A Rare Case of Adult Acute Disseminated Encephalomyelitis Associated with Primary Epstein-Barr Virus Infection

We report a rare case of acute disseminated encephalomyelitis (ADEM) secondary to a primary Epstein-Barr (EBV) infection, in a 22-year-old male. Symptomatic infectious mononucleosis and ADEM are both quite uncommon conditions in this age group

Natalizumab treatment shows low cumulative probabilities of confirmed disability worsening to EDSS milestones in the long-term setting.

Abstract Background Though the Expanded Disability Status Scale (EDSS) is commonly used to assess disability level in relapsing-remitting multiple sclerosis (RRMS), the criteria defining disability progression are used for patients with a wide range of baseline levels of disability in relatively short-term trials. As a result, not all EDSS changes carry the same weight in terms of future disability, and treatment benefits such as decreased risk of reaching particular disability milestones may not be reliably captured. The objectives of this analysis are to assess the probability of confirmed disability worsening to specific EDSS milestones (i.e., EDSS scores ≥3.0, ≥4.0, or ≥6.0) at 288 weeks in the Tysabri Observational Program (TOP) and to examine the impact of relapses occurring during natalizumab therapy in TOP patients who had received natalizumab for ≥24 months. Methods TOP is an ongoing, open-label, observational, prospective study of patients with RRMS in clinical practice. Enrolled patients were naive to natalizumab at treatment initiation or had received ≤3 doses at the time of enrollment. Intravenous natalizumab (300 mg) infusions were given every 4 weeks, and the EDSS was assessed at baseline and every 24 weeks during treatment. Results Of the 4161 patients enrolled in TOP with follow-up of at least 24 months, 3253 patients with available baseline EDSS scores had continued natalizumab treatment and 908 had discontinued (5.4% due to a reported lack of efficacy and 16.4% for other reasons) at the 24-month time point. Those who discontinued due to lack of efficacy had higher baseline EDSS scores (median 4.5 vs. 3.5), higher on-treatment relapse rates (0.82 vs. 0.23), and higher cumulative probabilities of EDSS worsening (16% vs. 9%) at 24 months than those completing therapy. Among 24-month completers, after approximately 5.5 years of natalizumab treatment, the cumulative probabilities of confirmed EDSS worsening by 1.0 and 2.0 points were 18.5% and 7.9%, respectively (24-week confirmation), and 13.5% and 5.3%, respectively (48-week confirmation). The risks of 24- and 48-week confirmed EDSS worsening were significantly higher in patients with on-treatment relapses than in those without relapses. An analysis of time to specific EDSS milestones showed that the probabilities of 48-week confirmed transition from EDSS scores of 0.0–2.0 to ≥3.0, 2.0–3.0 to ≥4.0, and 4.0–5.0 to ≥6.0 at week 288 in TOP were 11.1%, 11.8%, and 9.5%, respectively, with lower probabilities observed among patients without on-treatment relapses (8.1%, 8.4%, and 5.7%, respectively). Conclusions In TOP patients with a median (range) baseline EDSS score of 3.5 (0.0–9.5) who completed 24 months of natalizumab treatment, the rate of 48-week confirmed disability worsening events was below 15%; after approximately 5.5 years of natalizumab treatment, 86.5% and 94.7% of patients did not have EDSS score increases of ≥1.0 or ≥2.0 points, respectively. The presence of relapses was associated with higher rates of overall disability worsening. These results were confirmed by assessing transition to EDSS milestones. Lower rates of overall 48-week confirmed EDSS worsening and of transitioning from EDSS score 4.0–5.0 to ≥6.0 in the absence of relapses suggest that relapses remain a significant driver of disability worsening and that on-treatment relapses in natalizumab-treated patients are of prognostic importance

A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke

The value of administering intravenous alteplase before endovascular treatment (EVT) for acute ischemic stroke has not been studied extensively, particularly in non-Asian populations. METHODS We performed an open-label, multicenter, randomized trial in Europe involving patients with stroke who presented directly to a hospital that was capable of providing EVT and who were eligible for intravenous alteplase and EVT. Patients were randomly assigned in a 1:1 ratio to receive EVT alone or intravenous alteplase followed by EVT (the standard of care). The primary end point was functional outcome on the modified Rankin scale (range, 0 [no disability] to 6 [death]) at 90 days. We assessed the superiority of EVT alone over alteplase plus EVT, as well as noninferiority by a margin of 0.8 for the lower boundary of the 95% confidence interval for the odds ratio of the two trial groups. Death from any cause and symptomatic intracerebral hemorrhage were the main safety end points. RESULTS The analysis included 539 patients. The median score on the modified Rankin scale at 90 days was 3 (interquartile range, 2 to 5) with EVT alone and 2 (interquartile range, 2 to 5) with alteplase plus EVT. The adjusted common odds ratio was 0.84 (95% confidence interval [CI], 0.62 to 1.15; P=0.28), which showed neither superiority nor noninferiority of EVT alone. Mortality was 20.5% with EVT alone and 15.8% with alteplase plus EVT (adjusted odds ratio, 1.39; 95% CI, 0.84 to 2.30). Symptomatic intracerebral hemorrhage occurred in 5.9% and 5.3% of the patients in the respective groups (adjusted odds ratio, 1.30; 95% CI, 0.60 to 2.81). CONCLUSIONS In a randomized trial involving European patients, EVT alone was neither superior nor noninferior to intravenous alteplase followed by EVT with regard to disability outcome at 90 days after stroke. The incidence of symptomatic intracerebral hemorrhage was similar in the two groups

Urgent Carotid Endarterectomy in Patients with Acute Neurological Symptoms The Results of a Single Center Prospective Nonrandomized Study

peer reviewe

Les Biostimulants : Qu’en savons-nous ? Quelles alternatives pour l’agriculture Guyanaise ?

L’agriculture doit relever le défi de nourrir une population grandissante avec des aliments sains, tout en assurant la protection et la préservation des ressources environnementales telles que l’eau, les sols et la biodiversité animale et végétale. Pour faire face à ce défi, l’agriculteur doit s’approprier de nouvelles connaissances, méthodes et outils pour produire des aliments en quantité et en qualité, tout en réduisant les apports chimiques de fertilisants et de produits phytosanitaires néfastes pour les ressources naturelles et la santé humaine. Concevoir des systèmes de culture permettant la transition de l’agrochimie à l’agroécologie est la voie à développer pour réussir ce challenge. Les biostimulants, les biopesticides et les biofertilisants, issus de produits et de processus naturels, constituent une alternative très prometteuse pour les producteurs, qui doivent renouer avec des pratiques et techniques agroécologiques traditionnelles innovantes. Cependant la méconnaissance sur les constituants moléculaires et modes d’actions (principes actifs) de ces produits, engagent scientifiques et agriculteurs dans un partenariat renforcé pour répondre, de manière adéquate, à la demande croissante de moyens permettant de lutter efficacement contre les stress biotiques et/ou abiotiques rencontrés sur les exploitations agricoles. Notre objectif est de décrire brièvement l’état des connaissances sur les biostimulants et biofertilisants, en présentant leurs enjeux pour l’agriculture guyanaise, définition, intérêt agronomique, mode de préparation et d’application, les risques éco-toxicologiques ainsi que le cadre réglementaire où ils se positionnent. Des études de cas concrètes et l’évaluation de leurs propriétés offrent aux utilisateurs potentiels des bases et repères pour leur fabrication et leur utilisation en production végétale. L’analyse de leur pertinence agronomique et de leurs conditions d’appropriations par les agriculteurs en Guyane dans des systèmes agro-écologiques, de même que leur potentiel de développement, seront abordés dans la conclusion et les perspectives.Agriculture faces the challenge of producing healthy food to feed an increasingly growing population, while ensuring the protection and preservation of environmental resources such as water, soil and animal and plant biodiversity. To meet this challenge, the farmer must acquire new knowledge, methods and tools to produce food in quantity and quality while reducing the use of chemicals and fertilizers inputs and phytosanitary products that are very detrimental to natural resources and human health. Driving crop systems in an agro-ecological way is the way to develop this challenge. Biostimulants and biofertilizers, derived from natural products and processes, are a very promising alternative for producers, who may review traditional innovative agro-ecological practices and technicals. However, ignorance of the molecular components and mode of action (active principle) of those products, engage scientists and farmers in a reinforced partnership to respond adequately to the increasing demand for means to effectively combat biotic and / or abiotic stresses encountered on farms. Our objective in this article is to present an inventory of knowledge on biostimulants and biofertilizers, presenting their challenges for Guyanese agriculture, definition, function, method of preparation and application, ecotoxicological risks and regulatory framework in which they position themselves. Concrete case studies and evaluation of their properties offer potential users, basics and benchmarks for their manufacture and use in crop production. The analysis of their agronomic relevance and their conditions of appropriation by farmers in French Guiana in agro-ecological systems, as well as their potential for development will be addressed in the conclusion and prospects

Obstacles to the use of intravenous tissue plasminogen activator for acute ischemic stroke. Is time the only barrier?

BACKGROUND AND AIMS: The short time window is frequently cited as the main reason for exclusion of intravenous tissue plasminogen activator (tPA) in acute stroke. Identifying and circumventing barriers to thrombolysis other than time could increase the frequency of treatment. The goal of this study was to identify whether the rate of treatment with tPA would increase if time window was not an obstacle to treatment. METHODS: In four hospitals we prospectively recorded the rate of tPA use in consecutive patients admitted with acute ischemic stroke and in those admitted within 3 hours, the reasons why thrombolysis was not given, and the potential gain in the rate of tPA use if all patients had been admitted within 3 hours considering all exclusion criteria other than time. RESULTS: We recruited 486 patients (258 men; mean age, 70.4 +/- 13.5 years), of whom 154 (31.7%) were admitted within 3 hours. The time of stroke onset was unknown in 28 (5.8%). The rate of tPA use was 11.1% in the whole study population and 35.1% in those admitted within 3 hours. In 'eligible' patients, TIA in 33 patients (21.4%), age >80 years in 27 (17.5%), mild stroke in 27 (17.5%), rapidly recovering stroke in 9 (5.8%), a too long door-to-needle time in 8 (5.2%), and severe hypertension in 5 (3.2%) were the main reasons for not to treat. Two patients were not treated despite the absence of documented reasons. If all patients had hypothetically been admitted within 3 hours, the rate of tPA use would have increased from 11.1% up to 27.9% of the whole population and up to 37.4% if aged patients and those with no documented reasons or with a rapidly recovering stroke had also been considered for treatment. CONCLUSIONS: Delayed presentation to hospital is the main factor limiting the use of thrombolysis in acute stroke, but additional patients would be treated if those with no contraindication, advanced age or rapidly recovering stroke were considered as eligible

Proposal of guidelines for stroke units

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Insecticidal and antifungal chemicals produced by plants: a review

International audienceLeaf-cutting ants of the Attini tribe are a major pest of agricultural and forestry productions in the New World. Economic losses caused by these ants were estimated at several million dollars per year. These ants need to live in symbiosis with a basidiomycete fungus. Due to their mutualistic interaction with the symbiotic fungus, management of Attini ants can be done with insecticides or fungicides or both. So far, synthetic pesticides were the main control means, albeit with negative effects on the environment. Very few studies describe alternative methods for the control of leaf-cutting ants such as the use of insecticidal and fungicidal plant extracts. There is therefore a need of knowledge on phytochemicals and plants that could be used as insecticides and fungicides. Here, we review chemicals of plant origin and species with insecticidal and fungicidal activities. We establish a list of plants and phytochemicals that could manage leaf-cutting ants and also other insects, notably insects that use fungus-based agriculture. An exhaustive literature search of 1965 references from 1923 to 2010 was conducted using scientific databases, chemical databases, botanical databases, and books to identify published papers related to insecticidal and fungicidal chemical compounds stemmed from plant species. The major points are the following: (1) 119 and 284 chemicals have been cited in the literature for their insecticidal and fungicidal activities, respectively; (2) 656 and 1,064 plant species have significant insecticidal and fungicidal activities, respectively; (3) 3 main chemical classes were most cited for these activities: alkaloids, phenolics, and terpenoids; (4) 20 interesting chemicals with the both insecticidal and fungicidal activities were found; and (5) 305 plant species containing these chemicals were cited. To conclude, 20 chemicals: caryophyllene oxide, cinnamaldehyde, eugenol, helenalin, linalool, menthone, myristicin, pulegone, thymol, anethole, anisaldehyde, elemicin, isopimpinellin, plumbagin, podophyllotoxin, psoralen, xanthotoxin, anonaine, solamargine, and tomatine; two main plant families, Lamiaceae and Apiaceae; and 17 species of these families were particularly interesting for the management of leaf-cutting ants