scholarly journals Predictors of Surgical Candidacy in 414 Epilepsy Patients Admitted to the EMU

2013 ◽  
Vol 40 (3) ◽  
pp. 372-377 ◽  
Author(s):  
Alireza Mansouri ◽  
Aria Fallah ◽  
George M. Ibrahim ◽  
Taufik A. Valiante
Keyword(s):  
Refractory Epilepsy ◽  
Male Gender ◽  
Eeg Analysis ◽  
Multivariate Logistic Regression ◽  
Toronto Western Hospital ◽  
Resource Limitations ◽  
Patient Admissions ◽  
Surgical Evaluation ◽  
Male Patients ◽  
Epilepsy Monitoring

Objectives:Admission to an Epilepsy Monitoring Unit (EMU) is essential for pre-surgical evaluation of patients with medically-refractory epilepsy; however, prolonged referral times and resource limitations are significant access barriers. Therefore, identification of pre-EMU variables that predict potential surgical candidates can assist in the triage of patient admissions to the EMU.Methods:In this hypothesis-generating study, a retrospective analysis of patients admitted for pre-surgical evaluation to the Toronto Western Hospital EMU (2004-2011) was performed. Univariate and multivariate logistic regression was used to identify variables that could independently predict subsequent surgical candidacy following EMU evaluation.Results:Four hundred and fourteen patients were admitted to the EMU. Overall, 259 patients (62.5%) were identified as potential surgical candidates. One hundred and seven patients (25.8%) required invasive electroencephalogram (iEEG) implantations; of 75 patients consenting to iEEG analysis 39 underwent a subsequent resective procedure. Male patients and those with a lesion on MRI were 1.9 times more likely to be surgical candidates (95% CI 1.18-2.98 and 0.94-3.80, respectively), while patients with non-localizable seizures were seven times less likely (95% CI 0.02-1.25).Conclusion:In this retrospective, hypothesis-generating study male gender, presence of a lesion on MRI and localizable seizures on routine outpatient EEG analysis independently predicted subsequent resective epilepsy surgical candidacy in EMU patients. Upon validation by other studies, these variables may be considered by clinicians referring patients to the EMU in order to improve wait times and optimize patient care.

scholarly journals Sleep apnoea is a risk factor for severe COVID-19

2021 ◽  
Vol 8 (1) ◽  
pp. e000845
Author(s):  
Satu Strausz ◽  
Tuomo Kiiskinen ◽  
Martin Broberg ◽  
Sanni Ruotsalainen ◽  
Jukka Koskela ◽  
...  
Keyword(s):  
Risk Factor ◽  
Independent Risk Factor ◽  
Causes Of Death ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Male Gender ◽  
Multivariate Logistic Regression Model ◽  
Multivariate Logistic Regression ◽  
Obstructive Sleep ◽  
Positive Controls

BackgroundObstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19.We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19.MethodsOSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies.ResultsWe identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10−5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021).ConclusionRisk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19.

Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature

2012 ◽  
Vol 32 (3) ◽  
pp. E12 ◽  
Author(s):  
David E. Connor ◽  
Menarvia Nixon ◽  
Anil Nanda ◽  
Bharat Guthikonda
Keyword(s):  
Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Epileptiform Activity ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Class I ◽  
Class Iii ◽  
Surgical Evaluation ◽  
Pediatric Populations ◽  
Medically Refractory Epilepsy

Object The authors conducted a study to evaluate the published results of vagal nerve stimulation (VNS) for medically refractory seizures according to evidence-based criteria. Methods The authors performed a review of available literature published between 1980 and 2010. Inclusion criteria for articles included more than 10 patients evaluated, average follow-up of 1 or more years, inclusion of medically refractory epilepsy, and consistent preoperative surgical evaluation. Articles were divided into 4 classes of evidence according to criteria established by the American Academy of Neurology. Results A total of 70 publications were reviewed, of which 20 were selected for review based on inclusion and exclusion criteria. There were 2 articles that provided Class I evidence, 7 that met criteria for Class II evidence, and 11 that provided Class III evidence. The majority of evidence supports VNS usage in partial epilepsy with a seizure reduction of 50% or more in the majority of cases and freedom from seizure in 6%–27% of patients who responded to stimulation. High stimulation with a gradual increase in VNS stimulation over the first 6 weeks to 3 months postoperatively is well supported by Class I and II data. Predictors of positive response included absence of bilateral interictal epileptiform activity and cortical malformations. Conclusions Vagal nerve stimulation is a safe and effective alternative for adult and pediatric populations with epilepsy refractory to medical and other surgical management.

Occupational silica exposure in an Australian systemic sclerosis cohort

Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3900-3905 ◽  
Author(s):  
Shreeya Patel ◽  
Kathleen Morrisroe ◽  
Susanna Proudman ◽  
Dylan Hansen ◽  
Joanne Sahhar ◽  
...  
Keyword(s):  
Physical Disability ◽  
Poor Prognosis ◽  
Multivariable Analysis ◽  
Clinical Manifestations ◽  
Subsequent Development ◽  
Male Gender ◽  
Disease Course ◽  
Silica Exposure ◽  
Disease Characteristics ◽  
Male Patients

Abstract Objective To determine the frequency of self-reported occupational exposure to silica in SSc patients enrolled in the Australian Scleroderma Cohort Study, and to compare the disease characteristics of the silica-exposed patients with those of the non-exposed patients. Method Data collected over a 12-year period from 1670 SSc patients were analysed. We compared the demographic and clinical characteristics of those who reported occupational silica exposure with those who did not. A subgroup analysis of male patients was performed, as well as a multivariable analysis of correlates of silica exposure. Results Overall, 126 (7.5%) of the cohort reported occupational silica exposure. These individuals were more likely to be male (73 of 231, i.e. 31.6% males exposed) and to have worked in mining and construction industries. Those who reported silica exposure were younger at the onset of SSc skin involvement [odds ratio (OR) 0.9, P = 0.02], of male gender (OR 14.9, P < 0.001), have joint contractures (OR 1.8, P = 0.05) and have higher physical disability as defined by scleroderma HAQ (OR 1.4, P = 0.01). Conclusion The highest percentage of silica exposure was found in males. These patients were more likely to have the presence of certain clinical manifestations and Scl-70 antibody, which is known to confer a poor prognosis. These findings support the association between occupational silica exposure and the subsequent development of SSc. Further investigation is required to describe the range of clinical manifestations and disease course, including prognosis and treatment response, in those diagnosed with occupationally induced SSc compared with idiopathic SSc.

Proportion of Unmarried Siblings of Homosexual and Non Homosexual Gender-Dysphoric Patients*

1992 ◽  
Vol 37 (3) ◽  
pp. 163-167 ◽  
Author(s):  
Ray Blanchard ◽  
Peter M. Sheridan
Keyword(s):  
Logistic Regression ◽  
Common Law ◽  
Male Gender ◽  
The Other ◽  
Heterosexual Relationships ◽  
Homosexual Male ◽  
Sexual Histories ◽  
Male Patients ◽  
Romantic Interest

Among the siblings of homosexuals, a lack of sexual and romantic interest in women may be independent of erotic feelings for men. This study investigated the sexual histories of siblings of gender-dysphoric outpatients. The patients were classified into three groups: non homosexual males, homosexual males and homosexual females. Their siblings consisted of 301 brothers and 284 sisters over the age of 25. Logistic regression showed that the brothers of the homosexual male patients were significantly less likely to have been married, either legally or common-law, than the brothers of the other gender-dysphoric groups, even with age and relative birth order taken into account. This finding suggests that the low propensity for long term heterosexual relationships seen in homosexual male gender-dysphoric patients also tends to appear in their brothers.

The Maudsley bipolar disorder project Clinical characteristics of bipolar disorder I in a Catchment area treatment sample

2003 ◽  
Vol 18 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Vanessa Raymont ◽  
David Bettany ◽  
Sophia Frangou
Keyword(s):  
Bipolar Disorder ◽  
Substance Abuse ◽  
Catchment Area ◽  
Clinical Characteristics ◽  
Age Of Onset ◽  
Psychiatric Service ◽  
Male Gender ◽  
Younger Age ◽  
Male Patients ◽  
Psychotic Features

AbstractThe clinical characteristics of bipolar I disorder (BD1) have prognostic and therapeutic importance. The aim of this study was to examine the effect of demographic and clinical variables on the course of BD1. We reviewed the case notes of all BD1 patients (n = 63) receiving treatment in a London psychiatric service during a 1-month period. Depressive and manic onsets were equally likely without any gender difference. The earlier the age of onset, the more likely it was for patients to experience psychotic features. Only depressive onsets predicted a higher number of episodes of the same polarity. Male gender and substance abuse were associated with younger age at first presentation, while women with co-morbid substance abuse had more manic episodes. Male patients were more likely than females to be unemployed or single.

scholarly journals Vitamin D Serum Levels in Subjects Tested for SARS-CoV-2: What Are the Differences among Acute, Healed, and Negative COVID-19 Patients? A Multicenter Real-Practice Study

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3932
Author(s):  
Luca Gallelli ◽  
Gaia Chiara Mannino ◽  
Filippo Luciani ◽  
Alessandro de Sire ◽  
Elettra Mancuso ◽  
...  
Keyword(s):  
Vitamin D ◽  
Hypovitaminosis D ◽  
Serum Levels ◽  
Male Gender ◽  
Active Vitamin ◽  
Significant Difference ◽  
Male Patients ◽  
Practice Study ◽  
Real Practice ◽  
Fast Acting

Vitamin D might play a role in counteracting COVID-19, albeit strong evidence is still lacking in the literature. The present multicenter real-practice study aimed to evaluate the differences of 25(OH)D3 serum levels in adults tested for SARS-CoV-2 (acute COVID-19 patients, subjects healed from COVID-19, and non-infected ones) recruited over a 6-month period (March–September 2021). In a sample of 117 subjects, a statistically significant difference was found, with acute COVID-19 patients demonstrating the lowest levels of serum 25(OH)D3 (9.63 ± 8.70 ng/mL), significantly lower than values reported by no-COVID-19 patients (15.96 ± 5.99 ng/mL, p = 0.0091) and healed COVID-19 patients (11.52 ± 4.90 ng/mL, p > 0.05). Male gender across the three groups displayed unfluctuating 25(OH)D3 levels, hinting at an inability to ensure adequate levels of the active vitamin D3 form (1α,25(OH)2D3). As a secondary endpoint, we assessed the correlation between serum 25(OH)D3 levels and pro-inflammatory cytokine interleukin-6 (IL-6) in patients with extremely low serum 25(OH)D3 levels (<1 ng/mL) and in a subset supplemented with 1α,25(OH)2D3. Although patients with severe hypovitaminosis-D showed no significant increase in IL-6 levels, acute COVID-19 patients manifested high circulating IL-6 at admission (females = 127.64 ± 22.24 pg/mL, males = 139.28 ± 48.95 ng/mL) which dropped drastically after the administration of 1α,25(OH)2D3 (1.84 ± 0.77 pg/mL and 2.65 ± 0.92 ng/mL, respectively). Taken together, these findings suggest that an administration of 1α,25(OH)2D3 might be helpful for treating male patients with an acute COVID-19 infection. Further studies on rapid correction of vitamin D deficiency with fast acting metabolites are warranted in COVID-19 patients.

scholarly journals In-hospital Mortality in SARS-CoV-2 stratified by Gender: A Retrospective Study

2021 ◽  
Author(s):  
Mohammed Al Jarallah ◽  
Rajesh Rajan ◽  
Raja Dashti ◽  
Ahmad R Alsabar ◽  
Jiazhu Pan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Independent Predictor ◽  
Average Length ◽  
Female Gender ◽  
Mortality Rates ◽  
Male Gender ◽  
Hospital Death ◽  
Male Patients ◽  
Length Of Hospitalization

Abstract Background: The aim of this study was to determine in-hospital mortality in patients presenting with acute respiratory syndrome corona virus 2 (SARS-CoV-2) and to evaluate for any differences in outcome according to gender. Methods: Patients with SRS-CoV-2 infection were recruited into this retrospective cohort study between February 26 and September 8, 2020 and strаtified ассоrding tо the gender. Results: In tоtаl оf 3360 раtients (meаn аge 44 ± 17 years) were included, of whom 2221 (66%) were mаle. The average length of hospitalization was 13 days (range: 2–31 days). During hospitalization and follow-up 176 patients (5.24%) died. Mortality rates were significantly different according to gender (p=<0.001). Specifically, male gender was associated with significantly greater mortality when compared to female gender with results significant at an alpha of 0.05, LL = 28.67, df = 1, p = 0.001, suggesting that gender could reliably determine mortality rates. The coefficient for the males was significant, B = 1.02, SE = 0.21, HR = 2.78, p< .001, indicating that an observation in the male category will have a hazard 2.78 times greater than that in the female category. Multivariate logistic regression confirmed male patients admitted with SARS-CoV-2had higher сumulаtive аll-саuse in-hоsрitаl mоrtаlity (6.8% vs. 2.3%; аdjusted оdds rаtiо (аОR), 2.80; 95% (СI): [1.61 - 5.03]; р < 0.001). Conclusions: Male gender was an independent predictor of in-hospital death in this study. The mortality rate among male SARS-CoV-2 patients was 2.8 times higher when compared with females.

scholarly journals Intraoperative computed tomography for intracranial electrode implantation surgery in medically refractory epilepsy

2015 ◽  
Vol 122 (3) ◽  
pp. 526-531 ◽  
Author(s):  
Darrin J. Lee ◽  
Marike Zwienenberg-Lee ◽  
Masud Seyal ◽  
Kiarash Shahlaie
Keyword(s):  
Wound Closure ◽  
Refractory Epilepsy ◽  
Ct Scans ◽  
Surgical Team ◽  
Electrode Implantation ◽  
Mri Studies ◽  
Subdural Electrode ◽  
Intracranial Electrode ◽  
Epilepsy Monitoring ◽  
Medically Refractory Epilepsy

OBJECT Accurate placement of intracranial depth and subdural electrodes is important in evaluating patients with medically refractory epilepsy for possible resection. Confirming electrode locations on postoperative CT scans does not allow for immediate replacement of malpositioned electrodes, and thus revision surgery is required in select cases. Intraoperative CT (iCT) using the Medtronic O-arm device has been performed to detect electrode locations in deep brain stimulation surgery, but its application in epilepsy surgery has not been explored. In the present study, the authors describe their institutional experience in using the O-arm to facilitate accurate placement of intracranial electrodes for epilepsy monitoring. METHODS In this retrospective study, the authors evaluated consecutive patients who had undergone subdural and/or depth electrode implantation for epilepsy monitoring between November 2010 and September 2012. The O-arm device is used to obtain iCT images, which are then merged with the preoperative planning MRI studies and reviewed by the surgical team to confirm final positioning. Minor modifications in patient positioning and operative field preparation are necessary to safely incorporate the O-arm device into routine intracranial electrode implantation surgery. The device does not obstruct surgeon access for bur hole or craniotomy surgery. Depth and subdural electrode locations are easily identified on iCT, which merge with MRI studies without difficulty, allowing the epilepsy surgical team to intraoperatively confirm lead locations. RESULTS Depth and subdural electrodes were implanted in 10 consecutive patients by using routine surgical techniques together with preoperative stereotactic planning and intraoperative neuronavigation. No wound infections or other surgical complications occurred. In one patient, the hippocampal depth electrode was believed to be in a suboptimal position and was repositioned before final wound closure. Additionally, 4 strip electrodes were replaced due to suboptimal positioning. Postoperative CT scans did not differ from iCT studies in the first 3 patients in the series and thus were not obtained in the final 7 patients. Overall, operative time was extended by approximately 10–15 minutes for O-arm positioning, less than 1 minute for image acquisition, and approximately 10 minutes for image transfer, fusion, and intraoperative analysis (total time 21–26 minutes). CONCLUSIONS The O-arm device can be easily incorporated into routine intracranial electrode implantation surgery in standard-sized operating rooms. The technique provides accurate 3D visualization of depth and subdural electrode contacts, and the intraoperative images can be easily merged with preoperative MRI studies to confirm lead positions before final wound closure. Intraoperative CT obviates the need for routine postoperative CT and has the potential to improve the accuracy of intracranial electroencephalography recordings and may reduce the necessity for revision surgery.

P.020 Septo-optic dysplasia plus manifesting with medically refractory epilepsy

2016 ◽  
Vol 43 (S2) ◽  
pp. S26-S26
Author(s):  
MO Al.Khateeb ◽  
S Mirsattari ◽  
D Diosy ◽  
R McLachlan
Keyword(s):  
Refractory Epilepsy ◽  
Intractable Epilepsy ◽  
Nerve Stimulator ◽  
Vagus Nerve Stimulator ◽  
Malformation Of Cortical Development ◽  
Functional Hemispherectomy ◽  
London Health ◽  
Epilepsy Monitoring ◽  
Video Eeg ◽  
Medically Refractory Epilepsy

Background: Septo-Optic Dysplasia is a rare disorder with developmental malformations that was first reported by De Morsier.SOD associated with refractory epilepsy has not been well studied. We report six cases with SOD in patients with malformation of cortical development(MCD) and medically refractory epilepsy that underwent video-EEG telemetry. Methods: Six cases of SOD plus were admitted to the Epilepsy Monitoring Unit at London Health Sciences Centre because of medically refractory epilepsy. Functional hemispherectomy in one patient resulted in significant reduction of her seizures while insertion of a vagus nerve stimulator was not successful in controlling seizures in another patient. Right temporal resection for one patient resulted in about 60% reduction in her seizures. The remaining three patients were not surgical candidates and they remained on antiepileptic drugs. Results: MCD was present in 4/6 patients. Bilateral optic nerve hypoplasia was found in 50% of the patients. EEG was abnormal in all cases(6/6).Intractable epilepsy was found in 6/6 patients. Conclusions: SOD plus was associated with medically refractory epilepsy.

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