Provider Practices of Phenobarbital Discontinuation in Neonatal Seizures

2017 ◽  
Vol 33 (2) ◽  
pp. 153-157 ◽  
Author(s):  
Niranjana Natarajan ◽  
Christopher W. Beatty ◽  
Juliane Gust ◽  
Lorie Hamiwka
Keyword(s):  
Seizure Control ◽  
Prolonged Treatment ◽  
Published Data ◽  
Neonatal Seizures ◽  
Early Discontinuation ◽  
Treatment Length ◽  
Provider Practices ◽  
Factors Influencing ◽  
Symptomatic Seizures ◽  
Infectious Etiology

Neonatal seizures are treated with phenobarbital and prolonged treatment does not prevent postneonatal epilepsy. The authors documented factors influencing phenobarbital use and determined whether published data changed practice. A total of 83 neonates with symptomatic seizures, clinical or electrographic, were evaluated for treatment, incidence of postneonatal epilepsy, and associated factors. Median phenobarbital treatment was 81 days. Nineteen children (23%) developed postneonatal epilepsy. Longer duration of seizures and an infectious etiology were associated with postneonatal epilepsy suggesting no impact on duration of phenobarbital treatment. Treatment duration was associated with duration of seizures and use of a second antiseizure medication. This study supports early discontinuation of phenobarbital and suggests providers utilize factors such as use of a second antiseizure medication and time to seizure control to determine phenobarbital duration, despite prior studies suggesting no impact of treatment length.

scholarly journals Midazolam for treatment of refractory neonatal seizures: a case report

1994 ◽  
Vol 52 (2) ◽  
pp. 260-262 ◽  
Author(s):  
José Luiz Dias Gherpelli ◽  
Francisco José C. Luccas ◽  
Israel Roitman ◽  
Eduardo Juan Troster
Keyword(s):  
Case Report ◽  
Status Epilepticus ◽  
Continuous Infusion ◽  
Seizure Control ◽  
Neonatal Period ◽  
Hyaline Membrane Disease ◽  
Water Soluble ◽  
Neonatal Seizures ◽  
Hyaline Membrane ◽  
Ischemic Encephalopathy

Midazolam is a short-acting water soluble benzodiazepine that has been used with an increasing frequency in the last years. Although there are reports on its use in status epilepticus, there is none in the neonatal period. A pre-term (35 w) AGA newborn infant with a severe hypoxic-ischemic encephalopathy secondary to grade ED hyaline membrane disease developed status epilepticus in the first 6 hours of life and was successfully treated with midazolam after phenobarbital and phenytoin failed to achieve seizure control. Dosage schedule was 0.2 mg/kg IV, followed by continuous infusion of 0.025 mg/kg/h. Midazolam is an effective drug for neonatal status epilepticus and more experience should accumulate before it can be routinely employed in the neonatal period. This case shows that it is a possible option before using more dangerous drugs, such as thionembutal.

scholarly journals Factors influencing early discontinuation in a 3-month group weight loss program

2014 ◽  
Vol 1 ◽  
pp. 1-5
Author(s):  
Tomasz Wikarek ◽  
Barbara Zahorska-Markiewicz ◽  
Wojciech Gruszka ◽  
Piotr Dąbrowski ◽  
Kamil Barański ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Loss Program ◽  
Early Discontinuation ◽  
Factors Influencing

scholarly journals Profile of neonatal epilepsies

Neurology ◽  
2017 ◽  
Vol 89 (9) ◽  
pp. 893-899 ◽  
Author(s):  
Renée A. Shellhaas ◽  
Courtney J. Wusthoff ◽  
Tammy N. Tsuchida ◽  
Hannah C. Glass ◽  
Catherine J. Chu ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Diagnostic Testing ◽  
Epileptic Encephalopathy ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Epileptic Encephalopathies ◽  
Brain Malformations ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures ◽  
Structural Brain

Objective:Although individual neonatal epilepsy syndromes are rare, as a group they represent a sizable subgroup of neonatal seizure etiologies. We evaluated the profile of neonatal epilepsies in a prospective cohort of newborns with seizures.Methods:Consecutive newborns with seizures were enrolled in the Neonatal Seizure Registry (an association of 7 US children's hospitals). Treatment and diagnostic testing were at the clinicians' discretion. Neonates with seizures related to epileptic encephalopathies (without structural brain abnormalities), brain malformations, or benign familial epilepsies were included in this analysis.Results:Among 611 consecutive newborns with seizures, 79 (13%) had epilepsy (35 epileptic encephalopathy, 32 congenital brain malformations, 11 benign familial neonatal epilepsy [BFNE], 1 benign neonatal seizures). Twenty-nine (83%) with epileptic encephalopathy had genetic testing and 24/29 (83%) had a genetic etiology. Pathogenic or likely pathogenic KCNQ2 variants (n = 10) were the most commonly identified etiology of epileptic encephalopathy. Among 23 neonates with brain malformations who had genetic testing, 7 had putative genetic etiologies. Six infants with BFNE had genetic testing; 3 had pathogenic KCNQ2 variants and 1 had a pathogenic KCNQ3 variant. Comorbid illnesses that predisposed to acute symptomatic seizures occurred in 3/35 neonates with epileptic encephalopathy vs 10/32 with brain malformations (p = 0.03). Death or discharge to hospice were more common among newborns with brain malformations (11/32) than those with epileptic encephalopathy (3/35, p = 0.01).Conclusions:Neonatal epilepsy is often due to identifiable genetic causes. Genetic testing is now warranted for newborns with epilepsy in order to guide management and inform discussions of prognosis.

Parenting and Schizophrenia: An Australian Study of Expressed Emotion

1987 ◽  
Vol 21 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Gordon Parker ◽  
Penny Johnson
Keyword(s):  
Los Angeles ◽  
Expressed Emotion ◽  
The United States ◽  
Demographic Variables ◽  
Published Data ◽  
Australian Study ◽  
Factors Influencing ◽  
Number Of Factors ◽  
Scale Scores ◽  
Family Interview

Parents of 66 schizophrenic Sydney patients were interviewed using the abbreviated Camberwell Family Interview (CFI). Using preestablished criteria, 71% of the mothers, 58% of the fathers and 74% of the households were categorised as being of high expressed emotion (EE) status. Comparison is made with published data on the CFI and on EE categorisation for similar groups studied in England, the United States and India. The Sydney families were described as ‘vocal, ambitious and aggressive’, and EE scale scores more resembled the Los Angeles families than the British families originally studied. A number of factors influencing high EE categorisation (e.g., family intactness, socio-demographic variables) are noted.

Evaluation of Ph+/CD34+ Residual Cells in Chronic Myeloid Leukemia Patients after Long Lasting Treatment with Imatinib Mesylate.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1999-1999
Author(s):  
Monica Bocchia ◽  
Elisabetta Abruzzese ◽  
Micaela Ippoliti ◽  
Simona Calabrese ◽  
Alessandro Gozzetti ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Chronic Myeloid Leukemia ◽  
Imatinib Mesylate ◽  
Median Time ◽  
False Positive ◽  
Myeloid Leukemia ◽  
Prolonged Treatment ◽  
Published Data ◽  
Imatinib Treatment ◽  
Cd34 Cells

Abstract Although the success of imatinib mesylate therapy represents an exciting advance in targeted cancer therapy, it has still to be determined whether responses to this p210 inhibitor in chronic myeloid leukemia (CML) patients will be durable. In fact most of clinical studies agree on the evidence of a persistent molecular disease in the majority of treated patients and altough the absolute level of bcr-abl transcript may vary over the treatment, yet a molecular complete response is of rare observation. In addition, discontinuation of imatinib exerts always in rapid loss of response. In accordance to this the persistence of malignant progenitors in patients in complete cytogenetic response (CCR) after short term imatinib treatment, has been recently demonstrated. In particular, Bathia et al. showed in 12/15 patients studied after a median time of 10 months of imatinib treatment a median of 11% of residual CML CD34+ progenitors in the bone marrow (by FISH Dual Fusion bcr/abl analysis)while only 3/15 patients had no detectable residual CD34+ cells. Less is known about residual Ph+/CD34+ cells surviving after a prolonged therapy with this targeting drug. Thus, we evaluated the amount of bone marrow residual CD34+ cells in 17 CML patients in stable CCR after a long lasting treatment with imatinib. At the time of evaluation, the patients were on conventional dose (400mg) Imatinib for a median time of 48 months (range 36–58 months) having achieved a CCR status (conventionally defined as the complete absence of t(9;22) on caryotypic analysis) within 3 to 6 months of treatment. However all of them still showed molecular disease as detected by nested RT-PCR. Bone marrow CD34+ cell-enriched populations were selected from mononuclear cells using immunomagnetic column separation and were evaluated after cytospin by FISH using a bcr-abl Dual Color Extra Signal Probe(LSI bcr-abl ES, Vysis), that is able to detect bcr-abl fusion in interphase nuclei with a false positive signal rate close to 0. A minimum of 100 CD34+ nuclei per each sample were evaluated. Interestingly, in 8/17 patients no Ph+/CD34+ cells were detected, while in the remaining 9/17 patients a median of 2% (range 0.5–11%) of bcr-abl positive progenitors were still observed. In this small selected serie of patients prolonged treatment with imatinib appears to be correlated with a lower, yet detectable, amount of residual bone marrow Ph+/CD34+ cells when compared to previously published data. This result could be partly explained with the different specificity and sensitivity of the probe used (bcr/abl ES<1% false positive; bcr-abl Dual Fusion 8–10% false positive) The clinical significance of these data as well as the role of this cell target to monitor minimal residual disease in CML needs to be evaluated on a larger serie of patients.

Pre-Earthquake Vulnerability Assessment

1987 ◽  
Vol 3 (1) ◽  
pp. 107-115 ◽  
Author(s):  
Reuben Eldar ◽  
Jakov Adler
Keyword(s):  
Vulnerability Assessment ◽  
Causes Of Death ◽  
Health Planning ◽  
Health Sector ◽  
Health Care Facilities ◽  
Published Data ◽  
Factors Influencing ◽  
Care Facilities ◽  
Significant Magnitude ◽  
Earthquake Vulnerability

AbstractHealth planning for disasters builds on an awareness of ways in which the disaster affects health and on anticipation of tasks to be performed by the health sector.In view of the possibility of an earthquake of significant magnitude in Israel, and in the absence of previous earthquake experience, published data of earthquake health effects were studied, such as causes of death and injury, casualty rates and factors influencing these, distribution of injuries and their severity, effect on health care facilities and on physical, social and psychological environments. Implications of the studied data were applied to relevant conditions in Israel and to an earthquake there. A predisaster vulnerability assessment was thus obtained, pointing to the nature, size, and space and time distribution of tasks the health sector would be expected to perform should an earthquake occur in Israel.On the basis of this assessment some recommendations for the preparation and preparedness of the health sector for such an occurrence are submitted.

Data Analysis of the Inactivation of Foodborne Microorganisms under High Hydrostatic Pressure To Establish Global Kinetic Parameters and Influencing Factors

2011 ◽  
Vol 74 (12) ◽  
pp. 2097-2106 ◽  
Author(s):  
SOFÍA M. SANTILLANA FARAKOS ◽  
MARCEL H. ZWIETERING
Keyword(s):  
Hydrostatic Pressure ◽  
Kinetic Parameters ◽  
High Hydrostatic Pressure ◽  
Bacterial Spores ◽  
Published Data ◽  
Soy Milk ◽  
Microbial Resistance ◽  
Future Studies ◽  
Factors Influencing ◽  
Clostridium Spp

The inactivation rate of foodborne microorganisms under high hydrostatic pressure (HHP) is influenced by factors such as substrate, species, strain, temperature, pH, and stage of growth of the cell. In this study, 445 DP-values from previously published data were analyzed, including those from bacterial spores, vegetative cells, and yeasts. Three secondary linear inactivation models with pressure and/or temperature as process parameters were tested to estimate global log DP-, zP-, and zT-values, and the influence of these parameters and additional factors was assessed. The results show that significant differences in microbial resistance are mainly the result of temperature, highlighting the need for its inclusion as a process parameter. Perhaps due to the large number of data and very distinct factors, the remaining factors showed no significant differences in microbial resistance, except in the case of Clostridium spp. in soy milk, which showed decreased resistance in this substrate compared with its behavior in other products. These results serve to establish priorities among factors influencing HHP inactivation and to estimate global kinetic parameters as a basis for setting target levels of inactivation. Moreover, they can be used as a benchmark for comparison of microbial HHP inactivation data gathered in future studies.

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