Overnight Electroencephalogram to Forecast Epilepsy Development in Children with Autism Spectrum Disorders.

OBJECTIVE: To establish the utility of long-term electroencephalogram (EEG) in forecasting epilepsy onset in children with autism spectrum disorder (ASD). STUDY DESIGN: A single-institution, retrospective analysis of children with ASD, examining long-term overnight EEG recordings collected over a period of 15 years, was conducted. Clinical EEG findings, patient demographics, medical histories, and additional Autism Diagnostic Observation Schedule data were examined. Predictors for the timing of epilepsy onset were evaluated using survival analysis and Cox regression. RESULTS: Among 151 patients, 17.2% (n = 26) developed unprovoked seizures (Sz group), while 82.8% (n = 125) did not (non-Sz group). The Sz group displayed a higher percentage of interictal epileptiform discharges (IEDs) in their initial EEGs compared with the non-Sz group (46.2% vs 20.0%, P = .01). The Sz group also exhibited a greater frequency of slowing (42.3% vs 13.6%, P < .01). The presence of IEDs or slowing predicted an earlier seizure onset, based on survival analysis. Multivariate Cox proportional hazards regression revealed that the presence of any IEDs (HR 3.83, 95% CI 1.38-10.65, P = .01) or any slowing (HR 2.78, 95% CI 1.02-7.58, P = .046 significantly increased the risk of developing unprovoked seizures. CONCLUSION: Long-term EEGs are valuable for predicting future epilepsy in children with ASD. These findings can guide clinicians in early education and potential interventions for epilepsy prevention.

Development of a lower body negative pressure box with an environmental control system for physiological studies.

A headward fluid shift occurs during microgravity exposure, which causes the cardiovascular adaptive syndrome. Different countermeasures have been proposed to decrease its symptomatology, like the application of lower body negative pressure (LBNP). A LBNP box with an environment control system was developed, aiming to improve features of LBNP boxes used worldwide. It consists of five carbon steel ribs in the shape of a cylinder, which is wrapped with high pressure resistant and transparent vinyl. Inner and outer-wheeled trolleys can comfortably and easily move the subject in and out of the box. A custom-made skirt is secured around the subject's waist by an adjustable belt. The other end is secured between two window-type wooden structures, which seal the LBNP box. Inlet and an outlet valves connect the external to the internal environment of the chamber and tube system allows air to circulate gently. Electronic sensors are used to adjust the airflow keeping a pre-set negative pressure without changing humidity and temperature inside the box. Structural, pressure profile and leaking tests were performed with successful results. The improvements of the present LBNP box have substantially decreased the undesirable side effects of uncontrolled environment conditions during rapid pressure changes, and increased test subjects' comfort.

Replacing oxamniquine by praziquantel against Schistosoma mansoni infection in a rural community from the sugar-cane zone of Northeast Brazil: an epidemiological follow-up.

A group of 52 villagers was followed-up for three years regarding Schistosoma mansoni infection. All villagers were periodically surveyed by the Kato-Katz method. In March 1997 and March 1998 the positives were treated with oxamniquine (15-20 mg/kg), and in March 1999, with praziquantel (60 mg/kg). All infection indices decreased substantially between March 1999 and March 2000: prevalence of infection (from 32.7% to 21.2%), prevalence of moderate/heavy infection (from 7.7% to 1.9%), intensity of infection (from 23.1 epg to 7.4 epg) and reinfection (from 35.7% to 14.3%). Negativation increased from 53.8 to 82.4. An optimistic prognostic is assumed in the short term for the introduction of praziquantel in the study area.

[Evaluation of control measures implemented from 1977 to 1996 in the endemic area of schistosomiasis in Pernambuco, Brazil]. / Avaliação das ações de controle da esquistossomose implementadas entre 1977 e 1996 na área endêmica de Pernambuco, Brasil.

This study assesses the evolution of schistosomiasis in the endemic area of Pernambuco, using data from five campaigns of chemotherapy control carried out by national health programmes from 1977 to 1996. Analysis of the data showed that: a) the proportion of municipalities with prevalence above 25% was significantly higher in the coastal-forest zone than in the zone of transitional vegetation Agreste in the four evaluations made in the endemic area; b) the prevalence of infection decreased in both zones even when the interval between campaigns were more than five years. The last survey (1996) indicated a predominance of municipalities with prevalences below 25%. However, the majority of these municipalities had localities with prevalence above 50%. A proposal is presented for the identification of the problematic localities, where complementary measures to chemotherapy, such as systematic snail control, improved sanitation, health education and community mobilization, are still necessary.

Eotaxin and RANTES expression by the dermal endothelium is associated with eosinophil infiltration after ivermectin treatment of onchocerciasis.

The roles of eotaxin, RANTES, and MCP-3 expression in eosinophil recruitment to the site of parasite killing that occurs following ivermectin treatment of onchocerciasis were assessed in the skin of 13 Onchocerca volvulus-infected subjects and two noninfected controls before and after ivermectin treatment. Adverse reactions in infected subjects were associated with the appearance of eosinophils in the dermis as part of a perivascular inflammatory infiltrate. Although no expression of RANTES and eotaxin was seen in dermal vascular endothelial cells in biopsies taken before treatment (nor at any time in the skin of uninfected controls), endothelial expression of both eotaxin and RANTES was noted by 24 h following treatment. While RANTES expression was transient, eotaxin expression increased in parallel with increasing eosinophil recruitment up to 60 h posttreatment. These observations indicate that endothelial expression of eotaxin and RANTES may have an important role in eosinophil recruitment into the skin during helminth-killing reactions.

Partial left ventriculectomy: overall and late results in 44 class IV patients with 4-year follow-up.

BACKGROUND: This study reports long-term results of partial left ventriculectomy (PLV). METHODS: Forty-four patients with dilated cardiomyopathy were operated on in a 4-year study. Echocardiograms, catheterization, and stress tests with oxygen consumption (VO2) were performed. RESULTS: The survivors' preoperative ejection fractions of 22.1% +/- 4.9% improved to 30.9% +/- 9.4%, left ventricular (LV) end-diastolic diameter decreased from 79.4 +/- 9.3 mm to 61.9 +/- 8.2 mm, and maximum VO2 consumption improved from 8.8 +/- 3.9 mL/kg per minute to 15.8 +/- 6.1 mL/kg per minute at 22.6 months. These data also showed improvements in nonsurviving patients, according to the last evaluation before death. Seven of 12 survivors (58.3%) were in New York Heart Association (NYHA) I and II in December 1998. Twelve patients had elevated pulmonary vascular resistance (PVR) contraindicating heart transplant. In five patients the PVR returned to normal and one high-PVR patient was transplanted at the 16th postoperative month. Survival was 56.8%, 47.7%, 38.4%, and 35.9%, respectively, at 3, 6, 12, and 18 months, with a tendency to stabilize at 32.7% thereafter. Arrhythmias and heart failure were the main causes of death. CONCLUSIONS: In spite of improvement of ventricular function and quality of life of the survivors, high mortality is a limiting factor. PLV can be indicated as a bridge to heart transplantation in high-PVR patients or if ventricular assist devices or donor hearts are not available.

Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave.

A distributed multimedia electronic patient record (EPR) is a central component of a medicine-telematics application that supports physicians working in rural areas of South America, and offers medical services to scientists in Antarctica. A Hyperwave server is used to maintain the patient record. As opposed to common web servers--and as a second generation web server--Hyperwave provides the capability of holding documents in a distributed web space without the problem of broken links. This enables physicians to browse through a patient's record by using a standard browser even if the patient's record is distributed over several servers. The patient record is basically implemented on the "Good European Health Record" (GEHR) architecture.

Assessment of a remote sensing-based model for predicting malaria transmission risk in villages of Chiapas, Mexico.

A blind test of two remote sensing-based models for predicting adult populations of Anopheles albimanus in villages, an indicator of malaria transmission risk, was conducted in southern Chiapas, Mexico. One model was developed using a discriminant analysis approach, while the other was based on regression analysis. The models were developed in 1992 for an area around Tapachula, Chiapas, using Landsat Thematic Mapper (TM) satellite data and geographic information system functions. Using two remotely sensed landscape elements, the discriminant model was able to successfully distinguish between villages with high and low An. albimanus abundance with an overall accuracy of 90%. To test the predictive capability of the models, multitemporal TM data were used to generate a landscape map of the Huixtla area, northwest of Tapachula, where the models were used to predict risk for 40 villages. The resulting predictions were not disclosed until the end of the test. Independently, An. albimanus abundance data were collected in the 40 randomly selected villages for which the predictions had been made. These data were subsequently used to assess the models' accuracies. The discriminant model accurately predicted 79% of the high-abundance villages and 50% of the low-abundance villages, for an overall accuracy of 70%. The regression model correctly identified seven of the 10 villages with the highest mosquito abundance. This test demonstrated that remote sensing-based models generated for one area can be used successfully in another, comparable area.

[Bionomical aspects of the Squamatoides triviattus (Diptera, Sarcophagidae) under laboratory conditions]. / Aspectos bionômicos de Squamatoides trivittatus (Diptera, Sarcophagidae) sob condições de laboratório.

Experiments with Squamatoides trivitattus were carried out in two different controlled temperatures (16 +/- 1 degree C/50-60% RH and 27 +/- 1 degree C/70-80% RH). The viability of larvae and pupae at 27 degrees C was 89.82% and 92.75% respectively. Larvae did not develop at 16 degrees C. Larval development lasted for 20 +/- 4 hr, 16 +/- 8 hr and 60 +/- 7 hr for the first, second and third instars, respectively, completing a total of 96 +/- 6 hr. The mean pupal period lasted for 15.7 +/- 1.6 days. In longevity tables for the adults, life-expectancy for 50% of the colony submitted to 16 degrees C was of 1.78 weeks for males and 2.42 for females. At 27 degrees C a life-expectancy of 1.15 weeks for males and 0.78 week for females was recorded. The average life-spans for males and females at 16 degrees C were 3.5 +/- 2.0 and 3.8 +/- 2.6 weeks, respectively, and 1.9 +/- 1.2 weeks for both sexes. At 27 degrees C, the longevity recorded was of 2.1 +/- 1.3 weeks for males and 1.7 +/- 1.1 week for females.

Landscape surrounding human settlements and Anopheles albimanus (Diptera: Culicidae) abundance in Southern Chiapas, Mexico.

Landscape characteristics that may influence important components of the Anopheles albimanus Wiedemann life cycle, including potential breeding sites, suitable diurnal resting sites, and possible sources of blood meals, were analyzed at 14 villages in a malarious area of southern Mexico. An. albimanus adults were collected weekly in each village using UV-light traps between July 1991 and August 1992. Based on rainfall, the study was divided into 6 seasonal periods. Villages were considered to have high mosquito abundance when >5 mosquitoes per trap per night were collected during any 1 of the 6 seasonal periods. The extension and frequency of 11 land cover types surrounding villages were determined using aerial photographs and subsequently verified through field surveys. Elevation was the main landscape feature that separated villages with low and high mosquito abundance. All villages with high mosquito abundance were below 25 m. Transitional and mangrove land cover types were found only in the high mosquito abundance group. Flooded areas as potential breeding sites and potential adult resting sites in unmanaged pastures were significantly more frequent in areas surrounding villages with high mosquito abundance. No significant differences in density of cattle and horses were found among village groups. Overall, surrounding breeding sites located at low elevations in flooded unmanaged pastures seemed to be the most important determinants of An. albimanus adult abundance in the villages.

Remote sensing as a landscape epidemiologic tool to identify villages at high risk for malaria transmission.

A landscape approach using remote sensing and geographic information system (GIS) technologies was developed to discriminate between villages at high and low risk for malaria transmission, as defined by adult Anopheles albimanus abundance. Satellite data for an area in southern Chiapas, Mexico were digitally processed to generate a map of landscape elements. The GIS processes were used to determine the proportion of mapped landscape elements surrounding 40 villages where An. albimanus abundance data had been collected. The relationships between vector abundance and landscape element proportions were investigated using stepwise discriminant analysis and stepwise linear regression. Both analyses indicated that the most important landscape elements in terms of explaining vector abundance were transitional swamp and unmanaged pasture. Discriminant functions generated for these two elements were able to correctly distinguish between villages with high and low vector abundance, with an overall accuracy of 90%. Regression results found both transitional swamp and unmanaged pasture proportions to be predictive of vector abundance during the mid-to-late wet season. This approach, which integrates remotely sensed data and GIS capabilities to identify villages with high vector-human contact risk, provides a promising tool for malaria surveillance programs that depend on labor-intensive field techniques. This is particularly relevant in areas where the lack of accurate surveillance capabilities may result in no malaria control action when, in fact, directed action is necessary. In general, this landscape approach could be applied to other vector-borne diseases in areas where 1) the landscape elements critical to vector survival are known and 2) these elements can be detected at remote sensing scales.