Mesial temporal lobe epilepsy with childhood febrile seizure.

OBJECTIVES: To evaluate the demographic and clinical manifestations of patients with mesial temporal sclerosis and temporal lobe epilepsy (MTS-TLE) with childhood febrile seizure (FS) and establishing the potential differences as compared to those without FS. We also investigated the surgery outcome in these two groups of patients. MATERIALS AND METHODS: In this retrospective study, all patients with a clinical diagnosis of drug-resistant TLE due to mesial temporal sclerosis, who underwent epilepsy surgery at Jefferson Comprehensive Epilepsy Center, were recruited. Patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was classified into two groups; seizure-free or relapsed. Clinical manifestations and outcome were compared between patients with MTS-TLE with FS and those without FS. RESULTS: Two hundred and sixty-two patients were eligible for this study. One hundred and seventy patients (64.9%) did not have FS in their childhood, while 92 patients (35.1%) reported experiencing FS in their childhood. Demographic and clinical characteristics of these two groups of patients were not different. Postoperative seizure outcome was not statistically different between these two groups of patients (P = 0.19). CONCLUSIONS: When MTS is the pathological substrate of TLE, clinical manifestations and response to surgical treatment of patients are very similar in patients with history of febrile seizure in their childhood compared to those without such an experience. In other words, when the subgroup of patients with MTS-TLE and drug-resistant seizures is examined history of childhood febrile seizure loses its value as a distinguishing factor in characteristics or predictive factor for surgery outcome.

Nitrogen removal in a shallow maturation pond with sludge accumulated during 10 years of operation in Brazil.

Accumulated sludge in polishing (maturation) ponds reduces the hydraulic retention time (smaller useful volume), and this could potentially lead to a decrease in performance. However, settled biomass, present in the sediments, can contribute to nitrogen removal by different mechanisms such as nitrification and denitrification. This study investigated the influence of the bottom sludge present in a shallow maturation pond treating the effluent from an anaerobic reactor on the nitrification and denitrification processes. Nitrification and denitrification rates were determined in sediment cores by applying ammonia pulses. Environmental conditions in the medium were measured and bacteria detected and quantified by real-time polymerase chain reaction (real-time PCR). The pond showed daily cycles of mixing and stratification and most of the bacteria involved in nitrogen removal decreased in concentration from the upper to the lower part of the sludge layer. The results indicate that denitrifiers, nitrifiers and anammox bacteria coexisted in the sludge, and thus different metabolic pathways were involved in ammonium removal in the system. Therefore, the sediment contributed to nitrogen removal, even with a decrease in the hydraulic retention time in the pond due to the volume occupied by the sludge.

Effect of chenodeoxycholic acid and the bile acid sequestrant colesevelam on glucagon-like peptide-1 secretion.

AIM: To evaluate the effects of the primary human bile acid, chenodeoxycholic acid (CDCA), and the bile acid sequestrant (BAS) colesevelam, instilled into the stomach, on plasma levels of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide, glucose, insulin, C-peptide, glucagon, cholecystokinin and gastrin, as well as on gastric emptying, gallbladder volume, appetite and food intake. METHODS: On four separate days, nine patients with type 2 diabetes, and 10 matched healthy control subjects received bolus instillations of (i) CDCA, (ii) colesevelam, (iii) CDCA + colesevelam or (iv) placebo. At baseline and for 180 min after instillation, blood was sampled. RESULTS: In both the type 2 diabetes group and the healthy control group, CDCA elicited an increase in GLP-1 levels compared with colesevelam, CDCA + colesevelam and placebo, respectively (p < 0.05). The interventions did not affect plasma glucose, insulin or C-peptide concentrations in any of the groups. CDCA elicited a small increase in plasma insulin : glucose ratio compared with colesevelam, CDCA + colesevelam and placebo in both groups. Compared with colesevelam, CDCA + colesevelam and placebo, respectively, CDCA increased glucagon and delayed gastric emptying in both groups. CONCLUSIONS: CDCA increased GLP-1 and glucagon secretion, and delayed gastric emptying. We speculate that bile acid-induced activation of TGR5 on L cells increases GLP-1 secretion, which, in turn, may result in amplification of glucose-stimulated insulin secretion. Furthermore our data suggest that colesevelam does not have an acute effect on GLP-1 secretion in humans.

Seasonality of birth in patients with temporal lobe epilepsy.

OBJECTIVES: We investigated the seasonal pattern in births of patients with temporal lobe epilepsy and mesial temporal sclerosis. We hypothesized that the seasonal pattern in births of these patients is different from that in the general population. MATERIALS AND METHODS: In this retrospective study, all patients who were evaluated for epilepsy surgery at Jefferson Comprehensive Epilepsy Center, Thomas Jefferson, Philadelphia, USA, between 1986 and 2014 and had a diagnosis of mesial temporal sclerosis (made by definite imaging findings of atrophy and/or sclerosis) were included. The seasonality in births of patients was compared with the seasonal pattern in the live births of the general population from Pennsylvania State. RESULTS: Two hundred and eighty-two patients (146 females and 136 males) were studied. The seasonality pattern in birth of patients was not statistically different from that in the general population. CONCLUSIONS: The observed contradictory findings among various studies indicate the need for further studies to elucidate whether season of birth brings the possibility of acquiring various epilepsy syndromes in the future. To investigate any possible association between season of birth and epilepsy, we suggest avoid pooling all patients with epilepsy together.

A comparison of occipital and temporal lobe epilepsies.

PURPOSE: Differentiating between occipital lobe epilepsy (OLE) and temporal lobe epilepsy (TLE) is often challenging. This retrospective case-control study compares OLE to TLE and explores markers that suggest the diagnosis of OLE. METHODS: We queried the Jefferson Epilepsy Center surgery database for patients who underwent a resection that involved the occipital lobe. For each patient with OLE, three sequential case-control patients with TLE were matched. Demographic characteristics, symptoms, electrophysiological findings, imaging findings, and surgical outcome were compared. RESULTS: Nineteen patients with OLE and 57 patients with TLE were included in the study. Visual symptoms were unique to patients with OLE (8/19) and were not reported by patients with TLE (P < 0.0001). Occipital interictal spikes (IIS) were found only in one-third of the patients with OLE (6/19) and in no patients with TLE (P < 0.0001). IIS in the posterior temporal lobe were found in five of 19 patients with OLE vs one of 57 patients with TLE (P = 0.003). IIS involved more than one lobe of the brain in most patients with OLE (11/19) but only in nine of 57 the TLE group. (P = 0.0003) Multilobar resection was needed in most patients with OLE (15/19), typically including the temporal lobe, but in only one of the patients with TLE (P < 0.0001). CONCLUSION: Occipital lobe epilepsy is difficult to identify and may masquerade as temporal lobe epilepsy. Visual symptoms and occipital findings in the EEG suggest the diagnosis of OLE, but absence of these features, does not exclude the diagnosis. When posterior temporal EEG findings or multilobar involvement occurs, the diagnosis of OLE should be considered.

Comparison of simple, small, full-scale sewage treatment systems in Brazil: UASB-maturation ponds-coarse filter; UASB-horizontal subsurface-flow wetland; vertical-flow wetland (first stage of French system).

This paper presents a comparison between three simple sewage treatment lines involving natural processes: (a) upflow anaerobic sludge blanket (UASB) reactor-three maturation ponds in series-coarse rock filter; (b) UASB reactor-horizontal subsurface-flow constructed wetland; and (c) vertical-flow constructed wetlands treating raw sewage (first stage of the French system). The evaluation was based on several years of practical experience with three small full-scale plants receiving the same influent wastewater (population equivalents of 220, 60 and 100 inhabitants) in the city of Belo Horizonte, Brazil. The comparison included interpretation of concentrations and removal efficiencies based on monitoring data (organic matter, solids, nitrogen, phosphorus, coliforms and helminth eggs), together with an evaluation of practical aspects, such as land and volume requirements, sludge production and handling, plant management, clogging and others. Based on an integrated evaluation of all aspects involved, it is worth emphasizing that each system has its own specificities, and no generalization can be made on the best option. The overall conclusion is that the three lines are suitable for sewage treatment in small communities in warm-climate regions.

Field application of a planted fixed bed reactor (PFR) for support media and rhizosphere investigation using undisturbed samples from full-scale constructed wetlands.

This study presents a novel method for investigations on undisturbed samples from full-scale horizontal subsurface-flow constructed wetlands (HSSFCW). The planted fixed bed reactor (PFR), developed at the Helmholtz Center for Environmental Research (UFZ), is a universal test unit for planted soil filters that reproduces the operational conditions of a constructed wetland (CW) system in laboratory scale. The present research proposes modifications on the PFR original configuration in order to allow its operation in field conditions. A mobile device to obtain undisturbed samples from real-scale HSSFCW was also developed. The experimental setting is presented with two possible operational configurations. The first allows the removal and replacement of undisturbed samples in the CW bed for laboratory investigations, guaranteeing sample integrity with a mobile device. The second allows the continuous operation of the PFR and undisturbed samples as a fraction of the support media, reproducing the same environmental conditions outside the real-scale system. Investigations on the hydrodynamics of the adapted PFR were carried out with saline tracer tests, validating the proposed adaptation. Six adapted PFR units were installed next to full-scale HSSFCW beds and fed with interstitial liquid pumped from two regions of planted and unplanted support media. Fourteen points were monitored along the system, covering carbon fractions, nitrogen and sulfate. The results indicate the method as a promising tool for investigations on CW support media, rhizosphere and open space for studies on CW modeling, respirometry, kinetic parameters, microbial communities, redox potential and plant influence on HSSFCW.

Performance comparison between two equal stabilization ponds operating with and without sludge layer.

Stabilization ponds are a highly appropriate system for treating sewage in small to medium size communities. However, sludge accumulation at the pond bottom occurs with the passage of time, reducing the net pond volume, which, in principle, could affect its performance. The objective of this paper is to compare the behaviour of two equal ponds in parallel treating the same flow of municipal wastewater from an upflow anaerobic sludge blanket reactor in Brazil. Each pond treated a population equivalent of around 125 inhabitants. One pond had approximately 40% of its net volume occupied by sludge after 11 years of operation, while the other pond had previously undergone complete desludging. The study covers the removal of biochemical oxygen demand (BOD), chemical oxygen demand (COD), suspended solids (SS), nitrogen fractions and coliforms. Owing to the presence of a sludge layer, the theoretical hydraulic retention time (HRT) was lower in the pond without sludge. For BOD, COD, SS and Escherichia coli there were no significant differences (Wilcoxon matched-pairs test) between both ponds. The pond without sludge had significantly better removal efficiencies in terms of total Kjeldahl nitrogen and ammonia-N. The sludge layer probably allowed the occurrence of removal mechanisms that compensated for the reduction caused in the HRT.

The Issue of Leptospirosis in Grenada.

The aim of this study was to conduct a literature and secondary data review regarding leptospirosis and its impact in Grenada. The data analysed consisted of a published secondary source of animal investigations. The results of this investigation suggested that the burden of this disease is quite substantial and significant for the population of Grenada, as well as its global visitors. An examination into the literature related to public health policies and practices that could be suited to a developing nation like Grenada was then conducted. Recommendations were made regarding these analysed public health programmes revolving around surveillance, vector control, sanitation and education.

Kinetics of concentration decay of specific organic matter in UASB reactors operating with and without return of aerobic sludge.

This study aimed at assessing the influence of the return of excess aerobic sludge from a trickling filter (TF) upon the anaerobic digestion process in an upflow anaerobic sludge blanket (UASB) reactor, by evaluating its effect on the kinetics of the decay of specific organic matter (carbohydrates, proteins and lipids), as well as on the concentrations of volatile fatty acids in the UASB reactor. A pilot-scale UASB/TF system was used to perform the experiments, operating with (phase 2) and without (phase 1) excess sludge return from the TF to the UASB reactor. Sampling was carried out at different heights of the UASB reactor (0, 25, 125 and 225-cm height), and profile concentrations were determined for the following parameters: carbohydrates, proteins, lipids and volatile fatty acids. First-order kinetics showed the best fit to the decay of concentrations of carbohydrates, proteins, lipids and chemical oxygen demand (COD) in the UASB reactor. The parameters showing the best fit to the first-order kinetics were proteins and COD, during the sludge return phase. The occurrence of higher apparent reaction constants was further observed during the sludge return phase. For an influent COD concentration of 600 mg L-1 and hydraulic retention times of 2.1, 2.6 and 3.0 h in phase 1, the effluent COD concentrations were 125.3, 88.4 and 62.4 mg L-1, respectively, whereas in phase 2, the effluent COD concentrations were 75.5, 47.6 and 30.1 mg L-1, respectively.

Performance evaluation of a novel open trickling filter for the post-treatment of anaerobic effluents from small communities.

The objective of the work is to evaluate the performance of an innovative design of a trickling filter for small population sizes, which has been implemented for the post-treatment of sanitary effluent from a UASB (upflow anaerobic sludge blanket) reactor. The unit, named open trickling filter (OTF), operates with no side walls, no perforated bottom slab and no secondary settler. The OTF packing was 3.5 m high, composed of crushed stone, with a fixed distribution system made of channels with V-notch weirs. The OTF was operated with mean surface hydraulic loading rates of 4.1 and 9.3 m³ m⁻² d⁻¹, corresponding to population equivalents of approximately 250 and 550 inhabitants, respectively. For the surface hydraulic loading rate of 4.1 m³ m⁻² d⁻¹, the median removal efficiencies obtained by the OTF and overall system (UASB + OTF) were, respectively, 24 and 83% for total suspended solids (TSS), 44 and 79% for chemical oxygen demand (COD), 42 and 82% for biochemical oxygen demand (BOD), 40 and 40% for N-ammonia. For the surface hydraulic loading rate of 9.3 m³ m⁻² d⁻¹, the median removal efficiencies obtained by the OTF and global system (UASB + OTF) were 14 and 76% for TSS, 28 and 76% for COD, 25 and 86% for BOD, 15 and 15% for N-ammonia. Considering the great simplicity, no mechanization and small footprint of the system, these results can be considered satisfactory, suggesting that the OTF is suitable for small communities, especially in developing countries.

Performance of a single stage vertical flow constructed wetland system treating raw domestic sewage in Brazil.

This study investigated the behaviour of two intermittently fed vertical flow constructed wetlands (one planted with Tifton 85 and the other unplanted) working in parallel, treating raw municipal sewage in Brazil for a population equivalent around 100 inhabitants. Based on a monitoring programme of over 2 years, the following items were evaluated: influence of batch frequency and the presence of Tifton 85 on the wetlands performance in terms of several physico-chemical and biological constituents. The unit with plants performed better than the one without, indicating a positive influence of the presence of plants. More attachment by total and volatile solids and larger amount of bacteria involved in the nitrogen cycle were observed in the planted filter medium, which can explain its higher nitrification and solids removal. The application of a smaller influent volume with a higher batch frequency improved the performance of both units. No signs of medium clogging have been observed in both units. The system simplicity and the good removal efficiency of organic matter, suspended solids, ammonia and helminth eggs indicate its high applicability in small communities in developing countries such as Brazil.

Representing performance of horizontal flow treatment wetlands: The Tanks In Series (TIS) and the Plug Flow with Dispersion (PFD) approaches and their application to design.

Horizontal flow wetlands have been designed using the so-called P-k-C* approach, which has been largely embraced by the treatment wetlands literature. P is meant to represent the equivalent number of apparent tanks in series (hydraulic factor), but also incorporates the loss of biodegradability as the wastewater undergoes treatment (kinetic factor). For design purposes, literature proposes fixed values of P. The proposal of this paper is to decouple hydraulics from kinetics and use the traditional concept of N or NTIS (number of tanks in series) as a function of geometric relationships of the wetland to be designed, leaving kinetic elements to be dealt with solely by the first-order removal rate coefficient (k). From the literature, a database with 41 wetlands with data from tracer studies was used, and a novel regression-based equation was derived relating N with the ratio length/depth of horizontal wetlands. This equation can be used at the design stage for estimating N and, hence, the output concentration of the pollutant using the traditional structure of the TIS model, with a possible inclusion of background concentration (C*). The paper presents all relevant equations, including those from the plug-flow with dispersion model (PFD), and it is shown how to convert from one hydraulic model to the other, what is also believed to be a novel approach in the treatment wetland literature. Finally, the area-based removal rate coefficients (kA) proposed by Kadlec and Wallace (2009) for designs of horizontal wetlands treating domestic wastewater based on the P-k-C* approach are converted into kA values for the TIS model in the paper.

Lognormal behaviour of untreated and treated wastewater constituents.

This article presents an extensive study to select the theoretical probability distribution that represents the concentrations of major constituents from 35 wastewater treatment plants located in Brazil, as well as to verify the influence of the adopted treatment technology on the data distributions. Due to the lack of a solid basis for selecting the distributions that best fit the data, various distributions had to be tried and the choice was based on statistical tests and visual techniques, comprising a total of 3,444 tests undertaken. While comparing suitability of five distributions (normal, lognormal, gamma, exponential and rectangular) for analysis of data (influent and effluent biochemical oxygen demand, chemical oxygen demand, suspended solids, nitrogen, phosphorus, thermotolerant coliforms and flow), it was observed that the lognormal distribution was the most suitable, which is in agreement with the findings from other research studies. This conclusion requires a different position from the one currently adopted when analysing plant performance, in which symmetry of the data is generally implied, which has been shown not to be the case with the large array of data sets investigated.

UV disinfection of stabilization pond effluent: a feasible alternative for areas with land restriction.

The purpose of this research was to determine the feasibility of a UV photoreactor for the disinfection of effluent from a polishing pond following a UASB reactor treating domestic wastewater. For this, a 20 mm diameter photoreactor (20.7 litre volume) equipped with four 30 W submerged low-pressure mercury arc lamps was used. Three tests with contact times and doses ranging from 45 to 90 s and from 16.9 to 31.3 mW s cm(-2) were carried out. Inactivation of total coliforms and Escherichia coli varied from 2.6 to 3.4 log-units, even with the presence of suspended solids in the range of 87 to 102 mg L(-1). These results have shown that UV radiation disinfection of pond effluents can be a feasible alternative in areas with land restriction.

Tracer studies and hydraulic behaviour of planted and un-planted vertical-flow constructed wetlands.

The aim of this research was to assess the hydraulic behaviour of three intermittently-fed vertical flow wetland units operated in parallel, designed for the treatment of raw wastewater generated in the city of Belo Horizonte, Brazil. The system was designed to serve 100 PE (-1 m2/PE). The first filter was planted with cattail (Typha latifolia), the second with Tifton-85 (Cynodon spp.) and the third was maintained without plants (control unit). NaCl tracer tests were conducted to determine the residence time distribution. The tests were done with water when the system was unused (clean media) and also after an 11-month operation period with wastewater (used media), using two different dosing regimes (lower and higher frequency). Results showed a strong tendency towards the hydraulic completely mixed regime. A great dispersion in the units and the presence of short circuiting and dead zones were observed. The unsaturated condition in a large volume of the filter, even during the draining stage, was confirmed for the three units. The dosing regime, the resting period duration, the age of the filter and the presence of plants were found to influence the hydraulic processes in the units.

Anammox bacteria enrichment and characterization from municipal activated sludge.

A sustainable option for nitrogen removal is the anaerobic ammonium-oxidizing (anammox) process in which ammonium is oxidized to nitrogen gas with nitrite as electron acceptor. Application of this process, however, is limited by the availability of anammox biomass. In this study, two Brocadia-like anammox phylotypes were successfully enriched, detected and identified from an activated sludge taken from a domestic wastewater treatment plant (Minas Gerais, Brazil) employing a Sequencing Batch Reactor (SBR). The dominant phylotype was closely related to 'Candidatus Brocadia sinica', but one clone seemed to represent a novel species for which we propose the name 'Candidatus Brocadia brasiliensis'. Based on Fluorescence in situ hybridization (FISH) analysis, this enrichment led to a relative population size of 52.7% (±15.6) anammox bacteria after 6 months of cultivation. The cultivation process can be divided into three phases: phase 1 (approximately 25 days) was characterized by heterotrophic denitrification metabolism, phase 2 was the propagation phase and phase 3 (from the 87th day onwards), in which significant anammox activity was detected. A long-term performance of the SBR showed a near perfect removal of nitrite based on the influent NO(2)(-)-N concentration of 61-95 mg L(-1). The average ammonia removal efficiency was 90% with the influent NH(4)(+)-N concentration of 55-82 mg L(-1). Therefore, anammox cultivation and enrichment from activated sludge was possible under a controlled environment within 3 months.

[Personal contextual factors of the ICF draft from the Working Group "ICF" of Specialty Group II of the Geman Society for Social Medicine and Prevention]. / Personbezogene Faktoren der ICF - Entwurf der AG "ICF" des Fachbereichs II der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP).

Personal contextual factors play an essential part in the ICF model in relation to patient-centred care. It is generally assumed that their classification must refer to the country-specific social and cultural setting and its particular linguistic terms. Therefore personal factors are not classified as yet by the WHO for general use. In Germany in 2006 a group of experts working on the medical advisory board of statutory health insurance published a proposal for a systematic classification of relevant personal factors to describe the background of an individual's life and living. This classification was now further analysed and thoroughly revised by a more comprehensive group of German specialists working in different health care insurances and institutions, authorised by the German Society for Social Medicine and Prevention (DGSMP), supported by German-speaking Swiss ICF specialists. This classification is published as work in progress intending to broaden and prepare the process of discussion for a consensus conference to be held in Germany in 2011.

Characterisation of pathogenic bacteria in a UASB-polishing pond system using molecular techniques.

Molecular techniques have been commonly used to detect and quantify pathogenic bacteria in food, clinical and environmental samples, but in wastewater treatment plants few studies have been carried out. This work applied PCR with a specific set of primers to investigate pathogenic bacteria in a wastewater plant comprised of a UASB reactor followed by polishing ponds. In addition, in-situ hybridisation technique (FISH) was used to estimate the abundance of Escherichia coli in the system. According to the PCR results it was observed that Escherichia coli and Salmonella enterica subsp. enterica were not completely removed in the system, since they were detected either in the raw sewage or UASB and pond effluents. Shigella dysenteriae and Enterococcus spp. were detected in raw sewage and UASB, but not in the pond effluent. In contrast Staphylococcus aureus and Helicobacter pylori were not detected in any samples. The quantification of E. coli using FISH revealed values in the range of 10(7) cells/100 mL for raw sewage and 10(6) cells/100 mL for pond effluent, slightly higher than values obtained by traditional techniques. Finally the results show the applicability of PCR method for monitoring pathogenic bacteria in wastewater systems; however, more samples need to be analysed in order to certify the applicability of FISH to estimate pathogenic bacteria in WWT effluents.

Comparison between polishing (maturation) ponds and subsurface flow constructed wetlands (planted and unplanted) for the post-treatment of the effluent from UASB reactors.

This paper presents the results of a comparison of the performance of two treatment systems operating in parallel, with the same influent wastewater. The investigated systems are (i) UASB + three polishing ponds in series + coarse filter (200 population equivalents) and (ii) UASB + subsurface flow constructed wetlands (50 population equivalents). Two wetland units, operating in parallel, were analysed, being one planted (Typha latifolia) and the other unplanted. The systems were located in Belo Horizonte, Brazil. The wetland systems showed to be more efficient in the removal of organic matter and suspended solids, leading to good effluent BOD and COD concentrations and excellent SS concentrations. The planted wetland performed better than the unplanted unit, but the latter was also able to provide a good effluent quality. The polishing pond system was more efficient in the removal of nitrogen (ammonia) and coliforms (E. coli). Land requirements and cost considerations are presented.