Behavioral outcomes in children exposed prenatally to lamotrigine, valproate, or carbamazepine.

OBJECTIVES: To evaluate adaptive behavior outcomes of children prenatally exposed to lamotrigine, valproate, or carbamazepine, and to determine if these outcomes were dose-dependent. METHODS: Data were collected from women enrolled in the North American Anti epileptic Drug (AED) Pregnancy Registry who had taken lamotrigine, valproate, or carbamazepine monotherapies throughout pregnancy to suppress seizures. The adaptive behavior of 252 exposed children (including 104 lamotrigine-exposed, 97 carbamazepine-exposed, and 51 valproate-exposed), ages 3- to 6-years-old, was measured using the Vineland-II Adaptive Behavior Scales, administered to each mother by telephone. Mean Adaptive Behavior Composite (ABC), domain standard scores for communication, daily living, socialization and motor skills, and adaptive levels were analyzed and correlated with first trimester drug dose. RESULTS: After adjusting for maternal age, education, folate use, cigarette and alcohol exposure, gestational age, and birth weight by propensity score analysis, the mean ABC score for valproate-exposed children was 95.6 (95% CI [91, 101]), versus 100.8 (95% CI [98, 103]) and 103.5 (95% CI [101, 106]) for carbamazepine- and lamotrigine-exposed children, respectively (ANOVA; p=0.017). Significant differences were observed among the three drug groups in the ABC (p=0.017), socialization (p=0.026), and motor (p=0.018) domains, with a trend toward significance in the communication domain (p=0.053). Valproate-exposed children scored lowest and lamotrigine-exposed children scored highest in every category. Valproate-exposed children were most likely to perform at a low or moderately low adaptive level in each category. Higher valproate dose was associated with significantly lower ABC (p=0.020), socialization (p=0.009), and motor (p=0.041) scores before adjusting for confounders. After adjusting for the above variables, increasing VPA dose was associated with decreasing Vineland scores in all domains, but the relationships were not statistically significant. No dose effect was observed for carbamazepine or lamotrigine. CONCLUSIONS: Unlike carbamazepine and lamotrigine, prenatal valproate exposure was associated with adaptive behavior impairments with specific deficits in socialization and motor function, along with a relative weakness in communication. Increasing valproate dose was associated with a decline in adaptive functioning. This finding of a linear dose-dependent teratogenic effect suggests that valproate should be avoided at any dose during pregnancy. However, some women with epilepsy controlled only by valproate will decide, in consultation with their provider, that the benefits of continuing valproate during pregnancy outweigh the fetal risks. Faced with difficult choices, clinicians should be supportive as these patients consider their options.

[Emotional stress as a clinical model to study the pathogenesis of the initial phase of the general adaptation syndrome].

INTRODUCTION: General adaptation syndrome (GAS), the basis of the development of which is stress phenomenon, is an essential component of the pathogenesis of many diseases and syndromes. However, the patho genesis of GAS hitherto is considered exclusively from the endocrinological viewpoint. This relates primarily to the initial phase of the GAS, a clinical model for the study of which may be psycho-emotional stress (PES), which we studied using three groups of volunteers. METHODS: The first one consists of 25 students who were waiting for unaccustomed physical activity (17 men) and play debut on the stage (8 women). The second group consists of 48 children (2-14 years) who expected for "planned" surgery. The third group of volunteers is made up of 80 students (41 women and 39 men) during the first exam. The concentration of cortisol, endotoxin (ET), the activity of antiendotoxin immunity (AEI) and the haemostatic system parameters were determined in the blood serum of volunteers in various combinations. RESULTS: We found laboratory evidence for PES at 92% of students of the first group, 58% of children of the second one and in 21% of students of the third group of volunteers (mostly women). The concentration of ET increased at 13 (52%) volunteers of the first group with a significant increase of average indicators in the whole group (from 0.84 ± 0.06 to 1.19 ± 0.04 EU/ml). At children of the second group, the average concentration of ET increased even more significantly (from 0.42 ± 0.02 to 1.63 ± 0.11 EU/ml), which was accompanied by the activation of the hemostasis system. A degree of the activation was directly dependent on the level of ET in the general circulation and on an activity of AEI. Examination stress in the third group of volunteers is accompanied by activation of plasma hemostasis (increased initial thrombosis rate and reduced the time it starts, lag-period) in 26% of female students and 15% of male students. CONCLUSION: We suggest that it is possible to use the PES as a clinical model for studying the initial phase of the GAS, examine the role of excess of intestinal ET in the general blood circulation (endotoxin aggression) in the induction of systemic inflammation, which is very likely participated in the initiation of the GAS.

[Contemporary legislation and importance of psychophysiologic examination in system of medical support for workers engaged into production with radiation and nuclear danger].

In accordance with contemporary legislation, the article covers materials on specification and approbation of concept model for psychophysiologic examination in medical establishments during medical examination of workers engaged into production with raidation and nuclear danger. The authors defined methodology, examination methods and designed an order of psychophysiologic examination. The psychophysiologic examination and purpose-oriented rehabilitation appeared efficient.

[The influence of spa and resort-based therapy on the incorporated cesium elimination rate in children presenting with environmental disadaptation syndrome].

A total of 50 children presenting with environmental disadaptation syndrome have been treated based at N.K. Krupskaya health resort (Zheleznovodsk). The therapy included the consumption of mineral water with low salt content from the Slavyansky spring at a dose of 3-5 cub.ml per 1 kg b.w. 30 min before meal, thrice daily. Its influence on the radionuclide elimination rate from the organism of the patients previously exposed to enhanced levels of background radiation was estimated from the results of spectrometric and radiochemical analysis of their urine. It was shown that introduction of drinking mineral water into the program of combined spa and resort-based therapy causes a 2-3-fold increase in the cesium excretion rate and thereby reduces the internal radiation load.

[Risks of surgery and anesthesia and optimization of anesthesiological maintenance of abdominal delivery].

The paper deals with abdominal labor pain relief in pregnant women at high risk for impaired development of the general adaptation syndrome: significant sympathicotonia, placental ischemia-reperfusion syndrome, and systemic inflammatory response syndrome. All these syndromes are attended by either impaired oxygen transport or a high risk for the occurrence of such at surgery. The detection and correction of these impairments in development of the general adaptation syndrome in pregnancy, which are provided by the author's modified rating scale for risks of surgery and anesthesia, contribute to the development of the body's compensated metabolic reaction to surgical injury, reducing the number of maternal, fetal, and neonatal complications.

[Anesthetic service and the postoperative period in pregnant women with gestosis].

The paper analyzes the results of using in the anesthetic maintenance of pregnant females with gestosis the algorithm of preventing possible impairments in the development of the general adaptation syndrome in response to pregnancy and surgical labor. Calcium antagonists (eliminating dysfunction of secondary calcium messenger), ketonal, and tranexamic acid (which inhibiting a number of pain and inflammation mediators), and hydroxyethyl starch-130/04 solution (regenerating the endothelium) were administered to prevent the clinical manifestations of the intraabdominal compartment syndrome, ischemia-pefusion, and the second wave of the systemic inflammatory response syndrome in response to surgery. The differential use of the above agents at all stages of anesthetic maintenance in pregnant women with gestosis promoted the postoperative preservation of the most efficient eukinetic hemodynamics and physiological sympathicotonia and the elimination of water metabolic disturbances more early than in the control puerperas. A more physiological postoperative course in the study group puerperas called for much less pharmacotherapy, which created more favorable conditions for postoperative maternal-neonatal contact (feeding, etc.).

Síndrome de burnout: estudio sobre agentes de salud del ßrea de emergencias del GCBA / Burnout: study on agents of health of GCBA's emergencies areas

En 1982 C. Maslach definió a este síndrome en las siguientes dimensiones: cansancio emocional, despersonalización y disminución de logros personales. En este estudio se intenta evaluar su prevalencia y distribución en los agentes de salud del ßrea de emergencia, identificar las variables de riesgo, y determinar sus efectos en el desempe±o laboral, para luego poder crear estrategias que disminuyan los factores de riesgo

Estrés en recién nacidos internados en unidad de cuidados intensivos (UCIN): propuestas para minimizar sus efectos / Stress in newborn hospitalized in intensive care units (ICU): proposals to minimize its effects

Se presenta un trabajo de actualización y revisión bibliográfica sobre el tema de estrés en los recién nacidos internados en las Unidades de Cuidados Intensivos Neonatales. Se define este estrés y se lo diferencia del distrés o estrés crónico, explicando sus componentes fisio-psicopatológicos y sus etapas. Se clasifican sus desencadenantes o estresores. Se caracteriza el estrés en los RN y sus padres, y cuáles son sus indicadores. Se plantea las propuestas y recursos desde el equipo de salud y cómo lo enfrentan y superan el RN y su familia. ¿Qué es ôresilienciaõ? Se hace una revisión de las resoluciones según diferentes autores y se relata la modalidad de trabajo y la experiencia en la UCIN en el Hospital ôRamón Sardáõ.

[The remote effects of chronic exposure to ionizing radiation and electromagnetic fields with respect to hygienic standardization]. / Otdalennye éffekty khronicheskogo vozdeistviia ioniziruiushchego izlucheniia i élektromagnitnykh polei primenitel'no k gigienicheskomu normirovaniiu.

A variety and rate of non-cancer diseases occurred in humans as a result of chronic exposure to ionizing radiation or to electromagnetic radiation (EMR) of high and superhigh frequency have been compared. The intensity of EMR was slightly higher than a sanitary standard for population. A risk of health impairments in workers having occupational exposure to EMR was assessed on the basis of Selie's concept of development of non-specific reaction of the body to chronic stress factors (general adaptation syndrome), models of changes in the body compensatory reserves and calculations of radiation risk after severe and chronic exposure to ionizing radiation.

Endocrine stress response in jugular-vein cannulated rats upon multiple exposure to either diethyl-ether, halothane/O2/N2O or sham anaesthesia.

The main objective of this study was to assess the endocrine stress response to multiple anaesthesia followed by sham anaesthesia in order to detect any memory effects. For this purpose, jugular-vein cannulated rats were subjected to either sham, diethyl-ether or halothane/O2/N2O anaesthesia, and their plasma ACTH, corticosterone, glucose, adrenaline and noradrenaline levels measured. The study had three separate experiments, each consisting of a control and treatment group. In two experiments, the rats were exposed to high or low concentrations (40-15%) of diethyl ether, using either a jar containing cotton soaked in diethyl ether or a vaporizer. In the third experiment, rats were exposed to halothane/O2/N2O. Control animals underwent sham anaesthesia. Blood samples were taken 6 min before and at 5, 15 and 55 min after starting the exposure (t = 0 min). For each variable, the dt5 (level at t = 5 min minus that at t = -6 min) and the cumulative levels over the one-hour period as determined by the area under the curve (AUC) were calculated. Further, the peak levels (Cmax) were determined. The mean time needed to induce anaesthesia was 68, 121 and 55 s for exposure to high and low concentrations of diethyl ether and to halothane/O2/N2O, respectively. Increased noradrenaline and adrenaline dt5 levels were observed only after the first exposure to the high concentration of diethyl ether. Multiple anaesthesia sessions using either diethyl ether or halothane/O2/N2O did not clearly influence adrenaline and noradrenaline levels. Diethyl ether induced a sharp rise in plasma ACTH and glucose levels, irrespective of the concentration used. The response of the ACTH and glucose was similar for single and multiple exposure. An increased response of ACTH, corticosterone and glucose to sham anaesthesia following multiple induction of anaesthesia was observed for the high concentration of diethyl ether only. Halothane/O2/N2O raised plasma glucose without differences between single and multiple anaesthesia sessions. Upon sham anaesthesia following multiple exposures to halothane/O2/N2O, glucose levels were significantly increased. This study indicates that repeated anaesthesia in rats can elicit an increased stress response during subsequent handling and change of environment.

[The characteristics of disorders of general adaptation reactions in people who suffered as a consequence of the accident at the Chernobyl Atomic Electric Power Station and their correction by means of balneo- and phytotherapy]. / Osoblyvosti porushen' zahal'nykh adaptatsiinykh reaktsii u osib, iaki postrazhdaly vnaslidok avariï na ChAES, ta ïkh korektsiia zasobamy bal'neo- i fitoterapiï.

Pathological general adaptive reactions of the body (GARs) were found out to occur on 33.8 +/- 5.0 of patients with chronic pathologies of the urinary and digestive organs, arriving at the Truskavets health resort from the areas contaminated with radionuclides, compared with 7.0 +/- 2.1% of diseased controls. Complex spa treatment during a period of two weeks involving ingestion of the mineral water "naftusia" has a beneficial effect on pathologic and premorbid GARs though not effectively so. Adaptogenic effect of balneotherapy is potentiated by use of balsam "Kryms'kyi" but not a home preparation ginseng.