Double antiglutamatergic treatment in patients with status epilepticus: A case series.

INTRODUCTION: Status epilepticus (SE) continues to be a challenging neurological emergency with high morbidity and mortality. During treatment, different regimens are practiced encompassing all known seizure termination mechanisms. To our knowledge, this is the first case series report describing EEG patterns and clinical outcomes in patients treated with ketamine and perampanel (PER) concomitantly. OBJECTIVE: To assess clinical and electrographic outcomes in patients receiving dual antiglutamatergic therapy in SE. RESULTS: Twenty-one out of twenty five patients were treated with ketamine, and four patients with ketamine were associated with PER. In the ketamine plus PER group, three out of four patients had convulsive SE, and one had non-convulsive status epilepticus (NCSE), whereas eight patients in the ketamine group had NCSE. The incidence of beta pattern appearance on EEG after starting patients on ketamine and PER was achieved in all four patients (100%) compared to (61.9%) in the other group. A burst suppression pattern was recorded in 75% of patients treated with ketamine and PER, in comparison to 28.5% of patients in patients treated with a different regimen. The time to resolution of SE was significantly shorter in the ketamine group (median 24 (24-64) h vs. 6 (05-144) h p > 0.05). Moreover, the average number of days on IV anesthetic was slightly lower in a patient treated with PER concomitantly. In terms of morbidity, the average increase in mRS was also lower in the ketamine and PER group, although it was not statistically significant. CONCLUSIONS: Dual anti-glutamatergic therapy could provide a favorable approach to treating SE, which yet needs to be further investigated through larger randomized control studies.

Analysis of CAST in 9 Lebanese hospitals between 2008 and 2017.

BACKGROUND: Cumulative Antibiotic Susceptibility Testing (CAST) plays a crucial role in providing knowledge about the evolution of bacterial resistance. The preparation of such report is however prone to many errors. This study investigated the variety of mistakes detected in the CAST of 9 Lebanese hospitals. METHODS: Nine Lebanese hospitals were involved, where 21 different errors were looked for and analyzed. The total number of errors in each year was calculated and averaged according to the number of hospitals. Obtaining the average number of errors per hospital per year allowed the comparison of each hospital individually. RESULTS: The average number of errors in 2008 was 38.75 and increased to 51.5 in 2012. The average number of errors then decreased to 37.89 by 2017. The most common error between 2008-2017 was the incoherent percentages. Superimposing these results allowed to determine if hospitals in general were following the trend of average errors. Some hospitals were constantly improving, others were making a variable number of errors over the years. CONCLUSION: The percentages of errors found here are alarming, urging therefore educating microbiologists on preparing CAST correctly. Future studies should aim to study the physician's level of knowledge on the proper utilization of CAST.