Epidemiology of cutaneous leishmaniasis in children of Khyber Pakhtunkhwa, Pakistan.

OBJECTIVES: In Pakistan, cutaneous leishmaniasis is an emerging tropical disease and a very high number (>70%) of children are afflicted by this marring infection. This study aimed to scrutinise the prevalence, spatial distribution and socio-demographic and behavioural risk factors associated with cutaneous leishmaniasis in children aged <5-15 years in Khyber Pakhtunkhwa. METHODS: A total of 1, 559 clinically confirmed records of children diagnosed with cutaneous leishmaniasis (January-December) from 2020 and 2022 were obtained from selected district hospitals. In addition, a risk factors-related questionnaire was administered to 1, 011 households (400 in 2020 and 611 in 2022) in nine districts during a household survey. RESULTS: The maximum number of cutaneous leishmaniasis cases was recorded in 2022 (n = 877, 56.25%) as compared to 2020 (n = 682, 43.75%). The hospital records showed a greater number of male patients in the 2022 cohort (n = 603, 68.76%). The highest number of cases were observed in children aged 5-9 years in 2022 (n = 282, 32.16%) and 2020 (n = 255, 37.39%). In 2020 and 2022, cutaneous leishmaniasis cases showed peak aggregation in March (n = 118, 17.3%) and January (n = 322, 36.72%). From a spatial analysis, the maximum number of cutaneous leishmaniasis cases was recorded at 59-1700 m elevation in various land-use/land-cover and climatic regions with quaternary alluvium rock formations. A multivariate logistic regression model analysis of risk factors from the households survey suggested that age group, socio-economic status, construction materials of the house, use of insect repellents, Afghan refugee camps in the village/district, knowledge and biting times of sand flies, frequent use of mosquito bed nets, presence of domestic animals in the house, knowledge of the transmission period and peak month of leishmaniasis infection increased the risk of acquiring cutaneous leishmaniasis (p value < 0.05). CONCLUSION: Our analysis demonstrated that cutaneous leishmaniasis in children is influenced by a variety of environmental, socio-demographic and behavioural risk factors in Khyber Pakhtunkhwa. The increase in recorded cases of cutaneous leishmaniasis in children in 2022 compared to 2020 suggests that the infection likely extended to new foci in the province.

A Hybrid Approach for Energy Consumption and Improvement in Sensor Network Lifespan in Wireless Sensor Networks.

In this paper, we propose an improved clustering algorithm for wireless sensor networks (WSNs) that aims to increase network lifetime and efficiency. We introduce an enhanced fuzzy spider monkey optimization technique and a hidden Markov model-based clustering algorithm for selecting cluster heads. Our approach considers factors such as network cluster head energy, cluster head density, and cluster head position. We also enhance the energy-efficient routing strategy for connecting cluster heads to the base station. Additionally, we introduce a polling control method to improve network performance while maintaining energy efficiency during steady transmission periods. Simulation results demonstrate a 1.2% improvement in network performance using our proposed model.

Real-world effectiveness and satisfaction with intravenous eptinezumab treatment in patients with chronic migraine: REVIEW, an observational, multi-site, US-based study.

BACKGROUND: Despite recent advancements in migraine treatment, some patients continue to endure significant disease burden. Due to the controlled nature of randomized trials in migraine prevention, many real-world patients with comorbidities or prior exposure to certain therapies are excluded. Capturing evidence of the effectiveness of treatment in real-world clinical settings can further shape treatment paradigms. The objective of this study was to develop a comprehensive understanding of both patients' and physicians' real-world experiences with eptinezumab for chronic migraine (CM). METHODS: REVIEW (Real-world EVidence and Insights into Experiences With eptinezumab) is an observational, multi-site (n = 4), US-based study designed to evaluate real-world experiences of patients treated with eptinezumab and their treating physicians. Patients were ≥ 18 years of age, with a diagnosis of CM, who had completed ≥ 2 consecutive eptinezumab infusion cycles (≥ 6 months of exposure). The study included a retrospective chart review, a patient survey, and a semi-structured physician interview that assessed patient and/or physician satisfaction with elements of daily living / well-being, migraine symptomology, and perspectives of the eptinezumab infusion experience. RESULTS: Of the 94 patients enrolled, 83% (78/94) were female, the mean age was 49.2 years, and the mean time since migraine diagnosis was 15.4 years. Before eptinezumab treatment, patients experienced a mean of 8 self-reported "good" days/month, which increased to 18 after treatment. Most patients took, on average, ≥ 10 days/month of prescription and/or over-the-counter medication (81% [75/93] and 66% [61/93], respectively) to treat migraine attacks before eptinezumab treatment, which dropped to 26% (24/93) and 23% (21/93) following eptinezumab treatment. Prior to receiving eptinezumab, 62% (58/93) of patients indicated being at least slightly concerned about infusions; after eptinezumab infusion, this dropped to 14% (13/93). These patient survey findings were consistent with physician responses. CONCLUSION: This real-world evidence study demonstrated high overall satisfaction with the effectiveness of eptinezumab treatment for CM among most patients and their physicians.

Essential oils of four wild plants inhibit the blood seeking behaviour of female Aedes aegytpi.

Aedes aegypti (Diptera: Culicidae) mosquito is an important vector of many disease-causing pathogens. An effective way to escape from these mosquito-borne diseases is to prevent mosquito bites. In the current study, essential oils of Lepidium pinnatifidum, Mentha longifolia, Origanum vulgare, and Agrimonia eupatoria were evaluated for their repellent potential against Ae. aegypti females. Essential oils were extracted using steam distillation from freshly collected aerial parts of the plants and tested against 4-5 day old females of Ae. aegypti through the human bait technique for repellency and repellent longevity assays. The chemical composition of extracted essential oils was explored by gas chromatography coupled with mass spectrometry (GC-MS). The essential oils of L. pinnatifidum, M. longifolia, O. vulgare, and A. eupatoria at a dose of 33 µg/cm2 showed 100%, 94%, 87%, and 83% mosquito repellent activity, respectively. Furthermore, M. longifolia and O. vulgare essential oils exhibited 100% repellency at a dose of 165 µg/cm2, whereas A. eupatoria essential oil showed 100% repellency only at 330 µg/cm2. In the time-span bioassay, M. longifolia and O. vulgare essential oils showed protection against Ae. aegypti bites for 90 and 75 min, respectively whereas both A. eupatoria and L. pinnatifidum were found active for 45 min. Phenylacetonitrile (94%), piperitone oxide (34%), carvacrol (20%) and α-pinene (62%) were the most abundant compounds in L. pinnatifidum, M. longifolia, O. vulgare and A. eupatoria essential oils, respectively. The current study demonstrates that M. longifolia and O. vulgare essential oils possess the potential to be used as an alternative to synthetic chemicals to protect humans from mosquito bites.

The role of urgent care centers in headache management: a quality improvement project.

BACKGROUND: Patients with headache often seek urgent medical care to treat pain and associated symptoms that do not respond to therapeutic options at home. Urgent Cares (UCs) may be suitable for the evaluation and treatment of such patients but there is little data on how headache is evaluated in UC settings and what types of treatments are available. We conducted a study to evaluate the types of care available for patients with headache presenting to UCs. DESIGN: Cross-Sectional. METHODS: Headache specialists across the United States contacted UCs to collect data on a questionnaire. Questions asked about UC staffing (e.g. number and backgrounds of staff, hours of operation), average length of UC visits for headache, treatments and tests available for patients presenting with headache, and disposition including to the ED. RESULTS: Data from 10 UC programs comprised of 61 individual UC sites revealed: The vast majority (8/10; 80%) had diagnostic testing onsite for headache evaluation. A small majority (6/10; 60%) had the American Headache Society recommended intravenous medications for acute migraine available. Half (5/10) had a headache protocol in place. The majority (6/10; 60%) had no follow up policy after UC discharge. CONCLUSIONS: UCs have the potential to provide expedited care for patients presenting for evaluation and treatment of headache. However, considerable variability exists amongst UCs in their abilities to manage headaches. This study reveals many opportunities for future research including the development of protocols and professional partnerships to help guide the evaluation, triage, and treatment of patients with headache in UC settings.

Vertical Distribution of Arthropod Interactions Within Turfgrass.

Arthropod predators are abundant in turfgrass systems, and they play an important role in managing pests. Understanding the vertical distribution of predation is critical to developing cultural strategies that enhance and conserve predatory services. However, little is known on how the predation is vertically distributed within the turfgrass canopy. Thus, the objective of this study was to determine the vertical distribution of predation within the turfgrass canopy. Clay models were used to emulate the general appearance of Noctuidae caterpillars, to estimate the predatory activity. The choice and no-choice experiments were conducted by placing clay models at 2.54, 5.08, and 7.62 cm from the thatch surface and denoted as lower, intermediate, and upper levels, respectively, within turfgrass canopy. The predator-mediated impressions, paired mark, scratch, deep cut mark, deep distortion, prick, dent, stacked surface impression, scooped mark, granulation, and U-shaped mark, were identified on clay models. The incidence and severity of impressions were significantly greater on clay models placed at the lower canopy level than on those placed at the intermediate and upper canopy levels in the choice and no-choice experiments (P < 0.05). Thus, predators are more likely to find their prey at the soil level. This information can be used to refine management strategies, such as mowing height and insecticide use for effectively managing soil-borne and foliar-feeding arthropod pests and beneficial arthropods.

Recent Advances in Sensors for Fire Detection.

Fire is indeed one of the major contributing factors to fatalities, property damage, and economic disruption. A large number of fire incidents across the world cause devastation beyond measure and description every year. To minimalize their impacts, the implementation of innovative and effective fire early warning technologies is essential. Despite the fact that research publications on fire detection technology have addressed the issue to some extent, fire detection technology still confronts hurdles in decreasing false alerts, improving sensitivity and dynamic responsibility, and providing protection for costly and complicated installations. In this review, we aim to provide a comprehensive analysis of the current futuristic practices in the context of fire detection and monitoring strategies, with an emphasis on the methods of detecting fire through the continuous monitoring of variables, such as temperature, flame, gaseous content, and smoke, along with their respective benefits and drawbacks, measuring standards, and parameter measurement spans. Current research directions and challenges related to the technology of fire detection and future perspectives on fabricating advanced fire sensors are also provided. We hope such a review can provide inspiration for fire sensor research dedicated to the development of advanced fire detection techniques.

A Novel Homomorphic Approach for Preserving Privacy of Patient Data in Telemedicine.

Globally, the surge in disease and urgency in maintaining social distancing has reawakened the use of telemedicine/telehealth. Amid the global health crisis, the world adopted the culture of online consultancy. Thus, there is a need to revamp the conventional model of the telemedicine system as per the current challenges and requirements. Security and privacy of data are main aspects to be considered in this era. Data-driven organizations also require compliance with regulatory bodies, such as HIPAA, PHI, and GDPR. These regulatory compliance bodies must ensure user data privacy by implementing necessary security measures. Patients and doctors are now connected to the cloud to access medical records, e.g., voice recordings of clinical sessions. Voice data reside in the cloud and can be compromised. While searching voice data, a patient's critical data can be leaked, exposed to cloud service providers, and spoofed by hackers. Secure, searchable encryption is a requirement for telemedicine systems for secure voice and phoneme searching. This research proposes the secure searching of phonemes from audio recordings using fully homomorphic encryption over the cloud. It utilizes IBM's homomorphic encryption library (HElib) and achieves indistinguishability. Testing and implementation were done on audio datasets of different sizes while varying the security parameters. The analysis includes a thorough security analysis along with leakage profiling. The proposed scheme achieved higher levels of security and privacy, especially when the security parameters increased. However, in use cases where higher levels of security were not desirous, one may rely on a reduction in the security parameters.

Influence of the Color, Shape, and Size of the Clay Model on Arthropod Interactions in Turfgrass.

Many predatory arthropods occur naturally in turfgrass, and they provide adequate control of lepidopteran pests, such as fall armyworm, Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae), and black cutworm, Agrotis ipsilon (Hufnagel) (Lepidoptera: Noctuidae). Recording predation is challenging under field conditions because predators rarely leave any evidence. Clay models were successfully employed for studying predation, and this technique is underutilized in turfgrass. Little is known about whether the characteristics of clay models, such as color, shape, and size, influence arthropod interactions in turfgrass. To improve the utility of clay models in turfgrass, the influence of the color, shape, and size of clay models on arthropod interactions was studied by exposing clay models during daytime and nighttime in a turfgrass field. The results showed that arthropods interacted with clay models, and various types of impressions were recorded, including paired marks, scratches, cuts, and pricks. Although the color of the clay model had no significant effects on arthropod interactions during the night, significantly greater numbers of impressions were noticed on the blue and green models than on the yellow models during the daytime. The caterpillar-shaped models captured significantly greater densities of impressions than the beetle-shaped models. Additionally, the number of impressions significantly increased with an increase in the size of the model regardless of shape.

Granular Data Access Control with a Patient-Centric Policy Update for Healthcare.

Healthcare is a multi-actor environment that requires independent actors to have a different view of the same data, hence leading to different access rights. Ciphertext Policy-Attribute-based Encryption (CP-ABE) provides a one-to-many access control mechanism by defining an attribute's policy over ciphertext. Although, all users satisfying the policy are given access to the same data, this limits its usage in the provision of hierarchical access control and in situations where different users/actors need to have granular access of the data. Moreover, most of the existing CP-ABE schemes either provide static access control or in certain cases the policy update is computationally intensive involving all non-revoked users to actively participate. Aiming to tackle both the challenges, this paper proposes a patient-centric multi message CP-ABE scheme with efficient policy update. Firstly, a general overview of the system architecture implementing the proposed access control mechanism is presented. Thereafter, for enforcing access control a concrete cryptographic construction is proposed and implemented/tested over the physiological data gathered from a healthcare sensor: shimmer sensor. The experiment results reveal that the proposed construction has constant computational cost in both encryption and decryption operations and generates constant size ciphertext for both the original policy and its update parameters. Moreover, the scheme is proven to be selectively secure in the random oracle model under the q-Bilinear Diffie Hellman Exponent (q-BDHE) assumption. Performance analysis of the scheme depicts promising results for practical real-world healthcare applications.

Wearing Off Effect of OnabotulinumtoxinA Near the End of Treatment Cycle for Chronic Migraine: A 4-Year Clinical Experience.

INTRODUCTION: The injection interval for onabotulinumtoxinA (BoNTA) in the management of chronic migraine (CM) is 12 weeks (78-84 days). The aim of this study was to review patient-reported wearing off effect (WOE) of the therapeutic benefit of BoNTA near the end of the treatment cycle. We intended to describe the demographics of patients at baseline and compare groups of patients with multiple episodes of WOE. METHODS: We conducted a retrospective review of patients with CM who received uninterrupted BoNTA therapy from January 2014 to March 2018. The data from patient-reported WOE (worsening headache variables and neck pain) that occurred during the 4 weeks (28 days) prior to the scheduled re-injection of BoNTA for treatment cycles with injection interval ≤13 weeks and without obvious confounding factors were reviewed. RESULTS: We identified 98 eligible patients and analyzed 471 treatment cycles. Forty-three unique patients reported at least 1 occurrence of WOE. About 24/43 patients reported 1 WOE event and 19/43 patients reported ≥2 WOE events. Between the 2 groups, anxiety disorder and opioid use for headache were statistically significantly different. In the former group, the median interquartile range (IQR) dose of BoNTA was 165 (155, 175) units and the median IQR duration of the antinociceptive effect of BoNTA was 66.5 (63, 71.5) days. In the latter group, the median IQR dose of BoNTA was 167 (155, 173.3) units and the median IQR duration of the antinociceptive effect of BoNTA was 65.3 (62.5, 68.8) days. Up to 32% of these patients reported an increase in the use of abortive therapies to manage the symptoms of WOE. DISCUSSION: The primary goal of BoNTA in the treatment of CM is to mitigate the development of central sensitization. Since the 12-week injection paradigm may not provide sustained antinociceptive effect in all patients, it may account for the failure of response to BoNTA. Repeated occurrences of the WOE can potentially lead to medication overuse and impact quality of life.

Headache and Methemoglobinemia.

AIM: This basic review is intended to summarize the current knowledge of methemoglobinemia as an important cause of secondary headache with the hope of generating a growing interest in studying this phenomenon. BACKGROUND: We describe the pathological underpinnings of headaches generated by hypoxia. Possible mechanisms include cerebral vasodilation-associated stretching of the vessel nociceptors, sensitization of perivascular nociceptors mediated by nitric oxide, cerebral calcitonin gene-related peptide, activation of the cyclic adenosine monophosphate pathway, cortical spreading depression, disruption of the blood-brain barrier, and neurogenic inflammation. We review the clinical features, pathophysiology, and management of methemoglobinemia. We conducted a literature review of reports of symptomatic methemoglobinemia with headache. In addition, we describe a case report of a patient who presented with an acute onset of severe holocranial headache associated with rapidly progressive perioral paresthesia, cyanosis in lips and hands, nausea, and mild dyspnea on exertion. These features can be misinterpreted as an acute attack of migraine with pain-related hyperventilation syndrome and anxiety leading to clinically detrimental delay in the management of the progressive hypoxia. Her symptoms resolved following treatment with methylene blue. The complex relationship of migraine and hypoxia-related headaches is also reviewed. We propose that methemoglobinemia-associated headaches are possibly generated by stretching of the nociceptor nerve endings during cerebral vasodilation and hypoxia-mediated oxidative stress. CONCLUSIONS: The case highlights the need to broaden the formulated differential diagnosis of an acute onset severe holocranial headache and pay careful attention to other signs and symptoms that may provide hints on potential mechanism(s) for secondary headaches. We provide justification for the need to incorporate "Headache attributed to Methemoglobinemia" as a subtype under the section "Headache attributed to hypoxia and/or hypercapnia" of the International Classification of Headache Disorders to support clinical decision making.

Secondary hypothermia in patients with super-refractory status epilepticus managed with propofol and ketamine.

BACKGROUND: Therapeutic hypothermia as a potent nonpharmacologic antiseizure therapy has been investigated experimentally in animal models and humans. Although induced hypothermia has been shown to be neuroprotective in acute convulsive status epilepticus, whether its use will translate into improved outcomes for patients with super-refractory nonconvulsive status epilepticus (SRNCSE) has been debated. No clinical data are available on the occurrence and prognostic impact of secondary hypothermia (s-HT) in patients with SRNCSE. With the possibility of core to periphery redistribution of heat with propofol and a centrally mediated dose-dependent fall in body temperature with ketamine, we aimed to investigate the incidence of s-HT events in patients with SRNCSE managed with propofol and ketamine and their impact on clinical outcomes. METHODS: We performed a retrospective observational analysis of consecutive patients with SRNCSE managed with propofol and/or ketamine in a single-center neurological intensive care unit between December 1, 2012 and December 31, 2015. Patients were divided according to the occurrence of hypothermia (temperature < 35.0 °C) into an s-HT group and a nonhypothermia (n-HT) group. Patients who received targeted temperature management therapy were excluded. We compared the demographics, comorbidities, treatment characteristics, and outcomes between groups. RESULTS: Ninety-nine consecutive patients with SRNCSE managed with propofol and/or ketamine were identified during the study period. Twenty patients who received targeted temperature management were excluded, leaving a total of 79 patients for analysis. Hypothermia was observed in 52% (41/79) of the study population. Ketamine was used in 63/79 patients (80%). Ketamine infusion rates were higher and of longer duration among patients who developed s-HT compared with those who did not (mean dosage: 57.35 ±â€¯26.6 mcg/kg/min vs 37.17 ±â€¯15 mcg/kg/min, P = 0.001; duration: 116.36 ±â€¯81.9 h vs 88 ±â€¯89.7 h, P = 0.048). Propofol was used in 78/79 patients (99%), with no significant differences in characteristics between groups (mean dosage: 46.44 ±â€¯20.2 mcg/kg/min vs 36.9 ±â€¯12.9 mcg/kg/min, P = 0.058; duration: 125.43 ±â€¯96.4 h vs 102.3 ±â€¯87.1 h, P = 0.215). No significant differences in demographics, comorbidities, status epilepticus duration and resolution rates, and outcomes were observed between groups. CONCLUSION: In this single-center retrospective analysis of patients whose SRNCSE is being treated, higher doses and longer durations of ketamine were associated with the occurrence of s-HT. Further investigation is warranted to clarify the thermogenic effects of ketamine and its effect on status epilepticus outcomes.

Performance Evaluation and Validation of QCM (Query Control Mechanism) for QoS-Enabled Layered-Based Clustering for Reactive Flooding in the Internet of Things.

Internet of Things (IoT) facilitates a wide range of applications through sensor-based connected devices that require bandwidth and other network resources. Enhancement of efficient utilization of a heterogeneous IoT network is an open optimization problem that is mostly suffered by network flooding. Redundant, unwanted, and flooded queries are major causes of inefficient utilization of resources. Several query control mechanisms in the literature claimed to cater to the issues related to bandwidth, cost, and Quality of Service (QoS). This research article presented a statistical performance evaluation of different query control mechanisms that addressed minimization of energy consumption, energy cost and network flooding. Specifically, it evaluated the performance measure of Query Control Mechanism (QCM) for QoS-enabled layered-based clustering for reactive flooding in the Internet of Things. By statistical means, this study inferred the significant achievement of the QCM algorithm that outperformed the prevailing algorithms, i.e., Divide-and-Conquer (DnC), Service Level Agreements (SLA), and Hybrid Energy-aware Clustering Protocol for IoT (Hy-IoT) for identification and elimination of redundant flooding queries. The inferential analysis for performance evaluation of algorithms was measured in terms of three scenarios, i.e., energy consumption, delays and throughput with different intervals of traffic, malicious mote and malicious mote with realistic condition. It is evident from the results that the QCM algorithm outperforms the existing algorithms and the statistical probability value "P" < 0.05 indicates the performance of QCM is significant at the 95% confidence interval. Hence, it could be inferred from findings that the performance of the QCM algorithm was substantial as compared to that of other algorithms.

Functional Analysis of M-Locus Protein Kinase Revealed a Novel Regulatory Mechanism of Self-Incompatibility in Brassica napus L.

Self-incompatibility (SI) is a widespread mechanism in angiosperms that prevents inbreeding by rejecting self-pollen. However, the regulation of the SI response in Brassica napus is not well understood. Here, we report that the M-locus protein kinase (MLPK) BnaMLPKs, the functional homolog of BrMLPKs in Brassica rapa, controls SI in B. napus. We identified four paralogue MLPK genes in B. napus, including BnaA3.MLPK, BnaC3.MLPK, BnaA4.MLPK, and BnaC4.MLPK. Two transcripts of BnaA3.MLPK, BnaA3.MLPKf1 and BnaA3.MLPKf2, were generated by alternative splicing. Tissue expression pattern analysis demonstrated that BnaA3.MLPK, especially BnaA3.MLPKf2, is highly expressed in reproductive organs, particularly in stigmas. We subsequently created RNA-silencing lines and CRISPR/Cas9-induced quadruple mutants of BnaMLPKs in B. napus SI line S-70. Phenotypic analysis revealed that SI response is partially suppressed in RNA-silencing lines and is completely blocked in quadruple mutants. These results indicate the importance of BnaMLPKs in regulating the SI response of B. napus. We found that the expression of SI positive regulators S-locus receptor kinase (SRK) and Arm-Repeat Containing 1 (ARC1) are suppressed in bnmlpk mutant, whereas the self-compatibility (SC) element Glyoxalase I (GLO1) maintained a high expression level. Overall, our findings reveal a new regulatory mechanism of MLPK in the SI of B. napus.

Pyridoxine deficiency in adult patients with status epilepticus.

An 8-year-old girl treated at our facility for superrefractory status epilepticus was found to have a low pyridoxine level at 5 µg/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus. We reviewed the records on patients admitted to the neurological ICU for status epilepticus (SE). Eighty-one adult patients were identified with documented pyridoxine levels. For comparison purposes, we looked at pyridoxine levels in outpatients with epilepsy (n=132). Reported normal pyridoxine range is >10 ng/mL. All but six patients admitted for SE had low normal or undetectable pyridoxine levels. A selective pyridoxine deficiency was seen in 94% of patients with status epilepticus (compared to 39.4% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels.

Propofol-ketamine combination therapy for effective control of super-refractory status epilepticus.

Retrospective analysis was conducted of patients with SRSE who were treated simultaneously with propofol and ketamine. Sixty-seven patients were identified from 2012 to 2015, and outcomes documented were resolution and mortality. The duration of combined ketamine and propofol use ranged from 1 to 28 days (mean - 3.6 days). Infusion rates ranged up to 145 and 175 mcg/kg/min. Vasopressors were used in 53 patients (79%), and were given within the first 5 days of the ICU admission in 48 (91%) patients. The overall SRSE resolution rate was 91%, and the overall mortality including patients with anoxic brain injury was 39%. Of the 13 patients with SRSE as a result of anoxic brain injury, SRSE was controlled in 5 (56%). The primary determinant of mortality was family withdrawing care related to the presence of severe medical/neurological diseases.

Safety & pK of IV loading dose of lacosamide in the ICU.

A restrospective review of patients treated in the ICU for refractory status epilepticus who had received an initial IV loading dose of lacosamide (LCS) was performed. A total of 142 patients were identified. The first 34 patients received 400mg which by weight-based measurement ranged from 2 to 11 mg/kg. Higher mg/kg dosing had been used subsequently with doses up to 13 mg/kg. No patient required reduction in rate or cessation of infusion. Initiation of pressor agents was not needed during the infusion of the loading dose. Postinfusion LCS blood levels were drawn, and dosing of 10-12 mg/kg and higher resulted in blood levels above 15 µg/ml while doses of 2-6 mg/kg resulted in levels below 10 µg/ml. We conclude that a weight-based loading dose of 10-12 mg/kg at an infusion rate of 0.4 mg/kg/min is safe and will produce levels of 15 µg/ml and higher. This article is part of a Special Issue entitled "Status Epilepticus".

Operations in spinal surgery are not always needed. Do we operate more than we should?

Lumbar disc herniation and low back pain are the main cause of sickness during labor life. The decision for operation is thought to be taken easily and as a result a lot of money is being spent for treatment and rehabilitation. The aim of this study was to evaluate whether conservative treatment is sufficient for treatment of lumbar disc herniation and low back pain and what percentage of the patients operated are satisfied with social and everyday life two years after operation. One hundred and twenty seven patients (67 male and 60 female) were treated because of lumbar disc herniation. No neurological deficiency or muscle weakness was observed. Seventy two patients underwent conservative treatment. Fifty five patients underwent microsurgical discectomy. Back and leg pain are reported on a visual analog scale (VAS) and with the Oswestry disability index (ODI). The Short Form-36 health survey (SF-36) and the European Quality of Life questionnaire (EQ-5D) should also be completed. Surgical data, including diagnosis, are recorded by the surgeon without access to the patient's questionnaires. Both groups (conservative and operative) improved from baseline with regard to SF-36 and ODI (all P<0.01). The results 2 years after surgery were similar for both groups, as measured with the SF-36 and the ODI. Both groups improved from baseline to follow-up with regard to both back pain and leg pain (all P<0.01). The frequency of returning to work was analyzed for those patients who were less than 65 years of age at the time of follow up, and who had been working before surgery. Statistical analysis indicates that there are no significant differences between the groups. The decision for operation is thought to be taken easily and as a result a lot of money is being spent for treatment and rehabilitation. In conclusion, this study shows that operative treatment is equal in outcome to conservative treatment and should follow, seen from an economic perspective, the conservative treatment.

Robust polymer hybrid and assembly materials from structure tailoring to efficient catalytic remediation of emerging pollutants.

A massive amount of toxic substances and harmful chemicals are released every day into the outer environment, imposing serious environmental impacts on both land and aquatic animals. To date, research is constantly in progress to determine the best catalytic material for the effective remediation of these harmful pollutants. Hybrid nanomaterials prepared by combining functional polymers with inorganic nanostructures got attention as a promising area of research owing to their remarkable multifunctional properties deriving from their entire nanocomposite structure. The versatility of the existing nanomaterials' design in polymer-inorganic hybrids, with respect to their structure, composition, and architecture, opens new prospects for catalytic applications in environmental remediation. This review article provides comprehensive detail on catalytic polymer nanocomposites and highlights how they might act as a catalyst in the remediation of toxic pollutants. Additionally, it provides a detailed clarification of the processing of design and synthetic ways for manufacturing polymer nanocomposites and explores further into the concepts of precise design methodologies. Polymer nanocomposites are used for treating pollutants (electrocatalytic, biocatalytic, catalytic, and redox degradation). The three catalytic techniques that are frequently used are thoroughly illustrated. Furthermore, significant improvements in the method through which the aforementioned catalytic process and pollutants are extensively discussed. The final section summarizes challenges in research and the potential of catalytic polymer nanocomposites for environmental remediation.