Post-operative seizure after first time endoscopic third ventriculostomy in pediatric patients.

PURPOSE: Post-operative seizure rates after endoscopic third ventriculostomy (ETV) are not definitively known. We analyzed our institution's experience for all causes of hydrocephalus in pediatric patients undergoing ETV to determine rates of post-ETV seizure. METHODS: A retrospective review of institutional pediatric patients undergoing ETV from May 2014 to December 2018. Included were < 21 years, with 1-year follow-up. Exclusion criteria included ventriculoperitoneal shunts (VPS) prior to ETV, VPS within 7 days post-ETV, and prior seizure disorder. Data included age, gender, diagnosis, early post-operative seizure (within 7 days post-ETV), late post-operative seizures (after first 7 days and within first year post-ETV), concomitant choroid plexus cauterization (CPC), VPS conversion within 1 year, and administration of prophylactic antiepileptics. RESULTS: Sixty of 81 ETV cases were included; 41% underwent concomitant CPC. Of these, 53% (n = 32) were male, 46% (n = 28) female, averaging 5.8 years, with the most common diagnosis neoplasm-related obstructive hydrocephalus (38.3%, n = 23). Early post-operative seizure occurred in 6.7% (n = 4); late post-operative seizure occurred in 8.3% (n = 5). Late post-operative seizures were higher in patients experiencing early post-operative seizure versus those without (75% vs 3.7%, p = 0.003). Late post-operative seizure occurred in 13.6% (n = 3 patients) requiring VPS versus 5.3% (n = 2 patients) with successful ETV (p = 0.36). Rates did not correlate with pathology. No patients received prophylactic antiepileptics prior to surgery or exhibiting a seizure. CONCLUSIONS: Patients with early post-operative seizures have an increased likelihood of developing late post-operative seizures. Pediatric ETV patients may have a lower rate of both early and late post-operative seizure; underlying pathology may influence these rates.

Evaluating a telemedicine system to assist in the management of dermatology referrals.

BACKGROUND: Teledermatology systems fall into two categories: live video or store-and-forward. In the former, video-conferencing equipment is used to connect a patient with a remote consultant. This method has been evaluated as an aid to dermatology, but it is expensive both in terms of capital and running costs. Video consultations are generally longer than conventional ones and harder to schedule. Some authors have considered store-and-forward as an alternative to live video: instead of a consultation, specialists could make a rapid inspection of a transmitted still image. OBJECTIVES: A study was conducted to evaluate the role of telemedicine in the dermatology outpatients department of a district general hospital (Whittington Hospital NHS Trust, London, U.K.). METHODS: One hundred and ninety-four patients were seen by one of two consultant dermatologists. A nurse used a video camera to store digital images of each patient's problem and compiled a history from the GP's referral letter. The images were reviewed 13 months later by both dermatologists; they recorded a provisional diagnosis and an assessment of how urgent an appointment would have been made given the information provided by the system. A third consultant graded the level of agreement between the telemedicine diagnoses and the face-to-face consultations. RESULTS: High levels of agreement were found between the diagnoses of the dermatologists using the system to inspect images and those of the dermatologist who saw the patients (77%). Consultants using the system recommended fewer urgent appointments (32% compared with 64%) and felt that in 31% of cases the patient did not need to be seen. In 15% of these cases (5% of the total), however, their diagnosis differed significantly from that of the consultant who saw the patient. Had the system been in use, 14% of patients conventionally assigned a non-urgent appointment would have been seen urgently. CONCLUSIONS: The images allowed a reasonably accurate diagnosis. The software was not reliable (six cases could not be viewed), or easy to use (it took approximately an hour to view 20 cases) but an improved version could be used in triaging outpatient appointments.

Combinatorial chemistry toward understanding the function(s) of carbohydrates and carbohydrate conjugates.

Combinatorial chemistry has contributed significantly to understanding the structure-function relationships of biologically important molecules such as proteins and nucleic acids. However, carbohydrates and carbohydrate conjugates, which have been identified as key modulators of several biological functions have not enjoyed the same measure of success. The complexity and synthetic challenges of carbohydrate conjugates have resulted in a number of conceptual approaches to rapidly access sufficient quantities of these biomolecules. This article summarizes these combinatorial approaches and also highlights fully automated library synthesis of artificial glycopeptides with the goals of understanding their biological roles.

Glycomimetics: a programmed approach toward neoglycopeptide libraries.

A programmed synthesis of neoglycopeptides has been developed in which two, similar or different, glycoside moieties could be attached either (i) at the N-terminal of short peptides or (ii) one at the N-internal and the other(s) at the N-terminal site, in a highly flexible and controlled manner. A stepwise branching of N-terminal peptides has been achieved by glycoside aldehyde reductive amination followed by the glycoside carboxylic acid coupling (model 1). In another approach, after N-alkylation with glycoside aldehyde, the N-glycosylated derivative is subjected to peptide synthesis. This is then followed by the attachment of the second glycoside moiety at the N-terminal using either glycoside aldehyde or glycoside carboxylic acid derivative (model 2). Alternatively, the attachment of second and third glycoside derivatives could be achieved simultaneously, by reductive amination/carboxylic acid couplings (model 3). The methodologies presented here are highly versatile and combine diversity in both peptides/pseudopeptides and glycoside moieties.

Political freedom and the response to economic incentives: labor migration in Africa, 1972-1987.

PIP: This study examines the thesis that political institutions and the freedoms and civil rights generated by these institutions affect migration decisions. The hypothesis is based on one stated by Adam Smith in 1776, that economic conditions that reflect greater political freedoms and civil liberties harbor higher levels of resource mobility in response to economic incentives. Pooled cross-sectional and time-series analysis is based on data from the World Bank for 32 African countries during 1972-87. Findings support the hypothesis that migration rate is more affected by the expected returns ratio to labor in countries where civil liberties are greater than in nations with fewer civil liberties. The implication, from the inclusion of institutional factors in the model, is that civil liberties have an indirect impact on the rate of labor migration out of agriculture in Africa. The impact is a mix of economic incentives and civil liberties. In the political rights model, the most free countries had the largest migration elasticity. The findings on political rights impacts support findings by Friedman and McMillan that civil liberties are a more important determinant of economic growth than political rights. Further testing for measurement error confirmed that the data were flawed, but not so greatly that the basic findings were overturned. The migration out of African agriculture was found to be sensitive to the effect of price signals, which were conditioned by the degree of political rights and civil liberties. Policy makers are urged to consider both changes in pricing and institutions.^ieng

Comparative inhibition profiles of three non-sedating antihistamines assessed by an extended Lewis model.

Antihistaminic drugs are widely prescribed across a multitude of medical specialties such as Allergy and Dermatology. The potentially serious sedative effect of these valuable agents has previously restricted their full use and the choice of drug has been dictated more by individual patient acceptability than by any laboratory demonstrations of comparative efficacy. Unsurprisingly therefore, there is a trend towards prescribing those newer preparations which leave the central nervous system unclouded. We have studied the most frequently prescribed non-sedating antihistamine preparations, terfenadine (Triludan, Triludan Forte), cetirizine (Zirtek) and loratadine (Clarityn) in pharmacodynamic and relative efficacy trials using a quantifiable and reproducible extension of the classic Lewis model. The results indicate that two preparations, terfenadine 120 mg (Triludan Forte) and cetirizine 10 mg (Zirtek) are superior to their immediate rivals in degree of efficacy and/or speed of action. These results should assist clinicians in the positioning of effective, rapidly acting antihistamines for the symptomatic treatment of immediate hypersensitivity reactions such as urticaria and rhinitis.

The determinants of interdistrict labour in-migration in Pakistan, 1971-1980.

"This article begins by reviewing the previous literature pertinent to labour migration within Pakistan. Next, a migration equation at the aggregate level is specified, based on the expected socio-economic determinants of labour migration and data availability. Regression analysis was used to identify and quantify the determinants of interdistrict migration in Pakistan during the period 1971-1980. The results demonstrate that one of the major determinants of migration into a district was the percent of previous migrants in a district's population. Interdistrict migration was also significantly associated with the socio-economic variables of urbanization, population density, and literacy rates. The research presented here provides evidence that the movement of labour between districts in Pakistan is towards locations of superior socio-economic conditions."

Yuletide dermatitis.

An unwelcome aspect of the festive season is contact dermatitis. This may be a gift of cosmetics, jewellery or clothing, or may be food related. It is important to be aware of the possible causative agents as the mainstay of management is withdrawal.

Day care: can it prevent readmission to a psychiatric hospital?

This report concerns the readmission rate for patients involved in Day Care programs at Kingston Psychiatric Hospital. Readmissions were counted for a 3 year period, and results compared with groups of patients who did not attend Day Care. Seventy-three percent of the Day Care Group were readmitted within 3 years as compared to 45% of the main Control Group; however, the Day Care Group had the lowest mean number of readmissions, 1.08, as compared to the Control Group, with 1.25. The relative merits of these two ways of measuring admission rates is discussed in relation to the search for valid outcome criteria. The results were interpreted to indicate that Day Care and related support services help ensure that readmission only occurs in the event of a serious exacerbation of the psychiatric state.

The effects of dietary supplementation with fish oil in patients with psoriasis.

Ten patients with psoriasis resistant to conventional topical treatment were given dietary supplements of fish oil, providing approximately 12 g of eicosapentaenoic acid daily for a period of at least 6 weeks. In eight patients there was a modest improvement in their psoriasis, the principal effects being a diminution of erythema and scaling. The dietary treatment resulted in a substantial inhibition of leukotriene B4 production by the peripheral blood polymorphonuclear leukocytes in vitro. The discrepancy between the high degree of inhibition of leukotriene B4 synthesis and the modest therapeutic effect suggests that leukotriene B4 is not the only mediator involved in the development of the psoriatic lesion. Furthermore, the in vivo cutaneous levels of leukotriene B4 might not have been inhibited to the same extent as the polymorphonuclear leukocyte levels in vitro. Further studies on the use of fish oil supplements, both on their own and in conjunction with other forms of treatment in psoriasis are warranted. It will also be important to determine whether the altered profile of 5-lipoxygenase products found in the blood is also seen in the skin.

The effect of thalidomide on arachidonic acid metabolism in human polymorphonuclear leukocytes and platelets.

The effect of thalidomide on the metabolism of arachidonic acid by purified washed human platelets and polymorphonuclear leukocytes was examined. The drug was found to be without effect under the conditions used. The action of thalidomide cannot therefore be attributed to a direct inhibition of prostaglandin or leukotriene biosynthesis.