A study of psychogenic non-epileptic seizures in an inpatient video-electroencephalography monitoring service in Tabriz, Northwest of Iran

Background: Psychogenic non-epileptic seizures (PNES) are manifested as paroxysmal alterations in motor, sensory, autonomic, and/or cognitive and behavioral signs and symptoms, without associated ictal epileptiform discharges. A misdiagnosis of PNES as epilepsy results in a prolonged and unnecessary (antiepileptic) drug treatment and social and psychological stigma of epilepsy in these patients. This study aimed to determine the epidemiology, clinical manifestations, and associated factors of PNES in hospitalized patients in the video-electroencephalography (EEG) monitoring (VEM) service of Razi Hospital, Tabriz, Iran. Methods: In this cross-sectional descriptive study, 55 patients with a final diagnosis of PNES were selected from the patients referred to the VEM unit of Razi Hospital for the evaluation of epilepsy. The study was performed from May 2017 to June 2019. Patient information included demographic data and medical history (drug history, comorbidities, trauma, and family history). The clinical manifestations (semiology and duration of attacks) and EEG findings, as recorded by VEM during hospitalization, were collected. Results: 55 patients with PNES were studied with VEM, 27 (49.1%) of which were men, and 28 (50.9%) were women. The mean and standard deviation (SD) of age of the patients was 34.16 ± 12.64 years. No significant differences were observed in the semiology of PNES between men and women. Depression was the most common psychiatric comorbidity. Conclusion: The clinical manifestations of PNES in the present study were similar to those in most previous studies from other countries. The culture and sex of the patients did not seem to be a contributing factor in PNES semiology.

Download Full-text

Absence Seizure Detection Algorithm for Portable EEG Devices

Frontiers in Neurology ◽

10.3389/fneur.2021.685814 ◽

2021 ◽

Vol 12 ◽

Author(s):

Pawel Glaba ◽

Miroslaw Latka ◽

Małgorzata J. Krause ◽

Sławomir Kroczka ◽

Marta Kuryło ◽

...

Keyword(s):

Detection Rate ◽

Low Cost ◽

Clinical Manifestations ◽

Epileptic Seizures ◽

Seizure Detection ◽

Detection Algorithm ◽

Absence Epilepsy ◽

Absence Seizure ◽

Epileptiform Discharges ◽

Morlet Continuous Wavelet Transform

Absence seizures are generalized nonmotor epileptic seizures with abrupt onset and termination. Transient impairment of consciousness and spike-slow wave discharges (SWDs) in EEG are their characteristic manifestations. This type of seizure is severe in two common pediatric syndromes: childhood (CAE) and juvenile (JAE) absence epilepsy. The appearance of low-cost, portable EEG devices has paved the way for long-term, remote monitoring of CAE and JAE patients. The potential benefits of this kind of monitoring include facilitating diagnosis, personalized drug titration, and determining the duration of pharmacotherapy. Herein, we present a novel absence detection algorithm based on the properties of the complex Morlet continuous wavelet transform of SWDs. We used a dataset containing EEGs from 64 patients (37 h of recordings with almost 400 seizures) and 30 age and sex-matched controls (9 h of recordings) for development and testing. For seizures lasting longer than 2 s, the detector, which analyzed two bipolar EEG channels (Fp1-T3 and Fp2-T4), achieved a sensitivity of 97.6% with 0.7/h detection rate. In the patients, all false detections were associated with epileptiform discharges, which did not yield clinical manifestations. When the duration threshold was raised to 3 s, the false detection rate fell to 0.5/h. The overlap of automatically detected seizures with the actual seizures was equal to ~96%. For EEG recordings sampled at 250 Hz, the one-channel processing speed for midrange smartphones running Android 10 (about 0.2 s per 1 min of EEG) was high enough for real-time seizure detection.

Download Full-text

The Frequency and Causes of Subepidermal Gaps or Blisters and the Compliance Rate Between Clinical Diagnosis and Pathology Reports from 2015 to 2019

Journal of Skin and Stem Cell ◽

10.5812/jssc.118423 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Abbas Darjani ◽

Hojat Eftekhari ◽

Seyedeh Rojin Amini Rad ◽

Narges Alizadeh ◽

Rana Rafiee ◽

...

Keyword(s):

Clinical Diagnosis ◽

Skin Diseases ◽

Histopathological Examination ◽

Compliance Rate ◽

Clinical Manifestations ◽

Final Diagnosis ◽

Direct Immunofluorescence ◽

Diagnostic Challenge ◽

Cross Sectional ◽

Pathology Reports

Background: Skin diseases are the fourth most common cause of human illness, and blisters with different clinical manifestations make a diagnostic challenge. Objectives: This study aimed to evaluate the frequency and causes of subepidermal gaps or blisters, as well as the compliance rate between the initial and final clinical diagnoses based on pathology reports. Methods: In this cross-sectional study, pathology reports of subepidermal blisters or gaps were evaluated in the patients referred to the Razi Laboratory of Rasht from 2015 to 2019. The samples were examined by a pathologist after hematoxylin and eosin staining. The reports included demographic information, clinical differential diagnoses, final diagnosis, direct immunofluorescence findings, and salt split results. Finally, the compliance rate of clinical diagnosis with pathology reports was determined. Results: A total of 183 pathology reports were evaluated, 170 of which contained the final diagnosis. Females were more frequently affected by the disease, and pemphigoid bolus and lichen planus were the most prevalent final diagnoses. The compliance rate between the initial and final diagnoses was 94%. About 37.2% of the reports lacked direct immunofluorescence (DIF) and salt split, and only 42.6% of the samples had undergone DIF examination, while 20.2% had both DIF and salt split. There was no significant association between the compliance rate of the final diagnosis with age, sex, and undergoing diagnostic tests. Conclusions: A high incidence of subepidermal gaps or blisters was seen in middle-aged individuals and females. The compliance rate of the initial clinical diagnosis with the final diagnosis based on pathological reports was high. Our findings emphasize the importance of histopathological examination and the complementary role of direct immunofluorescence and salt split in diagnosis.

Download Full-text

High Anti-HCV Seroprevalence and Low Performance of ICT Strip in Diagnosing Hepatitis C Virus Infection in Children in Enugu Metropolis

The Open Virology Journal ◽

10.2174/1874357901812010149 ◽

2018 ◽

Vol 12 (1) ◽

pp. 149-156

Author(s):

Maryann C. Ezeilo ◽

Godwill A. Engwa ◽

Romanus I. Iroha ◽

Damian N. Odimegwu

Keyword(s):

Risk Factors ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Test Performance ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Hcv Infection ◽

Enzyme Linked Immunosorbent Assay ◽

Cross Sectional

Background:The lack of a vaccine for Hepatitis C virus (HCV) places children at a high risk of contracting the infection. It becomes necessary to accurately diagnose this infection for proper treatment as well as identifying potential risk factors for effective management.Aim:This study was conceived to assess the test performance of the commonly used Immunochromatographic test (ICT) strip and identify the associated clinical manifestations and risk factors of HCV in children in Enugu Metropolis.Method:A cross-sectional study involving randomly selected 270 children below six years of age was conducted in Enugu Nigeria. The subjects were screened for anti-HCV by ICT and Enzyme-Linked Immunosorbent Assay (ELISA) and the demographic, signs and symptoms and risk factors were collected.Results:A total of 50 out of 270 children were positive for anti-HCV with a seropositivity of 18.5%. ICT strip had a very low sensitivity of 38.00% with an accuracy of 88.52% in detecting anti-HCV. The presence of dark urine was associated (p= 0.01) with HCV infection.Conclusion:A seroprevalence of 18.5% of Anti-HCV was found in children below six years old in Enugu metropolis and the performance of ICT in diagnosing HCV infection was poor compared to ELISA.

Download Full-text

Factors affecting the hematological and nonhematological toxicities in B-cell lymphoma patients during treatment

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e18004 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e18004-e18004

Author(s):

P. Karimi ◽

A. Shokri ◽

L. Etemadi ◽

N. Negar Rezania

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

Demographic Data ◽

Bone Marrow Involvement ◽

Clinical Manifestations ◽

B Cell Lymphoma ◽

Hematological Toxicity ◽

Cross Sectional ◽

Factors Affecting ◽

Grade 3

e18004 Background: Despite recent improvements, toxicities in B-cell lymphoma patients during treatment remains a major challenge for leukemia community. The aim of this study was to determine factors affecting the hematological and non-hematological toxicities in B-cell lymphoma patients during treatment. Methods: This multicentral cross-sectional study was performed on 68 diagnosed B-cell lymphoma patients (17–72 y/o, mean age 53y/o) admitted in three cancer centers for treatment during 2003–2008. Patients with other malignancies, serious illness or infection were not included. Demographic data, clinical and para clinical manifestations were recorded during treatment. Results: 31 (45%) patients developed grade 2 or greater non-hematological toxicities: 11:fever, 8:chills, 6:vomiting, 4:rash, and 3:pruritus. Moreover, 7 patients developed grade 3 non-hematological toxicities. 42 (62%) patients developed grade 2 or greater hematological toxicities. Non-hematological toxicities were more frequent in patients with BM (Bone Marrow) involvement [15/32 (47%) versus 21/60 (35%), p = 0.01] and with extranodal disease [23/48 (48%) versus 11/42 (26%), p = 0.008]. The incidence of grade 3 or 4 hematological toxicity was higher in females than males [17/43 (40%) versus 13/50 (26%), p = 0.001]. Furthermore, being female was significantly associated with the development of grade 3 or 4 neutropenia [17/49 (35%) versus 8/53 (15%), p = 0.003]. In addition, high LDH was also associated with grade 3 or 4 leukopenia [7/27 (26%) versus 9/58 (16%), p = 0.01], but not with neutropenia. Conclusions: Multivariate analysis demonstrate that some factors like female gender, BM involvement, and serum LDH level could be useful for predicting the hematological and nonhematological toxicities in B-cell lymphoma patients during treatment. No significant financial relationships to disclose.

Download Full-text

ANALISIS HASIL PEMERIKSAAN FISIK DAN LABORATORIUM DEMAM BERDARAH DENGUE DERAJAT I DAN II DI RSUD H. SAHUDIN KUTACANE TAHUN 2021

Jurnal Maternitas Kebidanan ◽

10.34012/jumkep.v6i2.1969 ◽

2021 ◽

Vol 6 (2) ◽

pp. 73-83

Author(s):

Joharsah Joharsah ◽

Fika Lestari ◽

Purnama Sari Cane

Keyword(s):

Physical Examination ◽

Demographic Data ◽

Signs And Symptoms ◽

Oxygen Intake ◽

Normal Numbers ◽

Cross Sectional ◽

Dengue Disease ◽

Laboratory Results ◽

Physical Examinations ◽

Laboratory Examinations

Dengue fever is a severe fever that is often deadly, caused by a virus, characterized by capillary permeability, hemostasis abnormalities and in severe cases, shock syndrome loss of protein. The disease is divided into several degrees. To ensure patients suffer from DENGUE disease, it is necessary to perform physical and laboratory examinations such as hematology tests. This study aims to analyze the results of physical examinations and laboratories of DBD degrees I and II at H.Sahudin Kutacane Hospital. The study used descriptive methods with a Cross Sectional approach. Accidental sampling and the number of samples obtained is 20 respondents, among others, degrees I and II are 10 respondents. The data collection tool is carried out using observation sheets including demographic data, physical examination of DBD degrees I and II, and normal standard numbers and laboratory examination units of Amanah Kutacane Clinic. The results of research conducted from a physical examination of DBD degrees I and II show signs and symptoms of DENGUD disease that appear differently because in addition to the condition of a person's body response is different, It may also be because it has been given symptomatic and supportive treatment, while the laboratory results of DBD degrees I and II are only platelets whose value is low from normal numbers (150,000-450,000/μl) of 88,500/μl and 42,300/μl respectively and these laboratory results are affected by adequate fluid and oxygen intake and nutritious food intake so as to support proper administration of action/management

Download Full-text

Morphological Description of Frontal EEG Interictal and Ictal Discharges in an Adult Cohort of 175 Patients

Journal of Clinical Medicine ◽

10.3390/jcm10061219 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1219

Author(s):

Beatriz García-López ◽

María Sueiras-Gil ◽

Ana Isabel Gómez-Menéndez ◽

Fernando Vázquez-Sánchez ◽

María Carmen Lloria-Gil ◽

...

Keyword(s):

Frontal Lobe ◽

Epileptic Seizures ◽

Cross Sectional Study ◽

University Hospital ◽

Clinical Event ◽

Morphological Description ◽

Frontal Lobe Epilepsy ◽

Cross Sectional ◽

Sharp Waves ◽

Epileptiform Discharges

Clinical and electroencephalogram (EEG) features in frontal lobe epilepsy (FLE) vary considerably among patients, making the diagnosis a challenge. The objective of this study was to describe interictal and ictal EEG activity, identifying variables that could help to differentiate and diagnose frontal lobe epilepsy cases. A prospective cross-sectional study from patients with frontal interictal epileptiform discharges (IED) referred to the Vall d’Hebron University Hospital (Barcelona, Spain) after a clinical event compatible with epileptic seizures was designed. The interictal and ictal activity were analyzed to provide a detailed EEG description of the cases, using different statistical analyses. The morphological seizure pattern at the ictal onset remained globally unchanged over time in seizures arising from the frontal lobe for each patient. Isolated sharp waves were the most frequent waveforms in the expression of IED. Frontal lobe seizures are frequently short and sometimes appear grouped in clusters within the same recording. Often the ictal expression of the electrical activity in frontal lobe seizure is subtle and challenging to interpret. A description of the main findings is summarized to identify seizures arising from the frontal lobe and avoid false negatives findings in EEG interpretations.

Download Full-text

Clinical, Epidemiological and Demographic Profile of Patients Undergoing Holter (24 h) at a Health Center in Belém do Pará: a Retrospective Study

Journal of Cardiac Arrhythmias ◽

10.24207/jca.v34i1.3419 ◽

2021 ◽

Vol 34 (1) ◽

pp. 1-11

Author(s):

Fábio Benedito Filo Creão Garcia Pereira ◽

Lizandra Lujan Delpupo Trivilin ◽

Marcia Rayssa Farias Torres

Keyword(s):

Retrospective Study ◽

Health Center ◽

Statistical Significance ◽

Demographic Data ◽

Clinical Manifestations ◽

Clinical Importance ◽

Cardiac Events ◽

Cross Sectional ◽

Demographic Profile ◽

Electrocardiographic Changes

Introduction: Dynamic electrocardiography by the Holter system can be divided into four major groups: evaluation of clinical manifestations related to the presence of altered heart rhythm; assessment of myocardial ischemia; risk assessment of future cardiac events; and therapeutic assessment. Objective: To identify the clinical, epidemiological and demographic profile that is associated with electrocardiographic changes in the 24-hour Holter in patients seen at the Escola do Marco Health Center in Belém do Pará, Brazil. Methods: We carried out a cross-sectional and retrospective study, with data from patients such as: clinical and electrocardiographic correlation, indications, tachyarrhythmias, bradyarrhythmias, medications in use, provenance, demographic data and behavior modification. All of the information was compiled in a standardized protocol. Results: The main electrocardiographic findings were: supraventricular and ventricular extrasystoles less than 1% (reported in 71 and 57% of patients, respectively). Conclusion: The 24-hour Holter still has an important role in the identification of patients with electrocardiographic changes. The main indications for the examination were to assess the severity of arrhythmia (32%) and palpitation to clarify (23%), and there were uncommon findings, but of great clinical importance and with statistical significance, such as almost three times more frequent nonsustained ventricular tachycardia in patients with heart failure, cardiac, symptomatic frequent extrasystole (> 3%), more frequent atrial fibrillation in the elderly and men (60%) and with underuse of anticoagulant therapy (20%) due to non-diagnosis prior to the exam, and changes in the ST segment with a tendency in patients with systemic arterial.

Download Full-text

Shall we treat patients with benign epileptiform discharges of childhood without epileptic seizures?

Russian Journal of Child Neurology ◽

10.17650/2073-8803-2019-14-1-7-13 ◽

2019 ◽

Vol 14 (1) ◽

pp. 7-13

Author(s):

N. A. Ermolenko ◽

I. S. Bakhtin ◽

I. A. Buchneva

Keyword(s):

Focal Epilepsy ◽

Clinical Manifestations ◽

Epileptic Seizures ◽

Healthy Children ◽

Epileptiform Discharges ◽

First Choice ◽

Long Term Follow Up ◽

Potential Risks

Benign epileptiform discharges of childhood are age-dependent electroencephalogram patterns associated with idiopathic benign focal epilepsy. Multiple studies have demonstrated that focal epileptiform discharges can be registered in patients without any clinical manifestations of epilepsy. Long-term follow-up of clinically healthy children with benign epileptiform discharges of childhood on electroencephalogram demonstrated that 14 % of them developed epileptic seizures with age and 50 % developed various cognitive and behavioral disorders. The question of whether or not to treat such patients (with benign epileptiform discharges of childhood on electroencephalogram but without epileptic seizure) is still being widely discussed. Individual decision making with the consideration of potential risks and benefits for a patient is preferable in this case. Valproic acid is the drug of first choice in these patients.

Download Full-text

A Retrospective Study on Snakebite Victims in a Tertiary Referral Center

Iranian Jornal of Toxicology ◽

10.32598/ijt.10.4.332.1 ◽

2016 ◽

Vol 10 (3) ◽

pp. 47-50

Author(s):

Nasim Zamani ◽

◽

Leila Modir-Fallah Rad ◽

Kambiz Soltaninejad ◽

Shahin Shadnia ◽

...

Keyword(s):

Hospital Admission ◽

Demographic Data ◽

Clinical Manifestations ◽

Public Health Problem ◽

Cross Sectional Study ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Laboratory Findings ◽

Cross Sectional ◽

Tertiary Referral Center

Background: Snakebite is a serious public health problem in the world. The annual incidence of snakebites ranges from 4.5-9.1 in 100,000 population in Iran. With regard to diversity of envenomation profiles in different geographical parts of Iran, the aim of this study was to determine the demographical data, clinical and laboratory findings, and the outcome of the snakebite victims referred to a tertiary referral hospital. Methods: In this retrospective, cross-sectional study in Loghman Hakim Hospital Poisoning Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, during a four-year period from March 2007 to March 2011. The demographic data, clinical manifestations, paraclinical findings, treatments performed before hospital admission, time elapsed between the bite and hospital admission, total dose of antivenom and the patients’ outcomes were investigated. Results: Seventy cases (58 males, 12 females) were evaluated. Most of the cases (79%) were older than 20 year old. The most common bite site was upper extremity (67%). Most of the patients were admitted within 5 h after the snakebite. The most common local and systemic manifestations were swelling (90%), pain (81.4%), nausea and vomiting (24.3%). Leukocytosis (35.7%) and thrombocytopenia (25.7%) were the most common laboratory abnormalities. Most of the patients (97.1%) were treated with antivenom. Fifty percent of the patients only received 3-5 vials of antivenom. The mortality rate was 1.4%. Necrosis of the toes and compartment syndrome were the only serious complications. Conclusion: The findings emphasize the importance of early admission to the hospital and treatment with antivenom to avoid morbidity and mortality.

Download Full-text

Are Strokes Mostly Genetically Based or Acquired? Stenosis vs Hypoplasia of Vertebral Artery Anomalous as The Leading Cause of Stroke (Anatomical Study of VA Anomalies in Neck Three-Dimensional Computed Tomography Angiography)

10.21203/rs.3.rs-791684/v1 ◽

2021 ◽

Author(s):

Farzaneh Mohammadi ◽

Hussein Soleimantabar ◽

Fatemeh Mohamadi ◽

Sofia Sabouri

Keyword(s):

Vertebral Artery ◽

Demographic Data ◽

Three Dimensional ◽

Neck Region ◽

Anatomical Study ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Anomalous Origin ◽

Cross Sectional ◽

Imaging Center

Abstract Background A thorough understanding of the vertebral artery (VA) variations and course of the artery and its related branches could significantly enhance the efficacy and safety of interventions involving the neck and spine. Here, we aimed to investigate the incidence of various VA variations in individuals presenting with signs and symptoms of stroke with our neurology team. In this cross-sectional study, all patients referred to our specialized medical imaging center and underwent neck CT-angiography (CTA) were enrolled in this study for two years from September 2019 onward. Patients' information forms were obtained to collect demographic data. Results An experienced board-certified radiologist evaluated the CTA images, recording the characteristics of VA, regarding dominance and any possible anomalies. These included anomalous origin, anomalous route, anomalous branching, stenosis, hypoplasia, atresia, thrombosis, and dissection. A total of 125 patients (53.6% females; mean age, 60.7 (11–87)) were included. In the case of VA dominance, 66.4% of cases were co-dominant while 16.0% were right, and 12.8% were left dominant. Overall, males had more VA anomalies than females, 24.8% and 17.6%, respectively (in general, 42.4% of all participants) (p = 0.020). Among patients, 4.0% (n = 5) had an anomalous origin and anomalous branching was reported in 5 patients (4.0%). Among the variations, significant stenosis (18.4%) and hypoplasia (17.6%) were the most prevalent anomalies with the earliest one having the higher rate. While anomalous branching was reported in 5 patients (4.0%). Conclusions VA variations are relatively common and should be addressed during procedures involving the neck region and would allow surgeons to avoid life threatening injury.

Download Full-text