A comparative study between ultrasound-guided thoracic paravertebral block, pectoral nerves block, and erector spinae block for pain management in cancer breast surgeries. A randomized controlled study

OBJECTIVES

Achieving adequate perioperative analgesia can be challenging in patients undergoing breast surgeries due to the complex nerve supply of the breast and axilla. The study aims to investigate the efficacy of ESPB in comparison to conventional regional anesthesia techniques (TPVB and PECS).

METHODS

Eighty female patients who were scheduled for elective MRM, with ASA score I-II, and aged between 18 and 60 years, were included in the study. Patients were randomized into four groups, the TPVB, PECS, ESPB, and the control group. All patients in either block groups received 25 ml bupivacaine 0.25% with ultrasound guidance. The control group received only opioids for perioperative pain management. The patients were observed for 48 h after surgery for the duration of analgesia (primary outcome).

RESULTS

ESPB has a shorter duration of analgesia than PECS block with no significant statistical difference compared with group TPVB. Morphine consumption is increased in ESPB compared to the PECS group, with an insignificant difference compared to group TPVB. There was an insignificant difference between the groups concerning hemodynamics and complications, with one pneumothorax case reported in the TPVB group.

CONCLUSION

PECS and ESPB represent a good alternative to TPVB for post-mastectomy analgesia with a superior analgesic effect of PECS block regarding opioid consumption, duration of the analgesia, and VAS score.

Inverse problem approach to regularized regression models with application to predicting recovery after stroke

Regression modelling is a powerful statistical tool often used in biomedical and clinical research. It could be formulated as an inverse problem that measures the discrepancy between the target outcome and the data produced by representation of the modelled predictors. This approach could simultaneously perform variable selection and coefficient estimation. We focus particularly on a linear regression issue, Y ∼ N ( X β , σ I n ) , where β ∈ R p is the parameter of interest and its components are the regression coefficients. The inverse problem finds an estimate for the parameter β , which is mapped by the linear operator ( L : β ⟶ X β ) to the observed outcome data Y = X β + ε . This problem could be conveyed by finding a solution in the affine subspaceL - 1 ( Y ) . However, in the presence of collinearity, high-dimensional data and high conditioning number of the related covariance matrix, the solution may not be unique, so the introduction of prior information to reduce the subsetL - 1 ( Y ) and regularize the inverse problem is needed. Informed by Huber's robust statistics framework, we propose an optimal regularizer to the regression problem. We compare results of the proposed method and other penalized regression regularization methods: ridge, lasso, adaptive-lasso and elastic-net under different strong hypothesis such as high conditioning number of the covariance matrix and high error amplitude, on both simulated and real data from the South London Stroke Register. The proposed approach can be extended to mixed regression models. Our inverse problem framework coupled with robust statistics methodology offer new insights in statistical regression and learning. It could open a new research development for model fitting and learning.

Determination of Cd, Cu, Ni and Pb in Selected rice Grain Available in Malaysia

This study aims to determine the levels of heavy metals (cadmium, copper, nickel and lead) in imported and domestically produced rice grains sold in Malaysia market. A total of 10 brands of rice samples was purchased from the local market and analyzed using atomic absorption spectroscopy (AAS). Good linearity was observed over the range studied with a correlation coefficients (R2) of 0.9884-0.9999. The range values of the metals detected in rice grain samples were 0.67-0.8 mg/kg for cadmium, 2.14-7.0 mg/kg for copper, 1.85-2.68 mg/kg for nickel and 0.94-3.28 mg/kg for lead. The mean value of rice obtained were above the permitted level set by the Malaysia Food Act 1983 (Act 281) and Food and Agriculture Organization of the United Nations/ World Health Organization (FAO/WHO) (2015). The Provisional Tolerance Weekly Intake (PTWI) calculated were also above the prescribed limit except for copper.   

Proteomics Profiling of Pancreatic Cancer and Pancreatitis for Biomarkers Discovery

Pancreatic cancer is one of the most aggressive malignancies with an increase in incidence predicted, particularly in African Americans. Pancreatic cancer is considered a silent disease with poor prognosis and a lack of early biomarkers for detection. Proteomics has been applied in many diseases for identifying or discovering biomarkers. It has long been suggested that chronic pancreatitis may be a risk factor for developing pancreatic cancer. This study identified proteins that are altered in expression in pancreatic cancer and pancreatitis compared to normal using proteomic technology. Proteins were extracted from laser captured micro-dissected tissues and separated in 2-DPAGE and imaged. The protein profiles of pancreatic cancer and pancreatitis are similar but differed with the protein profile of normal adjacent tissues. Representative proteins, overexpressed in tumor and pancreatitis but not normal tissues, were excised from gels, subjected to in-gel digestion, and analyzed by MALDI-TOF mass spectrometry. Proteins identified included transferrin, ER-60 protein, proapolipoprotein, tropomyosin 1, alpha 1 actin precursor, ACTB protein, and gamma 2 propeptide, aldehyde dehydrogenase 1A1, pancreatic lipase and annexin A1. Several proteins, which were shown in pancreatic cancer, were also observed in pancreatitis samples. Understanding the role of these specific proteins and their mechanistic action will give insights into their involvement in pancreatic cancers.

The risk to the cutaneous nerve branches in the anterior (Wagner) and snuff-box approaches to the trapezium: a cadaveric study

We compared the risk with the subcutaneous nerves with the anterior (Wagner) and snuff-box approaches to the trapezium in cadavers. Branches that crossed tattooed incision markings or lay within 1 cm of the markings were identified on six matched pairs of fresh-frozen cadaveric hands. Their distance from the proximal end of the incision was recorded. For anterior incisions, there were 20 vulnerable branches in total, at a mean distance of 22 mm from the proximal end of the incision. A total of 13 lay in the distal half of the incision. For snuff-box incisions, there were 18 vulnerable branches in total, at a mean distance of 11 mm from the proximal end of the incision, with 17 of them lying in the proximal half of the incision. Neither incision is without risk to nerve braches, but our study suggests a lesser risk of subcutaneous nerve damage with the snuff-box approach and highlights the greater risk in the proximal half of this incision.

Evaluating the use of cell phone messaging for community Ebola syndromic surveillance in high risked settings in Southern Sierra Leone

BACKGROUND

Most underdeveloped countries do not meet core disease outbreak surveillance because of the lack of human resources, laboratory and infrastructural facilities. The use of cell phone technology for disease outbreak syndromic surveillance is a new phenomenon in Sierra Leone despite its successes in other developing countries like Sri Lanka. In this study we set to evaluate the effectiveness of using cell phone technology for Ebola hemorrhagic fever syndromic surveillance in a high risked community in Sierra Leone.

OBJECTIVES

This study evaluated the effectiveness of using cell phone messaging (text and calls) for community Ebola hemorrhagic fever syndromic surveillance in high risked community in southern Sierra Leone.

METHOD

All cell phone syndromic surveillance data used for this study was reported as cell phone alert messages-texts and voice calls; by the Moyamba District Health Management Team for both Ebola hemorrhagic fever suspect and mortalities. We conducted a longitudinal data analysis of the monthly cumulative confirmed Ebola hemorrhagic fever cases and mortalities collected by both the traditional sentinel and community cell phone syndromic surveillance from August 2014 to October 2014.

RESULTS

A total of 129 and 49 Ebola hemorrhagic fever suspect and confirmed cases respectively were recorded using the community Ebola syndromic surveillance cell phone alert system by the Moyamba District Health Management Team in October 2014. The average number of Ebola hemorrhagic fever suspects and confirmed cases for October 2014 were 4.16 (Std.dev 3.76) and 1.58 (Std.dev 1.43) respectively. Thirty-four percent (n=76) of the community Ebola syndromic surveillance cell phone alerts that were followed-up within 24 hours reported Ebola hemorrhagic fever suspect cases while 65.92% (n=147) reported mortality.

CONCLUSION

Our study suggests some form of underreporting by the traditional sentinel Ebola hemorrhagic fever disease surveillance system in Moyamba District southern Sierra Leone for August-September 2014. Cell phone messaging technology can be effectively use as a tool for community epidemic surveillance from peripheral health care facilities to higher levels.

Sex differences in mania phenotype and ethanol consumption in the lateral hypothalamic kindled rat model

Sex differences have been observed in mania phenotypes in humans. However the mechanisms underlying this difference are poorly understood. Activating the lateral hypothalamus is implicated in manic-like behaviors in rodents. Using newly established lateral hypothalamus kindled (LHK) rat mania model, we investigated sex differences of manic-like behaviors and its correlation with voluntary ethanol intake. We stimulated the lateral hypothalamus bilaterally in the male and female Wistar rats over five consecutive days. We recorded and quantified kindling-induced behaviors for each individual animal. We also assessed ethanol consumption using a two-bottle choice ethanol drinking as well as circadian locomotor activity counts daily throughout the experiment. We found notable sex differences in several aspects of manic-like behaviors during kindling. Males exhibited a significantly increased locomotor activity during the light phase, and reduced rest interval. On the other hand, females displayed significantly higher ethanol consumption and more frequent rearing behavior. However, no sex differences were present in the duration of sexual, feeding or grooming behaviors or in dark-phase activity counts. The excessive alcohol intake in LHK female rats is reminiscent of clinically reported sex differences in bipolar patients while the other phenotypic sex differences such as rearing and locomotor activity are less clearly described in clinical studies. Overall, our results lend further evidence for the validity of the LHK rat as a useful model to study brain region-specific molecular changes during mania and its correlation with alcohol use disorders.

Tube bundle system: for monitoring of coal mine atmosphere

A tube bundle system (TBS) is a mechanical system for continuously drawing gas samples through tubes from multiple monitoring points located in an underground coal mine. The gas samples are drawn via vacuum pump to the surface and are typically analyzed for oxygen, methane, carbon dioxide and carbon monoxide. Results of the gas analyses are displayed and recorded for further analysis. Trends in the composition of the mine atmosphere, such as increasing methane or carbon monoxide concentration, can be detected early, permitting rapid intervention that prevents problems, such as a potentially explosive atmosphere behind seals, fire or spontaneous combustion. TBS is a well-developed technology and has been used in coal mines around the world for more than 50 years. Most longwall coal mines in Australia deploy a TBS, usually with 30 to 40 monitoring points as part of their atmospheric monitoring. The primary uses of a TBS are detecting spontaneous combustion and maintaining sealed areas inert. The TBS might also provide mine atmosphere gas composition data after a catastrophe occurs in an underground mine, if the sampling tubes are not damaged. TBSs are not an alternative to statutory gas and ventilation airflow monitoring by electronic sensors or people; rather, they are an option to consider in an overall mine atmosphere monitoring strategy. This paper describes the hardware, software and operation of a TBS and presents one example of typical data from a longwall coal mine.

Investigation of a nanofabrication process to achieve high aspect-ratio nanostructures on a quartz substrate

This work investigates the development of a nanofabrication process to achieve high aspect-ratio nanostructures on quartz substrates using electron beam lithography (EBL) patterning and fluorinated plasma etching processes. An imaging layer of a poly(methyl methacrylate) bi-layer resist was spun coated on quartz substrate and exposed by an e-beam with the designed patterns of sub-100 nm feature sizes using a Raith-150 EBL patterning tool. Additive pattern transfer was employed by depositing a 40 nm thick Nichrome layer on the resist pattern using a metal evaporator which was later lifted off by soaking in acetone. Nichrome was employed as an etch mask and an Oxford Plasmalab 80Plus reactive ion etcher was used for the etching process. The etching process was carried out in a gas mixture of CHF(3)/Ar with a flow rate ratio of 50/30 sccm, pressure of 20 mTorr, radiofrequency power of 200 W and at room temperature. These etching process parameters were found to achieve a 10 nm min(-1) etch rate and tall vertical side walls profile. An aspect-ratio of 10:1 was achieved on 60 nm feature size structures.

Growth monitoring still has a place in selected populations of children

In 1998, a multiprofessional group developed a consensus on growth monitoring in the UK. While routine serial measurements were not recommended in healthy children, it is clear that there is a subset of children at increased risk of growth-modifying disease who may benefit from growth monitoring. This subset includes children with genetic disorders at increased risk of thyroid dysfunction. Symptoms and signs of thyroid dysfunction are non-specific in the early stages of disease and are easily mistaken for features of an underlying genetic disorder. In this article, we report the case of a 2.8-year-old girl with 18q deletion syndrome who was profoundly weak, hypotonic and poorly responsive at diagnosis of Grave's disease. She was tall and her bone age was 2 years advanced, indicating long-standing disease. Growth monitoring of this patient should have enabled earlier diagnosis and avoided a serious and potentially fatal episode.

Characterization of the inflammatory cell infiltrate in herald patches and fully developed eruptions of pityriasis rosea

BACKGROUND

Pityriasis rosea (PR) is a common cutaneous papulosquamous disorder affecting young adults. Previous studies have suggested possibilities of a viral aetiology and the involvement of cell-mediated immunity, but these remain unproven to date.

AIM

To elucidate the possible pathomechanisms in PR by characterizing the inflammatory cellular infiltrate in herald patches and fully developed PR eruptions.

METHODS

In total, 12 biopsy specimens from 6 patients diagnosed with PR were examined. For each patient, biopsies were taken from both a herald patch and a secondary patch. Specimens were processed for histopathological examination and immunohistochemical staining with a large panel of monoclonal antibodies.

RESULTS

Histopathologically, all specimens showed epidermal changes such as parakeratosis, orthokeratosis, epidermal hyperplasia and spongiosis. Less common results included epidermal exocytosis and focal parakeratosis. In all biopsies, the dermal infiltrate of lymphocytes stained positively for monoclonal antibodies specific for T cells. The ratio of the CD4+ (helper) vs. CD8+ (cytotoxic) T cells in the dermal infiltrate was increased in most specimens. Increased staining for Langerhans cells was seen within the dermis of lesional skin. There were no marked differences found in histopathology and immunohistochemistry between the herald patch and secondary lesions. Overall, there was a lack of natural killer cell and B-cell activities in PR lesions.

CONCLUSIONS

Our results support a predominantly T-cell mediated immunity in the development of PR.

Myxozoan pathogens of Malaysian fishes cultured in ponds and net-cages

We describe new myxosporean species from Malaysian fishes cultured in pond farms and net-cages. Myxobolus omari sp. nov. and M. leptobarbi sp. nov. were found in the muscles of Pangasianodon hypophthalmus and Leptobarbus hoevenii, respectively, while plasmodia and spores of Thelohanellus zahrahae sp. nov. and Henneguya daoudi sp. nov. were detected in the gills of Barbonymus gonionotus and Trichogaster trichopterus, respectively. Plasmodia and spores found in these fishes differed from the known myxosporean species in respect of their morphology, tissue tropism and 18S rDNA structure. No major pathological changes were found, but in the future these species might pose a potential threat to more intensified fish culture.

Folate, vitamin B12 and homocysteine status in women of childbearing age: baseline data of folic acid wheat flour fortification in Iran

BACKGROUND

Folic acid fortification implemented mandatorily in many countries has been associated with significant increase in blood folate concentrations and reduction in the prevalence of neural tube defects. However, there are controversial findings on the probability of vitamin B(12) deficiency being masked in the population after folic acid fortification. Baseline data on folate and vitamin B(12) status are necessary before mandatory flour fortification is implemented.

OBJECTIVES

To assess dietary intake of folate and vitamin B(12) and to determine blood concentrations of folate, vitamin B(12) and homocysteine in women of childbearing age as baseline data regarding folic acid fortification in Iran.

METHODS

A descriptive cross-sectional survey was performed with 579 healthy women as a representative sample of the Golestan province. Fasting blood samples were taken and dietary (24-hour recall), health and sociodemographic data were collected with an interview. Serum concentrations of folate and vitamin B(12) were measured with radioimmunoassay, and plasma homocysteine concentrations were assessed by high-performance liquid chromatography with fluorescence detection.

RESULTS

Mean serum concentrations of folate and vitamin B(12) were 13.6 nmol/l (95% CI 12.8-14.4) and 194.4 pmol/l (95% CI 183.8-205.0), respectively. Inadequate serum folate levels were present in 14.3% of the women and 22.7% had serum vitamin B(12) levels below normal. Mean plasma homocysteine concentration was 12.6 micromol/l (95% CI 12.1-13.2) and hyperhomocysteinemia was observed in 38.3% of the women. Mean daily intake of folate and vitamin B(12) was 198.3 microg (95% CI 185.4-211.3) and 2.6 microg (95% CI 1.9-3.2), respectively. Folate intake from food was positively correlated with serum folate concentrations (r = 0.084, p < 0.05) and inversely correlated with plasma homocysteine concentrations (r = -0.115, p < 0.01).

CONCLUSIONS

An insufficient vitamin B(12) as well as folate status is present in Iranian women of childbearing age. The final evaluation will be carried out 18 months after flour fortification and the results will be compared with baseline data obtained from the present study in order to show the efficacy and safety of folic acid fortification in Iran.

Myxozoan pathogens in cultured Malaysian fishes. I. Myxozoan infections of the sutchi catfish Pangasius hypophthalmus in freshwater cage cultures

Cage-cultured sutchi catfish Pangasius hypophthalmus (Sauvage, 1878), a favourite food fish in Southeast Asia, proved to be infected by 6 myxozoan species. Three species belonged to the genus Hennegoides (H. berlandi, H. malayensis, and H. pangasii), 1 to Henneguya (H. shariffi) and 2 to Myxobolus (M. baskai, and M. pangasii). Five myxozoans infected the gills and 1 was found on the spleen. Myxozoans infecting the gills were characterised by a specific site selection. H. shariffi sp. n. and H. berlandi sp. n. formed plasmodia in the multi-layered epithelium of the gill filaments. Of the 2 vascular species H. pangasii sp. n. developed in the gill arteries, while M. baskai sp. n. infected the capillary network of the gill lamellae. Plasmodia of H. malayensis sp. n. were found inside the cartilaginous gill rays of the filaments. Large plasmodia of M. pangasii sp. n. were located in a groove of the spleen but they affected only the serosa layer covering the spleen.

Myxozoan pathogens in cultured Malaysian fishes. II. Myxozoan infections of redtail catfish Hemibagrus nemurus in freshwater cage cultures

Cage-cultured Asian redtail catfish Hemibagrus nemurus (Valenciennes, 1840), a popular food fish in Southeast Asia, proved to be infected by 3 myxozoan species. All the 3 species belonged to the genus Henneguya: 2 were identified as H. mystusia Sarkar, 1985 and H. hemibagri Tchang et Ma, 1993, while the other was described as H. basifilamentalis sp. n. All plasmodia were found in the gills and were characterised by a specific site selection. H. mystusia formed plasmodia in the multi-layered epithelium between the gill lamellae and in the non-lamellar edge of the gill filaments, while H. hemibagri developed in the capillary network of the lamellae. H. basifilamentalis sp. n. had large oval plasmodia located deep among the filaments just above the gill arch.

The sexual and reproductive health in men with generalized epilepsy: a multidisciplinary evaluation

This study was specifically aimed to evaluate the sexual and reproductive health in a group of men with generalized epilepsy. In total, 44 men with generalized epilepsy were included in this study, their ages between 18 and 48 years (29.2+/-9.9) and duration of illness between 2 and 35 years (11.2+/-7.4); 34 patients were treated with conventional antiepileptic drugs (AEDs). Sexological and psychological interviews together with serum total testosterone, E(2), FSH, LH and prolactin were determined. Hyposexuality was diagnosed in 61.4%. Erectile dysfunction (ED) and premature ejaculation represented 70.4 and 66.7%, respectively. Variables such as hyposexuality, seizure duration and its poor control on AEDs were significantly associated with depressive symptoms. Compared to the normal control group, all patients reported elevated E(2) levels (P<0.001), 10 had FSH (n=4) and LH (n=6) levels exceeding that of the normal range for controls and two had hyperprolactinemia. Although the patients' mean value of total testosterone remained within the normal range, but it was significantly lower in hyposexual men compared to nonhyposexual (P<0.002), only two epileptic patients had markedly reduced level of total testosterone beyond normal control levels. This study strongly supports that: (1) The risk of hyposexuality and reproductive disturbances is high in epileptic patients with GTC convulsions despite the AEDs utilized. The risk for SD is further increased by poor seizure control and the frequently accompanied depressive manifestations. (2) It is possible that elevated E2 could increase the risk of SD by reducing active testosterone through negative feedback and the reduction of active testosterone could increase seizure intractability to antiepileptic medications.

Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents

BACKGROUND

Absence seizures are brief epileptic seizures which present in childhood and adolescence. They are characterised by sudden loss of awareness and an electroencephalogram (EEG) typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently used to treat absence seizures. This review aims to determine the best choice of anticonvulsant for a child with typical absence seizures.

OBJECTIVES

To review the evidence for the effects of ethosuximide, valproate and lamotrigine as treatments for children and adolescents with absence seizures, when compared with placebo or each other.

SEARCH STRATEGY

We searched the Cochrane Epilepsy Group's Specialised Register (March 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to March 2005) and EMBASE (1988 to March 2005). No language restrictions were imposed. In addition, we contacted Sanofi Winthrop, Glaxo Wellcome (now GlaxoSmithKline) and Parke Davis (now Pfizer), manufacturers of sodium valproate, lamotrigine and ethosuximide respectively.

SELECTION CRITERIA

Randomised parallel group monotherapy or add-on trials which include a comparison of any of the following in children or adolescents with absence seizures: ethosuximide; sodium valproate; lamotrigine or placebo.

DATA COLLECTION AND ANALYSIS

Outcome measures were: (1) proportion of individuals seizure free at 1, 3, 6, 12 and 18 months post randomisation; (2) people with a 50% or greater reduction in seizure frequency; (3) normalisation of EEG and/or negative hyperventilation test and (4) adverse effects. Data were independently extracted by two review authors. Results are presented as relative risks (RR) with 95% confidence intervals (95% CI).

MAIN RESULTS

Five small trials were found, four of them were of poor methodological quality. One trial (29 participants) compared lamotrigine with placebo using a response conditional design. Individuals taking lamotrigine were significantly more likely to be seizure free than participants taking placebo during this short trial. Another trial compared lamotrigine with sodium valproate, the study lacked power to detect the difference in efficacy. Three studies compared ethosuximide, but because of diverse study designs and populations studied, we decided not to pool results in a meta-analysis. None of these studies found a difference between valproate and ethosuximide with respect to seizure control, but confidence intervals were wide and the existence of important differences could not be excluded.

AUTHORS' CONCLUSIONS

Although ethosuximide, lamotrigine and valproate are commonly used to treat people with absence seizures we have insufficient evidence to inform clinical practice, and the few trials included in this review were of poor methodological quality and did not have sufficient number of participants. More trials of better quality are needed.

A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1

Intracavernous injection of Trimix (Tx) is indicated for patients unsuitable for prostaglandin E1 (PgE1) injection due to lack of response, pain or cost. We believe that the ideal ratio of ingredient doses in Tx is yet to be found. We postulated that increasing the doses of individual drug components in an orderly manner would convey important data on penile hemodynamic response. Such information is needed to choose an effective and less costly alternative to PgE1 with least side effects. We set out to evaluate the impact of varying the ingredient dosage on response and short-term safety of Tx compared with PgE1. We prospectively randomized 180 consecutive patients with erectile dysfunction into nine equal groups and each group received a different dose of Tx, namely phentolamine (1 mg) plus one dose of PgE1 (2.5, 5 or 10 microg) and one dose of papaverine (5, 10 or 20 mg). Each patient was injected with 20 microg PgE1 and one dose of Tx in two clinic visits 1 week apart. Following injection, duplex ultrasound of cavernous arteries and axial rigidometry were carried out. Patients ranked the quality of erection, estimated overall satisfaction and reported time to detumescence and side effects. Patients' mean age was 50.5+/-11.7 y with underlying organic condition in 91.1%. There were no significant differences between PgE1 and Tx with regard to peak cavernous artery flow, time to erection, patients' satisfaction, average axial rigidity and pain. PgE1 produced higher end diastolic velocity, shorter duration of erection and less priapism. Patients did not show a preference for either drug or any particular dosage. We conclude that even at the smallest dose of ingredients of Tx, there are no significant differences in hemodynamic effects, rigidity, pain and self-satisfaction between the two drugs. However, Tx produces a longer duration of erection and more priapism than PgE1.

Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents

BACKGROUND

Absence seizures are brief epileptic seizures which present in childhood and adolescence. They are characterised by sudden loss of awareness and an electroencephalogram (EEG) typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently used to treat absence seizures. This review aims to determine the best choice of anticonvulsant for a child with typical absence seizures.

OBJECTIVES

To review the evidence for the effects of ethosuximide, valproate and lamotrigine as treatments for children and adolescents with absence seizures, when compared with placebo or each other.

SEARCH STRATEGY

We searched the Cochrane Epilepsy Group trials register, the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (January 1966 to March 2003) and EMBASE (1988 to March 2003). We also contacted Sanofi Winthrop, Glaxo Wellcome (now GlaxoSmithKline) and Parke Davis (now Pfizer), manufacturers of sodium valproate, lamotrigine and ethosuximide respectively.

SELECTION CRITERIA

Randomised parallel group monotherapy or add-on trials which include a comparison of any of the following in children or adolescents with absence seizures: ethosuximide; sodium valproate; lamotrigine or placebo.

DATA COLLECTION AND ANALYSIS

Outcome measures were: (i) proportion of individuals seizure free at 1, 6 and 18 months post randomisation; (ii) people with a 50% or greater reduction in seizure frequency; (iii) normalisation of EEG and/or negative hyperventilation test and (iv) adverse effects. Data were independently extracted by two reviewers. Results are presented as relative risks (RR) with 95% confidence intervals (95% CI).

MAIN RESULTS

Four small trials were found, which were of poor methodological quality. One trial (29 participants) compared lamotrigine with placebo using a response conditional design. Individuals taking lamotrigine were significantly more likely to be seizure free than participants taking placebo during this short trial. Three studies compared ethosuximide, but because of diverse study designs and populations studied, we decided not to pool results in a meta-analysis. None of these studies found a difference between valproate and ethosuximide with respect to seizure control, but confidence intervals were wide and the existence of important differences could not be excluded.

REVIEWER'S CONCLUSIONS

Although ethosuximide, lamotrigine and valproate are commonly used to treat people with absence seizures we have insufficient evidence to inform clinical practice, and the few trials included in this review were of poor methodological quality. More trials of better quality are needed.

An assessment of the POSSUM system in orthopaedic surgery

We describe the development and validation of a scoring system for auditing orthopaedic surgery. It is a minor modification of the POSSUM scoring system widely used in general surgery. The orthopaedic POSSUM system which we have developed gives predictions for mortality and morbidity which correlate well with the observed rates in a sample of 2326 orthopaedic operations over a period of 12 months.

An assessment of the POSSUM system in orthopaedic surgery

We describe the development and validation of a scoring system for auditing orthopaedic surgery. It is a minor modification of the POSSUM scoring system widely used in general surgery. The orthopaedic POSSUM system which we have developed gives predictions for mortality and morbidity which correlate well with the observed rates in a sample of 2326 orthopaedic operations over a period of 12 months.

Efficacy and tolerability of topiramate in childhood and adolescent epilepsy: a clinical experience

A 3-year retrospective review was undertaken of the use of topiramate in 51 children aged 3-16 years with partial and generalized epilepsies who attended a tertiary referral epilepsy centre in a large children's hospital. The mean follow-up period was 19 months (range 6-33 months). Twenty-six children (51%) were still receiving topiramate at the time of their last review. Fifteen children (29%) showed a greater than 50% reduction in their seizure frequency and four children (8%) became seizure free, three on topiramate monotherapy. The drug appeared to be most effective in children with moderate learning difficulties with 75% showing an improvement in seizure control compared with 25% of children with normal educational functioning. Topiramate was withdrawn in 25 patients. The reasons for withdrawal included adverse effects in 20, lack of effect in three and worsening of seizures in two patients. Adverse side effects were reported in 57% of the 51 patients. The majority of the side effects were related to behavioural and cognitive difficulties, with less-common side effects including anorexia, weight loss and headaches.

Delayed diagnosis of Duchenne muscular dystrophy

A late diagnosis of Duchenne muscular dystrophy has implications for both child and family. This repeat audit has shown that the diagnosis continues to be delayed. The failure to recognize that non-motor, and specifically speech and language delay are common features of this disease may detract from the motor difficulties in affected children and contribute to the late diagnosis of this disorder. In the absence of a national newborn screening programme for Duchenne muscular dystrophy, all health care professionals should be made more aware of the condition and have a lower threshold for measuring a creatine phosphokinase level.

Seroprevalence of hepatitis C virus infection among indigent urban pregnant women in Zimbabwe

OBJECTIVE

To estimate the seroprevalence of hepatitis C virus (HCV) infection among indigent pregnant women.

DESIGN

A serological survey study of indigent pregnant women admitted for labour and delivery.

SETTING

Harare Maternity Hospital, Harare, Zimbabwe.

SUBJECTS

A random sample of 1,607 women, delivering at the hospital during the study period agreed to participate in the research. Serum samples were available for 1,591 women.

MAIN OUTCOME MEASURES

Serum samples were tested for the presence of antibodies to HCV using a second generation agglutination assay and a third generation enzyme immuno-assay (EIA).

RESULTS

Of the 1,591 women tested 25 (1.6%) were anti-HCV positive (95% confidence interval 1.0% to 2.2%). The frequency of anti-HCV positives was associated with maternal age (p = 0.0202) and maternal syphilis status (p = 0.020). Gravidas aged 25 to 29 years had the highest anti-HCV seroprevalence (3.4%) as compared with gravidas of other age categories (1.0% to 1.5%). Women with serologic evidence of syphilis infection during the index pregnancy had an increased prevalence of anti-HCV as compared with those women without evidence of syphilis infection (7.9% versus 1.4%, p = 0.020). There was some evidence (p = 0.094) that a positive prior history of delivering a stillborn infant was also associated with an increased prevalence of anti-HCV (4.1% vs 1.4%). Other maternal characteristics, including hepatitis B virus carriage status, parity, and whether she had received prenatal care during the index pregnancy were not determinants of maternal anti-HCV status.

CONCLUSIONS

Overall, hepatitis C antibody was detected in 1.6% of indigent women delivering at Harare Maternity Hospital. This proportion of anti-HCV positive pregnant women is similar to estimates published for North American and European women. Factors positively associated with maternal seropositivity in our population included maternal age (between 25 to 29 years), prior history of delivering a stillborn infant, and seropositivity for syphilis during the index pregnancy. Given the relatively low seroprevalence of HCV and the fact that risk factors for HCV infection remain largely unknown, more studies are needed to identify high risk populations likely to benefit from HCV screening and treatment programmes.

A comparative study of age involution of the bursa of Fabricius an thymus in birds

The differential growth patterns of the bursa of Fabricius and thymus of Comet strain chicks were examined up to 60 days of age. It was found that the bursa increased in size, in relation to body weight, during the first 3 wk of life but thereafter underwent involution. The thymic tissue increased in weight throughout the period of investigation, from 3 to 58 days of age; when this total weight was related to the number of thymus glands, it was found that during the first days of life, thymus tissue was increased by the growth of pre-existing thymic glands but that this was followed by a phase when new thymus glands appeared with no increase in the size of the largest glands. Although the growth and involution patterns of the thymus and bursa differed it was found that, for each age group, a linear relationship existed between the bursa and thymus, suggesting that there may be a common control of development in the two organs.