composition of human milk, which in turn influences nutrient intake of breastfed infants. The aim of the present study was to identify food patterns and nutritional adequacy among lactating women in Europe. Data from a multicentre European longitudinal cohort (ATLAS study) were analysed to identify dietary patterns using cluster analysis. Dietary information from 180 lactating women was obtained using 3-d food diaries over the first 4 months of lactation. Four dietary patterns were identified: 'vege-oils', 'fish-poultry', 'confectionery-salads' and 'mixed dishes'. Nutrition adequacy was not significantly different between clusters, but the 'vege-oils' cluster tended to yield the highest nutrition adequacy measured by Mean Adequacy Ratio. Compared with European dietary reference values (DRVs) for lactating women, women in all clusters had inadequate intakes of energy, pantothenic acid, folate, vitamin C, vitamin A, vitamin D, zinc, iodine, potassium and linoleic acid. Adequate intake for fibre and \u3b1-linolenic acid was only achieved in the 'vege-oils' cluster. Overall, fat intake was above DRVs. The present study showed that various dietary patterns do not adequately supply all nutrients, indicating a need to promote overall healthy dietary habits for European lactating women