The non-clinical burden of febrile seizures: a systematic review.

Febrile seizures (FS) can be frightening for parents, even though they are usually harmless. Various questionnaires have been used to assess parental reactions and awareness about FS, revealing insufficient knowledge. Studies have shown that educational interventions significantly reduce parental concerns, improve knowledge, and promote better first-aid measures. Providing clear information and emotional support to parents is important to reduce their concerns and improve FS management. Healthcare providers should give comprehensive information about FS, including the risk of recurrence, and provide clear instructions on their management. The economic impact of FS includes direct and indirect costs. Studies have shown a decrease of hospitalizations and associated costs due to improved clinical adherence to guidelines, which also reduces the inappropriate use of healthcare resources. This systematic review provides a comprehensive overview of the existing literature on parental anxiety and education about FS, as well as their economic impact, aiming at identifying areas for improvement in the management of FS and providing valuable insights for healthcare providers and policymakers to better address the non-clinical burden of this condition.

Febrile Seizures: A Systematic Review of Different Guidelines.

BACKGROUND: Febrile seizures (FS) are the most common neurological disorder in pediatric age. FS affect 2% to 12% of children and result from a complex interplay of genetic and environmental factors. Effective management and unambiguous recommendations are crucial for allocating health care resources efficiently and ensuring cost-effectiveness in treating FS. METHODS: This systematic review compares existing guidelines to provide insights into FS management. Seven guidelines published between 1991 and 2021, from Japan, United Kingdom, United States, Mexico, India, and Italy, were included. Data extraction covered definitions, diagnostic criteria, hospital admission criteria, diagnostic tests, management, and prophylaxis recommendations. RESULTS: Hospital admission criteria varied but typically included age <18 months and complex FS. Neuroimaging and lumbar puncture recommendations varied, with most guidelines suggesting limited use. Pharmacologic prophylaxis was generally discouraged for simple FS but considered only for high-risk cases, due to the benign nature of FS and the potential side effects of antiseizure medications. CONCLUSIONS: Guidelines on FS exhibit similarities and differences, highlighting the need for standardized management and improved parental education to enhance clinical outcomes and reduce economic and social costs associated with FS. Future research should focus on creating updated international guidelines and ensuring their practical implementation.

Vernal Keratoconjunctivitis: A Systematic Review.

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral corneal and conjunctival problem which typically presents in young individuals. VKC is characterized by itching, photophobia, white mucous discharge, lacrimation, foreign body sensation, and pain due to corneal involvement of shield ulcers. Vernal keratoconjunctivitis is categorized within ocular diseases. The diagnosis is clinical, as no sure biomarkers pathognomonic of the disease have yet been identified. The VKC therapy relies on different types of drugs, from antihistamines and topical steroids to cyclosporine or tacrolimus eye drops. In extremely rare cases, there is also the need for surgical treatment for the debridement of ulcers, as well as for advanced glaucoma and cataracts, caused by excessive prolonged use of steroid eye drops. We performed a systematic review of the literature, according to PRISMA guideline recommendations. We searched the PubMed database from January 2016 to June 2023. Search terms were Vernal, Vernal keratoconjunctivitis, and VKC. We initially identified 211 articles. After the screening process, 168 studies were eligible according to our criteria and were included in the review. In this study, we performed a systematic literature review to provide a comprehensive overview of currently available diagnostic methods, management of VKC, and its treatments.

Gilbert or Crigler-Najjar syndrome? Neonatal severe unconjugated hyperbilirubinemia with P364L UGT1A1 homozygosity.

BACKGROUND: Several mutations of bilirubin uridine diphosphate-glucuronosyltransferase gene (UGT1A1) have been reported in patients with unconjugated hyperbilirubinemia. Few reports are available about the p.Pro364Leu mutation (P364L, c.1091C > T) in homozygous newborns. We describe the clinical, laboratory and therapeutic approach in two Chinese neonates with severe jaundice, homozygous for the P364L mutation. CASE PRESENTATION: Two Chinese breastfed female infants presented prolonged unconjugated hyperbilirubinemia at the age of 1 month. Total bilirubin was higher than 15 mg/dl (D < 1). An exhaustive etiological work-up to detect possible causes of hyperbilirubinemia (notably hemolytic ones) was negative. The promoter and coding regions of UGT1A1 were amplified by polymerase chain reaction (PCR) from genomic DNA isolated from leukocytes. Both patients resulted homozygous for a variant site within the coding region of the gene in the 4 exon, c.1091C > T, p.Pro364Leu. In front of the persistently high level of unconjugated bilirubin, phototherapy was performed without persistent results. A treatment with phenobarbital was then begun and bilirubin level progressively decreased, with a complete and persistent normalization. The therapy was stopped. CONCLUSION: UGT1A1 enzyme activity associated with the P364L mutation has been described as 35.6% of the wild-type enzyme activity. Photo-therapy and phenobarbital can be useful in front of persistently high level of unconjugated bilirubin. Our cases presented high bilirubin values, overlapping between Gilbert syndrome (GS) and Crigler-Najjar syndrome type II (CNS), but the complete normalization of bilirubin makes GS more likely. Homozygous P364L variant can be associated with severe neonatal unconjugated hyperbilirubinemia in Chinese infants, but jaundice can completely resolve in a few months, contrary to what happens in Crigler-Najjar syndrome type II.

Realization of Paris Agreement pledges may limit warming just below 2 °C.

Over the last five years prior to the Glasgow Climate Pact1, 154 Parties have submitted new or updated 2030 mitigation goals in their nationally determined contributions and 76 have put forward longer-term pledges. Quantifications of the pledges before the 2021 United Nations Climate Change Conference (COP26) suggested a less than 50 per cent chance of keeping warming below 2 degrees Celsius2-5. Here we show that warming can be kept just below 2 degrees Celsius if all conditional and unconditional pledges are implemented in full and on time. Peak warming could be limited to 1.9-2.0 degrees Celsius (5%-95% range 1.4-2.8 °C) in the full implementation case-building on a probabilistic characterization of Earth system uncertainties in line with the Working Group I contribution to the Sixth Assessment Report6 of the Intergovernmental Panel on Climate Change (IPCC). We retrospectively project twenty-first-century warming to show how the aggregate level of ambition changed from 2015 to 2021. Our results rely on the extrapolation of time-limited targets beyond 2030 or 2050, characteristics of the IPCC 1.5 °C Special Report (SR1.5) scenario database7 and the full implementation of pledges. More pessimistic assumptions on these factors would lead to higher temperature projections. A second, independent emissions modelling framework projected peak warming of 1.8 degrees Celsius, supporting the finding that realized pledges could limit warming to just below 2 degrees Celsius. Limiting warming not only to 'just below' but to 'well below' 2 degrees Celsius or 1.5 degrees Celsius urgently requires policies and actions to bring about steep emission reductions this decade, aligned with mid-century global net-zero CO2 emissions.

Reducing global air pollution: the scope for further policy interventions.

Over the last decades, energy and pollution control policies combined with structural changes in the economy decoupled emission trends from economic growth, increasingly also in the developing world. It is found that effective implementation of the presently decided national pollution control regulations should allow further economic growth without major deterioration of ambient air quality, but will not be enough to reduce pollution levels in many world regions. A combination of ambitious policies focusing on pollution controls, energy and climate, agricultural production systems and addressing human consumption habits could drastically improve air quality throughout the world. By 2040, mean population exposure to PM2.5 from anthropogenic sources could be reduced by about 75% relative to 2015 and brought well below the WHO guideline in large areas of the world. While the implementation of the proposed technical measures is likely to be technically feasible in the future, the transformative changes of current practices will require strong political will, supported by a full appreciation of the multiple benefits. Improved air quality would avoid a large share of the current 3-9 million cases of premature deaths annually. At the same time, the measures that deliver clean air would also significantly reduce emissions of greenhouse gases and contribute to multiple UN sustainable development goals. This article is part of a discussion meeting issue 'Air quality, past present and future'.

Encoding of time-varying stimuli in populations of cultured neurons.

We wondered whether random populations of dissociated cultured cortical neurons, despite of their lack of structure and/or regional specialization, are capable of modulating their neural activity as the effect of a time-varying stimulation - a simulated 'sensory' afference. More specifically, we used localized low-frequency, non-periodic trains of stimuli to simulate sensory afferences, and asked how much information about the original trains of stimuli could be extracted from the neural activity recorded at the different sites. Furthermore, motivated by the results of studies performed both in vivo and in vitro on different preparations, which suggested that isolated spikes and bursts may play different roles in coding time-varying signals, we explored the amount of such 'sensory' information that could be associated to these different firing modes. Finally, we asked whether and how such 'sensory' information is transferred from the sites of stimulation (i.e., the 'sensory' areas), to the other regions of the neural populations. To do this we applied stimulus reconstruction techniques and information theoretic concepts that are typically used to investigate neural coding in sensory systems.Our main results are that (1) slow variations of the rate of stimulation are coded into isolated spikes and in the time of occurrence of bursts (but not in the bursts' temporal structure); (2) increasing the rate of stimulation has the effect of increasing the proportion of isolated spikes in the average evoked response and their importance in coding for the stimuli; and, (3) the ability to recover the time course of the pattern of stimulation is strongly related to the degree of functional connectivity between stimulation and recording sites. These observations parallel similar findings in intact nervous systems regarding the complementary roles of bursts and tonic spikes in encoding sensory information.Our results also have interesting implications in the field of neuro-robotic interfaces. In fact, the ability of populations of neurons to code information is a prerequisite for obtaining hybrid systems, in which neuronal populations are used to control external devices.

Citología por punción aspirativa en el diagnóstico de masas cervicales / Cytology by aspirative punction in the cervix mass diagnosis

A survery of the diagnostic value of fine needle aspiration cytology in Otolaryngology was carried out over a 5 year period. The 275 aspirates were taken from a variety of head and neck sites and examined by an experienced cytopathologist. Cytology was accurate in 82.9% for benign lesions and 94.5% for malignant lesions. The technique was found to be a rapid, safe and costeffective diagnostic tool