The treatment gap in epilepsy: the current situation and ways forward

This article is a summary of a workshop held by the ILAE concerning the issue of the epilepsy treatment gap in developing countries. The gap is defined in terms of those people with epilepsy who are not being appropriately treated and is the result of an array of medical, political, social, economic, and cultural factors. The situation regarding the treatment gap for various countries is reviewed, along with some of its causes. Although the overall gap is estimated to be large, a number of recent projects and interventions have been effective in delivering appropriate treatment to people with epilepsy in underresourced countries of the developing world. It is hoped that these may be transferable elsewhere and that, combined with the ILAE/IBE/WHO Global Campaign against Epilepsy and increased support from the worldwide epilepsy community, the treatment gap will begin to be bridged.

Sporotrichosis: an emergent zoonosis in Rio de Janeiro

During the period from 1987 to 1998, 13 cases of human sporotrichosis were recorded at the Research Center Evandro Chagas Hospital (CPqHEC) in Rio de Janeiro. Two of these patients related scratch by a sick cat. During the subsequent period from July 1998 to July 2000, 66 human, 117 cats and 7 dogs with sporotrichosis were diagnosed at the CPqHEC. Fifty-two humans (78.8%) reported contact with cats with sporotrichosis, and 31 (47%) of them reporting a history of a scratch or bite. This epidemic, unprecedented in the literature, involving cats, dogs and human beings may have started insidiously before 1998.

Cancer in the elderly: basic science and clinical aspects

The incidence of cancer increases progressively with age. Rearrangements of genomes have been found to accompany cellular aging. These factors, in concert with age-dependent alterations in immune function and host defense, may help to explain the increased risk of malignant disease in aged persons. The clinical presentation and natural history of neoplasia are also affected by aging. This conference reviews recent developments in these areas, examines the effects of drug use in the elderly and implications for management, and discusses current information on how age may influence the response of cancer to therapy.

Monitoring the fidelity of mitotic chromosome segregation by the spindle assembly checkpoint

Accurate chromosome segregation relies on activity of the spindle assembly checkpoint, a surveillance mechanism that prevents premature anaphase onset until all chromosomes are properly attached to the mitotic spindle apparatus and aligned at the metaphase plate. Defects in this mechanism contribute to chromosome instability and aneuploidy, a hallmark of malignant cells. Here, we review the molecular mechanisms of activation and silencing of the spindle assembly checkpoint and its relationship to tumourigenesis.

Parent Training Programs for Ethnic Minorities: a Meta-analysis of Adaptations and Effect

This meta-analysis focuses on parent training programs for ethnic minority families and reports on (i) the adaptation of program content and (ii) the process that informs these adaptations. Relevant studies are reviewed to determine the adaptations made and the impact of the adaptations on parenting and child outcomes. Studies were eligible for inclusion if they enrolled predominantly ethnic minority parents with children aged 0-12 years, used a randomized controlled trial design with post-intervention assessments, focused on group-based parent training programs and on prevention of parenting problems, and reported parenting behavior outcomes. A total of 18 studies were included in the analysis. The results show that parent training programs targeting ethnic minority parents have a small but significant effect on improving parenting behavior (k = 18, Cohen's d = 0.30), child outcomes (k = 16, Cohen's d = 0.13), and parental perspectives (k = 8, Cohen's d = 0.19). Most of the programs made adaptations related to surface and deep structure sensitivity. Programs with cultural adaptations, especially deep structure sensitivity (k = 7, Cohen's d = 0.54), are more effective in improving parenting behavior. Because only a third of the included studies provided details on the processes that guided the adaptations made, additional studies are needed to provide information on the process of adaptation; this will enable others to learn from the procedures that can be undertaken to culturally adapt interventions.

The influence of the onset of phonation on the frequency of stuttering

To test the hypothesis that the frequency with which vocalization must be initiated in a given speech segment and the frequency of attendant disfluency are positively related, two passages were constructed. One passage was composed entirely of voiced speech sounds (all-voiced passage). The other contained both voiceless and voiced sounds (combined passage). Thus, in reading the later material, subjects had to effect more “off-on” phonatory adjustments than in the all-voiced selection. Aside from this difference, the passages were closely matched along several other linguistic and phonetic parameters. Fourteen stutterers performed five massed oral readings of each passage. Statistical analyses all showed that there was significantly less stuttering and more rapid adaptation associated with the all-voiced material.

Growth and physiological responses to cadmium stress of two populations of Dittrichia viscosa (L.) Greuter

Two clones of Dittrichia viscosa (L.) Greuter from contrasting populations, DV-A (metallicolous) and DV-W (non-metallicolous), were studied to compare Cd accumulation and tolerance. After 10 days of hydroponic culture with 0, 5, 10, and 15 mg Cd L(-1), metal accumulation and plant growth were measured as well as other stress markers such as decrease in the content of photosynthetic pigments, lipid peroxidation, phenols, H(2)O(2), and free proline. We also analyzed the activity of the antioxidant enzymes guaiacol and ascorbate peroxidases, catalase, superoxide dismutase, and glutathione reductase as well as their isoform patterns. Our results confirmed a high Cd tolerance and accumulation in both clones of D. viscosa, which suggests that these traits are constitutive in this species. However, when the Cd concentration in solution exceeded 10 mg Cd L(-1), DV-A was more tolerant than DV-W. The physiological mechanisms involved in Cd tolerance also differed between them, although phenols and guaiacol peroxidase played an important role in both clones. The effective Cd detoxification of DV-A consisted mainly in a promoted ascorbate peroxidase activity and better efficiency of catalase and glutathione reductase enzymes.

Isolation of Sporothrix schenckii from the nails of domestic cats (Felis catus)

We report the first isolation of Sporothrix schenckii from the nail surfaces of cats. The fungus grew from nail clippings of three cats associated with three household outbreaks of sporotrichosis involving cats and human beings. The identification of the isolates was based on macroscopic and microscopic morphological characteristics at 25 degrees C and conversion of S. schenckii to the yeast-like form at 37 degrees C.

Land use and land cover changes in Zêzere watershed (Portugal)--Water quality implications

To understand the relations between land use allocation and water quality preservation within a watershed is essential to assure sustainable development. The land use and land cover (LUC) within Zêzere River watershed registered relevant changes in the last decades. These land use and land cover changes (LUCCs) have impacts in water quality, mainly in surface water degradation caused by surface runoff from artificial and agricultural areas, forest fires and burnt areas, and caused by sewage discharges from agroindustry and urban sprawl. In this context, the impact of LUCCs in the quality of surface water of the Zêzere watershed is evaluated, considering the changes for different types of LUC and establishing their possible correlations to the most relevant water quality changes. The results indicate that the loss of coniferous forest and the increase of transitional woodland-shrub are related to increased water's pH; while the growth in artificial surfaces and pastures leads mainly to the increase of soluble salts and fecal coliform concentration. These particular findings within the Zêzere watershed, show the relevance of addressing water quality impact driven from land use and should therefore be taken into account within the planning process in order to prevent water stress, namely within watersheds integrating drinking water catchments.

Use of thermal and vegetation index data from earth observing satellites to evaluate the risk of schistosomiasis in Bahia, Brazil

A geographic information system (GIS) was constructed using maps of regional agroclimatic features, vegetation indices and earth surface temperature data from environmental satellites, together with Schistosoma mansoni prevalence records from 270 municipalities including snail host distributions in Bahia, Brazil to study the spatial and temporal dynamics of infection and to identify environmental factors that influence the distribution of schistosomiasis. In an initial analysis, population density and duration (months) of the annual dry period were shown to be important determinants of disease. In cooperation with the National Institute of Spatial Research in Brazil (INPE), day and night imagery data covering the state of Bahia were selected at approximately bimonthly intervals in 1994 (six day-night pairs) from the data archives of the advanced very high resolution radiometer (AVHRR) sensor of the National Oceanic and Atmospheric Administration (NOAA)-11 satellite. A composite mosaic of these images was created to produce maps of: (1) average values between 0 and +1 of the normalized difference vegetation index (NDVI); and (2) average diurnal temperature differences (dT) on a scale of values between 0 and 15 degrees C. For each municipality, NDVI and dT were calculated for a 3x3 pixel (9 km(2) area) grid and analyzed for relationships to prevalence of schistosomiasis. Results showed a statistically significant relationship of prevalence to dT (rho=-0.218) and NDVI (rho=0.384) at the 95% level of confidence by the Spearman rank correlation coefficient. Results support use of NDVI, dT, dry period climatic stress factors and human population density for development of a GIS environmental risk assessment model for schistosomiasis in Brazil.

Management of Stage IV Macular Holes: When Standard Surgery Fails

Purpose

To report the surgical outcomes of reoperation of unclosed macular holes after initial vitrectomy with internal limiting membrane peeling.

Procedures

Seven eyes of 7 patients were submitted to a second procedure in which five radial retinal incisions were made, as deep as the retinal pigment epithelium, beginning one hole diameter away from its borders and extending centripetally until the hole's margins, avoiding the papilomacular bundle. Gas tamponade was performed and face-down positioning was recommended.

Results

Anatomical closure was achieved in all cases with the second procedure. Functional success was achieved in every patient; there was no loss of best corrected visual acuity (BCVA) lines. Mean line score gain was 5.6 lines (range 1–9 lines), with a mean final BCVA of 0.42 (range 0.05–0.5).

Conclusions

Perifoveal relaxing incisions in stage IV macular holes that remained unclosed after internal limiting membrane peeling vitrectomy seem to have a positive effect on MH closure rates. Larger case series and an extended follow-up period are necessary in order to assess the efficacy and safety profile of this so far promising technique.

Cervical dilatation over time is a poor predictor of severe adverse birth outcomes: a diagnostic accuracy study

OBJECTIVE

To assess the accuracy of the World Health Organization (WHO) partograph alert line and other candidate predictors in the identification of women at risk of developing severe adverse birth outcomes.

DESIGN

A facility-based, multicentre, prospective cohort study.

SETTING

Thirteen maternity hospitals located in Nigeria and Uganda.

POPULATION

A total of 9995 women with spontaneous onset of labour presenting at cervical dilatation of ≤6 cm or undergoing induction of labour.

METHODS

Research assistants collected data on sociodemographic, anthropometric, obstetric, and medical characteristics of study participants at hospital admission, multiple assessments during labour, and interventions during labour and childbirth. The alert line and action line, intrapartum monitoring parameters, and customised labour curves were assessed using sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and the J statistic.

OUTCOMES

Severe adverse birth outcomes.

RESULTS

The rate of severe adverse birth outcomes was 2.2% (223 women with severe adverse birth outcomes), the rate of augmentation of labour was 35.1% (3506 women), and the caesarean section rate was 13.2% (1323 women). Forty-nine percent of women in labour crossed the alert line (4163/8489). All reference labour curves had a diagnostic odds ratio ranging from 1.29 to 1.60. The J statistic was less than 10% for all reference curves.

CONCLUSIONS

Our findings suggest that labour is an extremely variable phenomenon, and the assessment of cervical dilatation over time is a poor predictor of severe adverse birth outcomes. The validity of a partograph alert line based on the 'one-centimetre per hour' rule should be re-evaluated.

FUNDING

Bill & Melinda Gates Foundation, United States Agency for International Development (USAID), UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and WHO (A65879).

TWEETABLE ABSTRACT

The alert line in check: results from a WHO study.

Haematogenous spread of Sporothrix schenckii in cats with naturally acquired sporotrichosis

The recovery of Sporothrix schenckii from blood samples is rare, and the diagnosis of systemic sporotrichosis is usually made at necropsy. In this report, S schenckii was isolated from two or more internal organs of nine necropsied cats with naturally acquired sporotrichosis. Haematogenous spread was demonstrated in vivo by the isolation of S schenckii from the peripheral blood of 17 (n = 49, 34.4 per cent) cats. Feline leukaemia virus (FeLV) was not detected, and co-infection with feline immunodeficiency virus (FIV), observed in nine cases (n = 43, 20.9 per cent), apparently did not affect the isolation of S schenckii from peripheral blood or from the internal organs.

Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria

The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations to introduce new vaccines. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions. Efforts to support country-level decision-making have largely focused on establishing global policies and equipping policy makers with the information to support decision-making on new vaccine introduction (NVI). Less attention has been given to understanding the interactions of policy actors and how the distribution of influence affects the policy process and decision-making. Social network analysis (SNA) is a social science technique concerned with explaining social phenomena using the structural and relational features of the network of actors involved. This approach can be used to identify how information is exchanged and who is included or excluded from the process. For this SNA of vaccine decision-making in Nigeria, we interviewed federal and state-level government officials, officers of bilateral and multilateral partner organizations, and other stakeholders such as health providers and the media. Using data culled from those interviews, we performed an SNA in order to map formal and informal relationships and the distribution of influence among vaccine decision-makers, as well as to explore linkages and pathways to stakeholders who can influence critical decisions in the policy process. Our findings indicate a relatively robust engagement of key stakeholders in Nigeria. We hypothesized that economic stakeholders and implementers would be important to ensure sustainable financing and strengthen programme implementation, but some economic and implementation stakeholders did not appear centrally on the map; this may suggest a need to strengthen the decision-making processes by engaging these stakeholders more centrally and earlier.

Signs of stigma and poor mental health among carriers of MRSA

BACKGROUND

Many countries have implemented guidelines to prevent transmission of meticillin-resistant Staphylococcus aureus (MRSA). Important contextual factors of stigma can be identified in the context of MRSA. Over the past decade, concerns have been raised over a possible stigmatizing effect of these actions.

AIM

To identify and quantify the occurrence of MRSA-associated stigma, and to explore its association with mental health in a country with an MRSA 'search and destroy' policy.

METHODS

In 2014, a questionnaire study among 57 Dutch MRSA carriers (people that carry MRSA without signs of MRSA infection) was performed. Stigma was measured with an adjusted version of the Berger HIV Stigma Scale. Mental health was measured with the five-item RAND Mental Health Inquiry.

FINDINGS

Thirty-two (56%) MRSA carriers reported stigma; of these, eight (14%) reported 'clear stigma' (Berger score >110) and 24 (42%) reported 'suggestive for stigma' (Berger score 76-110). Educational level, female sex and intensive MRSA eradication therapy were associated with higher stigma scores. Poor mental health (RAND score <60) was reported by 33% of MRSA carriers. Stigma and mental health scores were inversely correlated. Stigma was experienced most frequently in healthcare settings, and was seldom experienced in the religious community or at sport facilities.

CONCLUSION

A substantial proportion of MRSA carriers reported stigma due to MRSA, and stigma was associated with poor mental health. Anticipation of MRSA-associated stigma is warranted, both in the way that care is delivered by hospital staff and in the way that care is organized within the hospital.

Gender-dependent expression of leading and passenger strand of miR-21 and miR-16 in human colorectal cancer and adjacent colonic tissues

miRNAs are small regulatory RNA molecules involved in posttranscriptional gene silencing. Their biosynthesis results in the formation of duplex consisting of a leading and a passenger strand of mature miRNA. The leading strand exhibits the main activity but recent findings indicate a certain role of the passenger strand as well. Deregulated levels of miRNA were found in many types of cancers including colorectal cancer. miR-21 and miR-16 were indicated as possible markers of colorectal cancer, however, small attention to gender differences in their expression was paid so far. Therefore, the aim of our study was to investigate the expression of miR-21-5p, miR-21-3p, miR-16-5p and miR-16-3p in human colorectal cancer tissue and compare it to the adjacent tissues taken during surgery in men and women separately. Our results showed an up-regulation of all measured miRNAs in tumor tissue compared to adjacent tissues. As expected, tumors and adjacent tissues exhibited a significantly higher expression of leading miRNAs compared to passenger strand of miR-21 and miR-16. The expression of leading and passenger strand of miR-21 and miR-16 positively correlated exhibiting the highest correlation coefficient in the distal tissue. The expression pattern showed gender-dependent differences, with higher levels of miRNA in men than in women. Our findings indicate a gender-related expression pattern of miRNA, which should be considered as an important factor in generating new prognostic or diagnostic biomarkers.

Implementation of intersectoral community approaches targeting childhood obesity: a systematic review

The implementation of intersectoral community approaches targeting childhood obesity (IACO) is considered challenging. To help overcome these challenges, an overview of the evidence to date is needed. We searched four databases to identify papers that reported on the determinants of successful implementation of IACOs, resulting in the inclusion of 25 studies. We appraised study quality with the Crowe Critical Appraisal Tool and the Quality Framework; reported implementation outcome indicators were reviewed via narrative synthesis. Quality of included studies varied. The most frequently reported indicators of implementation success were fidelity and coverage. Determinants related to the social-political context and the organization were most often cited as influencing implementation, in particular, 'collaboration between community partners', 'the availability of (human) resources' and 'time available for implementation'. The association between determinants and implementation variability was never explicated. We conclude that although some insights into the effective implementation of IACOs are present, more research is needed. Emphasis should be placed on elucidating the relationship between determinants and implementation success. Research should further focus on developing a 'golden standard' for evaluating and reporting on implementation research. These actions will improve the comparison of study outcomes and may constitute the cumulative development of knowledge about the conditions for designing evidence-based implementation strategies.

Validation of a Portuguese version of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea: Analysis in a sleep clinic

INTRODUCTION

Screening methods have become increasingly important owing to the growing number of patients suspected of obstructive sleep apnea (OSA) being referred for sleep consultation. The STOP-Bang questionnaire has been validated as a screening tool for OSA in surgical patients.

OBJECTIVES

To evaluate the performance of a Portuguese version of the STOP-Bang questionnaire for the diagnosis of OSA in a sleep clinic.

METHODS

Prospectively, for 2 months, all patients referred to our clinic for clinical evaluation completed a translated version of the STOP-Bang questionnaire in Portuguese and underwent a sleep study.

RESULTS

We observed 216 patients and 215 (99.5%) were included. Age was 53.63±13.10 years, 63.3% were male patients, neck circumference was 40.4±44.11 cm and BMI was 29.41 [26.85; 33.06] kg/m(2). OSA was present in 78% of the patients, of whom, 33% had moderate and 37% had severe OSA. A STOP-Bang score ≥3 had a sensitivity and positive predictive value (PPV) for OSA of 93.4% and 86.6%, respectively. Each increase in the STOP-Bang score was associated with an increase in the probability of OSA and severe OSA; reaching a 95% OSA probability, for a score of 6, and a 73% severe OSA probability, for a score of 8. A score of 3 and 2 had a negative predictive value for moderate/severe OSA of 85.3% and 91.7%, respectively.

CONCLUSIONS

The STOP-Bang questionnaire showed high sensitivity and PPV for OSA with the probability of severe OSA steadily increasing, the higher the scores. Furthermore, a low score showed high predictive value for the exclusion of moderate/severe OSA. The STOP-Bang questionnaire can be a powerful tool for stratifying patients in the diagnosis of OSA.

In vitro biocompatibility study approaches to evaluate the safety profile of electrolyzed water for skin and eye

Electrolyzed water (EW) is a widely used disinfectant agent with high oxidation–reduction potential (ORP). Although EW has been used in many areas, such as food hygiene, agriculture, and animal husbandry, the studies presented in the literature are not enough to clarify the toxic effects of EW. The aim of this study is, therefore, to produce EWs at different pH, ORP, and chlorine concentrations and to assess their safety in terms of toxicology. At the beginning of the study, the antimicrobial activity of the EW types with respect to bacteria and fungus was investigated. EWs below pH 7 were all effective in inactivating Enterococcus hirae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans completely. In vitro studies of cell cultures revealed that different concentrations of EWs were not cytotoxic for the L929 cells under 10- to 80-fold dilutions. In addition, it has been determined that produced EWs did not have irritation potential, according to the in vitro EpiDerm™, reconstituted skin irritation test in the frames of biocompatibility tests. For the mucous membrane irritation test, the hen’s egg test-chorioallantoic membrane experiment was performed, and EWs were found to have no eye irritation. In conclusion, it has been shown that produced EWs with antimicrobial efficacy were found to be safe for skin and eye according to in vitro biocompatibility study studies. Thus, the establishment of a technological infrastructure for the EW production and the use of produced EW as an effective disinfectant in the food, medical, and agricultural areas should be encouraged.

Epilepsy and self-identity among the Dutch

This article discusses the relationship between societal images of epilepsy and the self-identity of Dutch people with epilepsy. I show that the condition of having epilepsy is only constructed as chronic if people continue to have seizures. Chronic epilepsy, or "real epilepsy" as it is sometimes called, is not burdened with such classic stereotypes as "the epileptic personality" or "the epileptic genius." However, Dutch people replace these stereotypes with stereotypes based on ideas about "tension" and "weak spots"--phenomena that are allegedly linked to "sensitive," "brooding" types of people and that are thought to trigger epileptic seizures. Thus there develops a notion of self related to frequency of epileptic seizures. Those who are close to people with epilepsy--relatives and non-medical professionals--play an important role in this development.

Modulation of cigarette smoke extract-induced human bronchial epithelial damage by eucalyptol and curcumin

Smoking is one of the most important leading death cause worldwide. From a toxicological perspective, cigarette smoke serves hazards especially for the human being exposed to passive smoke. Over the last decades, the effects of natural compounds on smoking-mediated respiratory diseases such as COPD, asthma, and lung cancer have been under investigation, as well as the mechanistic aspects of disease progression. In the present study, the protective mechanism of eucalyptol (EUC), curcumin (CUR), and their combination on BEAS-2B cells were investigated in vitro to understand their impact on cell death, oxidative cell injury, and inflammatory response induced by 3R4F reference cigarette extract (CSE). According to the present findings, EUC, CUR, and their combination improved cell viability, attenuated CSE-induced apoptosis, and LC3B expression. Further, CSE-induced oxidative damage and inflammatory response in human bronchial epithelial cells were remarkably reduced by the combination treatment through modification of enzymatic antioxidant activity, GSH, MDA, and intracellular ROS levels as well as nitrite and IL-6 levels. In addition, nuclear translocation of Nrf2, a regulatory protein involved in the indirect antioxidant response, was remarkably up-regulated with the combination pre-treatment. In conclusion, EUC and CUR in combination might be a potential therapeutic against smoking-induced lung diseases through antioxidant and inflammatory pathways and results represent valuable background for future in vivo pulmonary toxicity studies.

Mycological evaluation of bronchoalveolar lavage in cats with respiratory signs from Rio de Janeiro, Brazil

Twenty-three cats with respiratory signs who had domiciliary contact with cats with sporotrichosis were studied. Sneezing was the predominant extracutaneous sign. Twelve cats had no skin lesions and 11 had ulcerated skin lesions. Mycological culture of material obtained from the nasal cavity, oral cavity, bronchoalveolar lavage (BAL) and skin lesions, when present, was performed for all cats. In the case of autopsy, lung fragments were cultured. Sporothrix schenckii was isolated from four of the 12 cats without skin lesions: BAL (one cat) and oral and/or nasal cavity (three cats). The latter three animals developed nasal and distant skin lesions within the following 2-4 weeks. The cat with S. schenckii isolated from BAL did not develop skin lesions or lower respiratory tract symptoms during the 6 months of follow-up. S. schenckii was isolated from one or more biological samples of all 11 cats with skin lesions: oral cavity (five), nasal cavity (eight), BAL fluid (four), skin lesions (eight), and blood culture (one). No yeast-like structures were observed upon BAL cytology in any of the 23 cats. The results suggest that S. schenckii can cause infection of skin contiguous to the natural facial orifices through colonisation of the mucosal surfaces of the upper airways.