Background frequency can enhance the prognostication power of EEG patterns categories in comatose cardiac arrest survivors: a prospective, multicenter, observational cohort study

Background We assessed the prognostic accuracy of the standardized electroencephalography (EEG) patterns (“highly malignant,” “malignant,” and “benign”) according to the EEG timing (early vs. late) and investigated the EEG features to enhance the predictive power for poor neurologic outcome at 1 month after cardiac arrest. Methods This prospective, multicenter, observational, cohort study using data from Korean Hypothermia Network prospective registry included adult patients with out-of-hospital cardiac arrest (OHCA) treated with targeted temperature management (TTM) and underwent standard EEG within 7 days after cardiac arrest from 14 university-affiliated teaching hospitals in South Korea between October 2015 and December 2018. Early EEG was defined as EEG performed within 72 h after cardiac arrest. The primary outcome was poor neurological outcome (Cerebral Performance Category score 3–5) at 1 month. Results Among 489 comatose OHCA survivors with a median EEG time of 46.6 h, the “highly malignant” pattern (40.7%) was most prevalent, followed by the “benign” (33.9%) and “malignant” (25.4%) patterns. All patients with the highly malignant EEG pattern had poor neurologic outcomes, with 100% specificity in both groups but 59.3% and 56.1% sensitivity in the early and late EEG groups, respectively. However, for patients with “malignant” patterns, 84.8% sensitivity, 77.0% specificity, and 89.5% positive predictive value for poor neurologic outcome were observed. Only 3.5% (9/256) of patients with background EEG frequency of predominant delta waves or undetermined had good neurologic survival. The combination of “highly malignant” or “malignant” EEG pattern with background frequency of delta waves or undetermined increased specificity and positive predictive value, respectively, to up to 98.0% and 98.7%. Conclusions The “highly malignant” patterns predicted poor neurologic outcome with a high specificity regardless of EEG measurement time. The assessment of predominant background frequency in addition to EEG patterns can increase the prognostic value of OHCA survivors. Trial registration KORHN-PRO, NCT02827422. Registered 11 September 2016—Retrospectively registered.

Background Frequency Patterns in Standard Electroencephalography During Targeted Temperature Management as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors: a retrospective cohort study

Background Electroencephalography is a widely used tool for detecting epileptiform and assessing neurological outcomes after cardiac arrest. We investigated the prognostic value of standard electroencephalography during early post-cardiac arrest period and evaluated the performance of electroencephalography findings combined with other clinical features for predicting good outcome. Methods This observational registry-based study was conducted at tertiary care hospital in Korea. Data of all consecutive adult comatose out-of-hospital cardiac arrest survivors who underwent electroencephalography during targeted temperature management between 2010 and 2018 were extracted. Electroencephalography findings, classified according to the American Clinical Neurophysiological Society critical care electroencephalography terminology, and good neurologic outcome-related clinical features were identified via multivariable logistic analysis. Results Good outcomes were observed in 36.5% of 170 patients. Median electroencephalography time was 22.0 hours. Electroencephalography background, voltage and other findings (burst suppression, reactivity to pain stimuli) significantly differed between good and poor outcome groups. Electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 9.8 (95% confidence interval 3.9-24.9) in multivariable logistic analysis. Electroencephalography background frequency enabled identification of a good neurologic outcome (sensitivity, 83.87%; specificity, 75.93%). Combination of other clinical features (age<65 years, initial shockable rhythm, resuscitation duration<20 min) with electroencephalography findings increased predictive performance for good neurologic outcomes (sensitivity, 95.2%; specificity, 100%). ConclusionsBackground frequency patterns of standard electroencephalography during targeted temperature management may play a role as an early prognostic tool in out-of-hospital cardiac arrest patients.

Correlation Between Bispectral Index and Electrocorticographic Features During Epilepsy Surgery

Surgical resection guided by intraoperative electrocorticography (iECoG) has been in clinical use for many decades. The use of the bispectral index (BIS) for monitoring depth of anesthesia during different types of surgery, including epilepsy surgery, is increasing nowadays. The BIS is an EEG-derived variable indicating cortical electrical activity. However, the correlation between the BIS score and the iECoG score, with the purpose of optimizing the quality and time of the iECoG recordings in epilepsy surgery is unknown. The goal of this study was to evaluate the correlation between BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl. This is a prospective study that included patients with epilepsy who underwent epilepsy surgery guided by BIS and iECoG (September 2008 to October 2013). Clinical, physiological, and sociodemographic characteristics are shown. We correlated the iECoG parameters (presence of burst suppressions [BS], suppression time [seconds], background frequency [Hz], and type of iECoG score by Mathern et al) with BIS values. We included 28 patients, 15/28 (53.5%) female, general mean age of 30.5 years (range 13-56 years). Patients underwent epilepsy surgery: 22/28 (79%) temporal and 6/28 (21%) extratemporal. We found a nonlinear polynomial cubic relationship between the mentioned variables noting that a BIS range of 40 to 60 gave the following results: iECoG BS periods <5 seconds, background frequency 10 to 17 Hz, and iECoG score 2 characterized by lack of >20-Hz background frequencies. No BS were observed with a BIS > 60. In conclusion BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl have a nonlinear correlation. BS patterns were not found with a BIS > 60. These findings show that BIS is a nonlinear multidimensional measure, which possesses high variability with the iECoG parameters. BS patterns are not found with BIS > 60.

Detection of New Motifs Properties in Biodata

Biodata are rich of information. Knowing the properties of biological sequence can be valuable in analyzing data and making appropriate conclusions. This research applied naturalistic methodology to investigate the structural properties of biological sequences (i.e., DNA). The research implemented in the field of motif finding. Two new motifs properties were discovered named identical neighbors and adjacent neighbors. The analysis is done in different situations of background frequency and motif model, using distinctive real data set of varied data size. The analysis demonstrated the strong existence of the properties. Exploiting of these properties considers significant steps towards developing powerful algorithms in molecular biology.

Frequency of Transfusion Transmitted Diseases among Tribal Population of Rangamati in Bangladesh

Background: Frequency of transfusion transmitted diseases is unknown among tribal population of Rangamati. This study was undertaken to obtain data about burden of transfusion related diseases among tribal voluntary blood donors in Rangamati and to observe if there was any significant risk associated with ethnicity. The result expected to help identify health problems requiring urgent attention among tribal ethnic groups of Rangamati.Methods: A retrospective study was done in Rangamati General Hospital, Bangladesh where screening records of tribal voluntary blood donors from year 2005 to 2012 were scrutinized for seropositivity for hepatitis B & C, HIV, Syphilis and malaria infection. Frequency of these five diseases recorded .Results: Ninety six (3.81%) samples were positive for transfusion transmitted disease out of 2517 samples screened. Hepatitis B with 87 positive samples ranks highest. Frequency of seropositivity for HBsAg was 3.46%. Seropositivity of other diseases was Hepatitis C (0.28%), syphilis (0.04%) and malaria (0.04%). No samples were positive for HIV infection.Conclusion: Hepatitis B infection is the commonest transfusion transmitted disease among tribal population of Rangamati.Bangladesh J Medicine Jul 2014; 25 (2) : 52-54