Salivary Lactate Dehydrogenase in Relationship to the Severity of Hypoxic-Ischemic Encephalopathy among Newborn Infants

Introduction. Hypoxic-ischemic encephalopathy (HIE) is defined as a neurological complication that results from perinatal asphyxia. Previous studies had investigated various markers to early detect HIE; however, these markers appeared to have several drawbacks, especially in resource-limited settings. Aim. This study aimed at evaluating the predictive value of the salivary lactate dehydrogenase level as a potential predictor of hypoxic-ischemic encephalopathy for newborns. Materials and Methods. We included 30 neonates with HIE due to perinatal asphyxia and 30 healthy newborns that serve as controls, admitted at the intensive care unit for neonates and maternity ward at Ismailia area Clinics and Hospitals. We measured the LDH levels by using saliva samples that were collected for neonates maximum by 12 h after birth. Results. It was found that patients with HIE had a statistically significant higher salivary LDH level (1927 ± 390.3 IU/L) than patients without HIE (523.6 ± 142.8 IU/L) ( p < 0.001 ). Moreover, salivary LDH showed a good discriminative ability where the AUC was 0.966 regarding salivary LDH (95% CI: 0.917–1.0) ( p < 0.001 ). The best cutoff value was 1420 IU/L or more which showed the best results in predicting the occurrence of HIE with 98.3% and 97.6% sensitivity and specificity, respectively. Conclusion. Salivary LDH can be considered as a useful noninvasive laboratory marker that can accurately predict HIE incidence among neonates with asphyxia within 12 hours from birth. The cases in the HIE group were assigned into three stages according to the Sarnat and Sarnat staging system: stage I: mild (irritable, normal, or hypertonia and poor feeding); stage II: moderate (lethargy, hypotonia, and frequent seizure); stage III: severe (coma, flaccid, absent reflexes, and frequent seizure). There is a positive association between LDH levels and the severity of HIE.

A ROLE OF AYURVEDA IN THE MANAGEMENT OF APASMARA (EPILEPSY): A CASE STUDY

Apasmara (epilepsy) is defined as the apagama (deterioration) of smriti (memory) associated with bibhasta cheshta (seizures) due to derangement of dhi and satwa, mainly related to vata and rajo dosha vitiation, which effects both Sharira (body) and Mana (mind). The present antiepileptic drugs control the seizure attack, but long-term use generates adverse effect at cognitive level and leads to behavioral disorders, hence there is need of safe and effective treatment which not only controls seizure attack but helps to cure the disease. A 44-year-old man approached Kayachikitsa OPD with the complaints of frequent seizure attacks, since from at the age of one and half year with regular oral antiepileptic drugs medications (allopathic), the dose of medications increasing yearly and he was not satisfied with treatment, so he was advised with Panchakarma treatment starting from Deepana, Pachana, Vamana (medicated emesis), Virechana (medicated purgation), Basti (medicated enema), Shirodhara along with palliative treatment. After each treatment it was observed that the patient was satisfied with treatment and the complaints of seizure attack reduced in frequency and duration with improved quality of life. Palliative treatment was advised to continue along with modern medications.

VALTOCO® (Diazepam Nasal Spray) for the Acute Treatment of Intermittent Stereotypic Episodes of Frequent Seizure Activity

Valtoco® is a new FDA-approved nasal spray version of diazepam indicated for the treatment of acute, intermittent, and stereotypic episodes of frequent seizure activity in epilepsy patients six years of age and older. Although IV and rectal diazepam are already used to treat seizure clusters, Valtoco® has less variability in plasma concentration compared to rectal diazepam. Furthermore, the intranasal administration of Valtoco® is more convenient and less invasive than rectal or IV diazepam, making it ideal for self-administration outside of a hospital setting. Multiple clinical trials have taken place comparing Valtoco® to the oral, rectal, and IV forms of diazepam. Aside from mild nasal irritation and lacrimation, Valtoco® was found to have no increased safety risk in comparison to traditional forms of diazepam. This review of Valtoco® will include a history of diazepam prescribing and withdrawal treatment, Valtoco® drug information, its mechanism of action, pharmacokinetics and pharmacodynamics, and a comprehensive review of clinical studies.

Postpartum Posterior Reversible Encephalopathy Syndrome in A Patient Suspected to COVID-19

: The effect of novel betacoronavirus named as SARS-CoV-2 or COVID-19 on pregnancy outcomes and neonatal prognosis is not fully documented yet. In this article we describe a patient presented with frequent seizure and blurred vision 6 days after delivery without symptoms and laboratory data in favor of preeclampsia/eclampsia and evaluations consistent with Posterior Reversible Encephlopathy Syndrome. Also, there was mild clinical and radiological evidence of COVID-19 infection.

The enigma of transient splenial hyperintensity: In cryptococcal meningitis

ABSTRACTTransient hyperintensity in splenium of corpus callosum is a relatively infrequent finding in MRI. Although it has been most consistently linked with frequent seizure episodes, many other possible causes have been proposed by different workers. Cryptococcal meningitis as a cause of transient splenial hyperintensity has never been reported till date. Here, we report a young girl who is congenitally immunodeficient and had suffered from cryptococcal meningitis with typical transient splenial hyperintense lesions in MRI.

Epilepsy in Nepal

This is a review of epilepsy in Nepal. Nepal is a predominantly rural country with a population of 21 million. A community-based survey in Morang district showed that the prevalence of epilepsy was 7.3 per 1,000 population. A cohort of 300 cases in Shree Birendra Military Hospital showed that neurocysticercosis was the most important etiological cause. There are seven neurologists, 10 CT scanners, three MRIs, and four EEG machines in the country. The practice of anticonvulsant use varied according to different geographical locations. The treatment gap may be in excess of 70%. The epidemiology study in Morang district showed that the proportion seeking modern treatment was higher among those with more frequent seizure. None of the patients were able to attribute their illness to brain disease. Various forms of traditional treatment are widely practiced in all casts among Hindus as well as Buddhists.