Urolithiasis on the ketogenic diet with concurrent topiramate or zonisamide therapy.

Children with refractory epilepsy who are co-treated with the ketogenic diet (KD) and carbonic anhydrase inhibitor (CA-I) anti-epileptic medications including topiramate (TPM) and zonisamide (ZNS) are at risk for urolithiasis. Retrospective chart review of all children treated with ketogenic therapy at our institution was performed in order to estimate the minimal risk of developing signs or symptoms of stone disease. Children (N=93) were classified into groups according to KD+/-CA-I co-therapy. Fourteen patients had occult hematuria or worse, including 6 with radiologically confirmed stones. Three of 6 calculi developed in the KD+ZNS group of 17 patients who were co-treated for a cumulative total of 97 months (3.1 stones per 100 patient months). One confirmed stone was in the KD+TPM group of 22 children who were co-treated for a cumulative total of 263 months (0.4 stones per 100 patient months). All six patients had at least three of five biochemical risk factors including metabolic acidosis, concentrated urine, acid urine, hypercalciuria and hypocitraturia. Standard of care interventions to minimize hypercalciuria, crystalluria and stone formation used routinely by pediatric nephrologists should also be prescribed by neurologists treating patients with combination anti-epileptic therapy. Non-fasting KD initiation, fluid liberalization, potassium citrate prophylaxis as well as regular laboratory surveillance are indicated in this high risk population.

Beta blockers exposure and traumatic brain injury: a literature review.

Traumatic brain injury (TBI) continues to carry a significant public health burden and is anticipated to worsen worldwide over the next century. Recently the authors of several articles have suggested that exposure to beta blockers may improve mortality rates following TBI. The exact mechanism through which beta blockers mediate this effect is unknown. In this paper, the authors review the literature regarding the safety of beta blockers in patients with TBI. The findings of several recent retrospective cohort studies are examined and implications for future investigation are discussed. Future questions to be addressed include: the specific indications for the use of beta blockers in patients with TBI, the optimal type and dose of beta blocker given, the end point of beta blocker therapy, and the safety of beta blockers in cases of severe TBIs.

Fatores maternos e fetais associados ao nascimento de prematuros com 1.000 gramas ou menos. / Maternal and fetal factores associated with the birth of premature of 1,000g or less

O perfil das gestantes de baixo nivel socio-economico em nossa pesquisa, que deram a luz prematuros com 1.000 g ou menos, tem as seguintes caracteristicas: - nao eram primigestas; - tinham idade media de 26,6 anos; - nao fizeram seguimento pre-natal; - apresentaram alguma complicacao gestacional.Nao foi verificada nenhuma influencia da cor, estado civil e ocorrencia de abortos anteriores. O parto foi normal em 83,82% dos casos e a apresentacao cefalica em 77,94% das vezes. O bebe nasceu gravemente deprimido em 67,69% dos casos e com idade gestacional entre 22 e 30 semanas em 58,82% das vezes, sendo que 50,9% foram adequados para a idade gestacional e os demais; pequenos para a idade gestacional.As mortes neonatais ocorreram em 75% dos casos ate o 10o. dia de vida. Nos achados de necropsia predominaram: imaturidade cerebral e renal, atelectasia pulmonar congestao visceral generalizada e as sufusoes hemorragicas multiplas. Houve baixas-incidencias de persistencia do canal arterial e de membrana hialina