Clinical experience of clobazam as add-on treatment in a cohort of adults with epilepsy

Objective: Epilepsy is a common neurologic disorder affecting 1% of the world population with one-third of these patients failing to have seizure control for more than one year. Clobazam is a long-acting benzodiazepine used worldwide for the treatment of epilepsy. This antiepileptic drug has demonstrated great clinical benefits with mild side effects. The objective of this study was to better understand the efficacy of clobazam treatment on adult patients with refractory epilepsy. Design: A retrospective review of 44 adult patients with diagnosis of epilepsy that were seen at our Epilepsy Clinic between January 2014 and May 2015. Setting: An outpatient epilepsy clinic at the Hospital Universitario Fundación Santa Fe de Bogota, Colombia. Participants: 44 adult patients with diagnosis of epilepsy. Measurements: Seizure frequency, adverse effects and the use of concomitant AEDs were reviewed in each of the patient´s clinical charts. Results: The responder rate of patients with clobazam was 52% at 3 months, 50% at 6 months and 55% at 12 month. Seizure freedom rates at 3, 6 and 12 months were 18%, 25% and 25% respectively. Clobazam related adverse events occurred only in four patients (9%) at the end of the twelve months with somnolence being the most common. Conclusion: These findings suggest that clobazam treatment in adult patients with focal or generalized epilepsy is effective and safe. Its use should be considered early when first-line agents fail to provide seizure control.

Metacognitive experience and transfer of logical reasoning

The experiments examine the influence of metacognitive experience on the transfer of logical processes in a problem solving setting. Subjects were presented with two versions of Wason's (1966) selection task. Although they were able to perform successfully on the concrete tasks (following a minimal explanation of the correct solution on an initial trial), the majority were not able to transfer a successful method to the abstract tasks. Verbalization during, or following, the concrete tasks produced substantial transfer effects however. It is suggested that verbalization may lead to an increased awareness of past behaviour, particularly of those aspects necessary for successful solution.

Eye gaze in virtual environments: evaluating the need and initial work on implementation

For efficient collaboration between participants, eye gaze is seen as being critical for interaction. Video conferencing either does not attempt to support eye gaze (e.g. AcessGrid) or only approximates it in round table conditions (e.g. life size telepresence). Immersive collaborative virtual environments represent remote participants through avatars that follow their tracked movements. By additionally tracking people's eyes and representing their movement on their avatars, the line of gaze can be faithfully reproduced, as opposed to approximated. This paper presents the results of initial work that tested if the focus of gaze could be more accurately gauged if tracked eye movement was added to that of the head of an avatar observed in an immersive VE. An experiment was conducted to assess the difference between user's abilities to judge what objects an avatar is looking at with only head movements being displayed, while the eyes remained static, and with eye gaze and head movement information being displayed. The results from the experiment show that eye gaze is of vital importance to the subjects correctly identifying what a person is looking at in an immersive virtual environment. This is followed by a description of the work that is now being undertaken following the positive results from the experiment. We discuss the integration of an eye tracker more suitable for immersive mobile use and the software and techniques that were developed to integrate the user's real-world eye movements into calibrated eye gaze in an immersive virtual world. This is to be used in the creation of an immersive collaborative virtual environment supporting eye gaze and its ongoing experiments. Copyright (C) 2009 John Wiley & Sons, Ltd.

The relationship between L3 transfer and structural similarity across L3 development: raising across an experience in Brazilian Portuguese

The present study examines three competing models of morphosyntactic transfer in third language (L3) acquisition, examining the particular domain of the feature configuration of embedded T in L3 Brazilian Portuguese (BP) at the initial stages and then through development. The methodology alternates Spanish and English as the L1 and L2 to tease apart the source of transfer to L3 BP. Results from a scalar grammaticality acceptability task show unequivocal transfer of Spanish irrespective of Spanish’s status as an L1 or L2. The data thus support the Typological Primacy Model (Rothman 2010, 2011, 2013a, 2013b), which proposes that multilingual transfer is selected by factors related to comparative structural similarity. Given that Spanish transfer at the L3 initial stages creates the need for feature reconfiguration to converge on the target BP grammar, the second part of this chapter examines the developmental consequences of what the TPM models in cases of non-facilitative initial transfer, that is, the developmental path of feature reconfiguration of embedded T in L3 BP by English/Spanish bilinguals. Given what these data reveal, we address the role of regressive transfer as a correlate of L3 proficiency gains.

Effect of caries preventive measures directed to expectant mothers on caries experience in their children

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth

To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars. Design Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables. Results Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B. Conclusion The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.

Physics teachers initial education and professional performance: what do future teachers have to say?

This research deals with the discussion about Physics teachers’ undergraduate education and professional performance related to the knowledge acquired during this initial education. More specifically, we try to answer questions like: How do future teachers evaluate the knowledge acquired during their initial education as in terms of specific knowledge as pedagogical knowledge? What are their formative needs and future expectatives about professional performance and the school teaching environment? Data was constituted from a sample of 26 future high school physics teachers, one semester long, that were taking the supervised curricular training in a undergraduate Physics education program (called Licenciatura in Brazil), in São Paulo State public university. Besides the final report of this training, future teachers were asked to answer a questionnaire aiming to take their conceptions about their initial education program, their formative needs, future professional expectatives and high school teaching environment. According to the future teachers, the program they were about to finish was satisfactory in terms of Physics specific contents; however, about the pedagogical content knowledge and the pedagogical practice, they showed to be unsatisfied and insecure. The majority of the questionnaire responses demonstrated that they feel lack of teaching experience. Moreover, teachers emphasize other factors related to the future professional performance: possible difficulties to deal with students’ indiscipline, schools’ bad physical structure, limited number of Physics classes in high school level, lack of didactical laboratories and also they seem to be frightened that the expertise teachers do not be collaborative with the new ones. In this sense, the research outcomes shows the necessity of discussions about questions involving teachers knowledge, related to either, the Physics conceptual domain and the pedagogical one, since it matters directly to future teachers professional performance. Discussions in this sense can also help evaluation and restructuration of programs designed to initial and continuous teachers’ education.

Outcomes of Epileptic Spasms in Patients Aged Less Than 3 Years: Single-Center United States Experience

Retrospective review was performed of children aged <3 years with epileptic spasms at our center from 2004-2010. Short-term (<6 months) and long-term (>= 6 months) outcomes were assessed. We included 173 children (104 boys; median age of onset, 6.8 months) with epileptic spasms of known (62%) and unknown (38%) etiology. Treatments included adrenocorticotropic hormone (n = 103), vigabatrin (n = 82), phenobarbital (n = 34), and other agents (n = 121). Short-term treatment with adrenocorticotropic hormone and vigabatrin provided better epileptic spasm control in groups with known and unknown etiology than other agents. At follow-up (6-27 months), 54% of children manifested seizures, and 83% manifested developmental delay. Known etiology was a predictor of poor developmental outcome (P = 0.006), whereas bilateral/diffuse brain lesions predicted both poor development and seizures (P = 0.001 and 0.005, respectively). Initial presentations of epileptic spasms with hypotonia or developmental delay most strongly predicted both seizures and neurodevelopmental outcomes (P < 0.001). In a child presenting with epileptic spasms with developmental delay or hypotonia, no specific treatment may offer superior benefit. (c) 2012 Elsevier Inc. All rights reserved.

Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.

Use of different commercial Artemia sp. Enrichements in Octopus Vulgaris, paralarval rearing at initial planctonic phase: effects on growth, survival and fatty acid composition of the paralarvae

[EN] Octopus "paralarvae", are planktonic, swim actively and have high metabolic rates, requiring large quantities of live prey of adequate motility and nutritional quality ( Iglesias et al., 2000; Navarro and Villanueva, 2000, 2003). During the planktonic phase, they undergo strong morphological changes, after which the octopuses start settling to the bottom. The potential of Octopus vulgaris as candiadate for diversification of marine aquacultures are mainly due to its high food conversion rate and fast growth.( Iglesias et al 2006). Despite the research effort taken until now, paralarval rearing of O. vulgaris still suffers high mortalities which limited the industrial culture of this species. The main problems in the paralarval rearing stages are the high mortality rates and poor growth. These are attributed to the lack of standardized culture techniques and nutritional deficiencies in the diet of paralarvae, especially in n-3 highly unsaturated fatty acids (n-3 HUFA). The objective if this experience was to test different commercial live prey enrichment to improve nutritional quality of the artemia.

Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience

The characteristic features of Whipple's disease include abdominal pain, diarrhoea, wasting, and arthralgias, with the causative agent, Tropheryma whipplei, being detected mainly in intestinal biopsies. PCR technology has led to the identification of T. whipplei in specimens from various other locations, including the central nervous system and the heart. T. whipplei is now recognized as one of the causes of culture-negative endocarditis, and endocarditis can be the only manifestation of the infection with T. whipplei. Although it is considered a rare disease, the true incidence of endocarditis due to T. whipplei is not clearly established. With the increasing use of molecular methods, it is likely that T. whipplei will be more frequently identified. Questions also remain about the genetic variability of T. whipplei strains, optimal diagnostic procedures and therapeutic options. In the present study, we provide clinical data on four new patients with documented endocarditis due to T. whipplei in the context of the available published literature. There was no clinical involvement of the gastrointestinal tract. Genetic analysis of the T. whipplei strains with DNA isolated from the excised heart valves revealed little to no genetic variability. In a selected case, we describe acridine orange staining for early detection of the disease, prompting early adaptation of the antibiotic therapy. We provide long-term follow-up data on the patients. In our hands, an initial 2-week course of intravenous antibiotics followed by cotrimoxazole for at least 1 year was a suitable treatment option for T. whipplei endocarditis.

The challenge of triaging chest pain patients: the bernese university hospital experience

Accurate diagnosis of the causes of chest pain and dyspnea remain challenging. In this preliminary observational study with a 5-year follow-up, we attempted to find a simplified approach to selecting patients with chest pain needing immediate care based on the initial evaluation in ED. During a 24-month period were randomly selected 301 patients and a conditional inference tree (CIT) was used as the basis of the prognostic rule. Common diagnoses were musculoskeletal chest pain (27%), ACS (19%) and panic attack (12%). Using variables of ACS symptoms we estimated the likelihood of ACS based on a CIT to be high at 91% (32), low at 4% (198) and intermediate at 20.5-40% in (71) patients. Coronary catheterization was performed within 24 hours in 91% of the patients with ACS. A culprit lesion was found in 79%. Follow-up (median 4.2 years) information was available for 70% of the patients. Of the 164 patients without ACS who were followed up, 5 were treated with revascularization for stable angina pectoris, 2 were treated with revascularization for myocardial infarction, and 25 died. Although a simple triage decision tree could theoretically help to efficient select patients needing immediate care we need also to be vigilant for those presenting with atypical symptoms.

1.9 µm diode laser assisted vascular microanastomoses: Experience in 40 clinical procedures

Since the initial work of Jacobson and Suarez in 1960, microsurgery has evolved greatly. In 2009, we reported our clinical experience with 1.9 µm diode laser-assisted vascular microanastomoses (LAMA) for free flap reconstruction. In this report, the ongoing study is now expanded to include 11 additional procedures which were analyzed prospectively with a focus on the duration of the LAMA technique.

Safety and outcome of patients with an acute ST-elevation myocardial infarction transferred for primary coronary intervention: the Neuchâtel experience

BACKGROUND: Transferring patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI) from a community hospital to a PCI centre has been evaluated in randomised trials and shown to be safe and effective. A prolonged transfer time may restrict the benefit of this strategy. AIM: We sought to assess 1) safety of transfer from Neuchâtel to Berne, 2) time intervals of patients transferred either directly from on-site or after evaluation in the local emergency room, and 3) clinical long-term outcome. METHODS AND RESULTS: 42 patients with STEMI eligible for reperfusion therapy were prospectively included between January 2003 and June 2004. Twenty patients (48%, group 1) were directly transferred to the PCI centre from on-site. Twenty-two were transferred after initial treatment in the local emergency room: 11 patients (26%, group 2) presented spontaneously at the hospital and 11 patients (26%, group 3) were admitted by the rescue team. No major complication occurred during transport. Median transport time was 33 minutes. Median time from first healthcare contact to balloon consisted of 131 minutes in group 1, 158 minutes in group 2 and 174 minutes in group 3. The overall rate of Major Adverse Cardiac Events (MACE) at 6 months amounted to 9.5%. CONCLUSIONS: Transfer for primary PCI of our patients with acute STEMI was safe. Direct transfer from on-site to the PCI centre reduced the time of ischaemia. The overall MACE rate was low.

Total-body digital X-ray in trauma. An experience report on the first operational full body scanner in Europe and its possible role in ATLS

When patients enter our emergency room with suspected multiple injuries, Statscan provides a full body anterior and lateral image for initial diagnosis, and then zooms in on specific smaller areas for a more detailed evaluation. In order to examine the possible role of Statscan in the management of multiply injured patients we implemented a modified ATLS((R)) algorithm, where X-ray of C-spine, chest and pelvis have been replaced by single-total a.p./lat. body radiograph. Between 15 October 2006 and 1 February 2007 143 trauma patients (mean ISS 15+/-14 (3-75)) were included. We compared the time in resuscitation room to 650 patients (mean ISS 14+/-14 (3-75)) which were treated between 1 January 2002 and 1 January 2004 according to conventional ATLS protocol. The total-body scanning time was 3.5 min (3-6 min) compared to 25.7 (8-48 min) for conventional X-rays, The total ER time was unchanged 28.7 min (13-58 min) compared to 29.1 min (15-65 min) using conventional plain radiography. In 116/143 patients additional CT scans were necessary. In 98/116 full body trauma CT scans were performed. In 18/116 patients selective CT scans were ordered based on Statscan findings. In 43/143 additional conventional X-rays had to be performed, mainly due to inadequate a.p. views of fractured bones. All radiographs were transmitted over the hospital network (Picture Archiving and Communication System, PACS) for immediate simultaneous viewing at different places. The rapid availability of images for interpretation because of their digital nature and the reduced need for repeat exposures because of faulty radiography are also felt to be strengths.