Epilepsy's effect on cardiac rhythm and the autonomic nervous system

SUMMARY OBJECTIVE: Sudden unexpected death in epilepsy is the most common cause of death in young patients with epilepsy. The aim of this study was to evaluate changes in interictal electrocardiogram parameters and sympathetic skin responses as markers of autonomic dysfunction in patients with epilepsy and to determine their effects on the type and duration of epilepsy, frequency of seizures, and responses to treatment. METHODS: A total of 97 patients with epilepsy and 94 healthy controls were recruited. We recorded their clinical and demographic characteristics and analyzed sympathetic skin response latency and amplitude, electrocardiogram recordings, and seven cardiac rhythm parameters: P-wave duration, PR segment, QRS duration, QT interval, QT interval distribution, Tpe duration, and Tpe/QT interval ratio. RESULTS: P-wave durations, T-wave durations, QT and QT interval durations, and Tpe and sympathetic skin response latency were significantly longer among patients with epilepsy than the controls, and their heart rate was significantly lower. However, sympathetic skin response latency and heart rate were negatively correlated, and T-wave duration, QT duration, QT interval duration, and Tpe were positively correlated. CONCLUSION: Our results from interictal electrocardiograms indicate clinically significant arrhythmias among patients with epilepsy and the correlation of such arrhythmias with sympathetic skin responses. Thus, noninvasive tests that evaluate the autonomic system should be used to predict the risk of sudden unexpected death in epilepsy among patients with epilepsy.

Evaluation of the diagnostic performance and optimal cutoff value of a fourth-generation ELISA, VIDAS HIV-1/2 Duo Ultra assay, in a low-prevalence country.

In this study, we described the largest analysis to date conducted with VIDAS® HIV Duo Ultra assay. Additionally, we analyzed the diagnostic performance and cutoff values (TV) of HIV Duo Ultra assay and total cost analysis for HIV testing. Of 11,642 enzyme-linked immunosorbent assay (ELISA)-positive samples referred to our center for confirmation, 2000 were positive with HIV Duo Ultra, and of these, 87% were HIV-1 positive and 0.6% were HIV-1 indeterminate with the confirmatory test. Overall, the false-positivity rate was 1.75% for HIV Duo Ultra assay. The sensitivity and specificity were 100% and 99.1%, respectively, when the TV was set at the recommended cutoff value. Even increasing the cutoff value four times, sensitivity and specificity remained high, pointing out that a TV of 0.99 is highly indicative of HIV positivity. Retesting samples with HIV Duo Ultra assay decreased 80% of the confirmatory tests, revealing a significant decrease of 78% in the total costs and reporting time.

Comparison of cervico-vaginal colonization among sexually active women by intrauterine device use.

INTRODUCTION: In this study we aimed to evaluate the effect of intrauterine devices (IUDs) on cervico-vaginal colonization. METHODOLOGY: Cervico-vaginal samples of 96 patients with vaginal discharge were included in the study. Microscopic evaluation, bacteriological and fungal culture, and antigen testing for Chlamydia trachomatis using an immunochromatographic test method were performed. RESULTS: Trichomonas vaginalis was not detected by wet mount examination. Gram smear revealed that seven patients (7.3%) had Candida spp. and five (5.2%) had clue cell. Of the 96 swabs tested for conventional culture, pathogenic microorganisms were isolated from 24 patients. While Neisseria gonorrhoeae was not found in any of the sample, five (5.2%) were positive for Gardnerella vaginalis. Five (5.2%) were positive for C. trachomatis antigen, while three positivity only for C. trachomatis antigen, one had G. vaginalis additionally, and the other had a mixed infection. Chlamydial antigen positivity was higher among women over 30 years of age (p = 0.157). Increase in polymorphonuclear leukocytes (PNL) was detected 40% and 35.2% of samples, positive and negative, for chlamydial antigen, respectively (p = 1.000). Among IUD+ cases, increase in PNL, fungal elements,  E. coli and Gram-positive bacteria and decrease in Lactobacillus spp. were observed, compared to IUD-cases. No statistically significant relationship was detected between IUD and chlamydial antigen with the reported rates of 4.8% and 5.6% for IUD+ or IUD-, respectively (p > 0.05). CONCLUSION: Statistically significant relationship was not detected between IUD and cervico-vaginal colonization. More comprehensive studies using specific test methods should be conducted to better understand the relationship.

Pneumonia due to Enterobacter cancerogenus infection.

Enterobacter cancerogenus (formerly known as CDC Enteric Group 19; synonym with Enterobacter taylorae) has rarely been associated with human infections, and little is known regarding the epidemiology and clinical significance of this organism. We describe a community-acquired pneumonia case in a 44-year-old female due to E. cancerogenus. Identification and antimicrobial susceptibility of the microorganism was performed by the automatized VITEK 2 Compact system (bioMerieux, France). The clinical case suggests that E. cancerogenus is a potentially pathogenic microorganism in determined circumstances; underlying diseases such as bronchial asthma, empiric antibiotic treatment, wounds, diagnostic, or therapeutic instruments.