Síndrome de hemiconvulsión-hemiplejía-epilepsia: caso clínico y uso de dextrometorfano / Hemiconvulsion-hemiplegia-epilepsy syndrome: case report and use of dextromethorphan

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Predictores pronósticos de desarrollo neurológico en recién nacidos a término con crisis neonatales / Neurodevelopmental outcome predictors of term newborns with neonatal seizures

Introducción: El peso específico de las crisis neonatales en el pronóstico neurológico de recién nacidos a término no se conoce bien, por lo que el objetivo del estudio era describir predictores pronósticos en crisis neonatales. Sujetos y métodos: Estudio observacional prospectivo de recién nacidos a término con crisis clínicas en un centro terciario (2009-2018). Pronóstico adverso se definió como muerte, retraso global del desarrollo, parálisis cerebral o epilepsia. Se analizaron las características perinatales, la etiología, los hallazgos electroencefalográficos, la neuroimagen y los tratamientos antiepilépticos siguiendo un modelo de regresión logística. Resultados: Se incluyó a un total de 102 recién nacidos (52 de los cuales tenían desarrollo normal). Se registraron 12 fallecimientos. En el grupo de supervivientes, 38 niños tuvieron un pronóstico desfavorable (28 con retraso global del desarrollo, 27 con parálisis cerebral, 21 con epilepsia). De las variables pronósticas identificadas en el análisis univariante, las complicaciones perinatales, el inicio de las crisis en el primer día de vida, la actividad basal anormal moderada a grave, un patrón anormal en el electroencefalograma de amplitud integrada y la respuesta al tratamiento continuaron mostrándose como independientemente asociadas a pronóstico adverso después de aplicar un modelo de regresión logística. Conclusiones: Existen datos contradictorios sobre marcadores subrogados en crisis neonatales. Aparte de confirmar el valor predictivo de variables previamente descritas, se halló que la monitorización con electroencefalograma de amplitud integrada constituye una prometedora herramienta diagnóstica. En el futuro, se debería extender su utilización en el abordaje de estos pacientes, lo que sería de vital importancia para un diagnóstico y un tratamiento precoces

Introduction: The concrete burden of neonatal seizures in neurodevelopmental outcome of term newborns is still unknown in literature. The aim of this study was to describe prognostic predictors in neonatal seizures. Subjects and methods: Observational prospective study of term neonates with clinical seizures from a tertiary center (2009-2018). Adverse outcome was determined as death, global developmental delay, cerebral palsy or epilepsy. Perinatal characteristics, etiology, electrographic features, neuroimaging and antiepileptic treatment were analyzed in a logistic regression model. Results: A total of 102 newborns were included (52 infants with normal outcome). Twelve fatalities were registered. In the survival group, 38 children had an adverse outcome (28 global developmental delay, 27 cerebral palsy, 21 epilepsy). From the prognostic variables identified in univariate analysis, perinatal complications, seizure onset in the first day of life, moderate to severe abnormal background activity, abnormal amplitude-integrated EEG pattern, and treatment response remained independently associated with adverse outcome after a logistic regression model. Conclusions: There is conflicting data about surrogate markers in neonatal seizures. Aside from confirming the predictive value of previously described variables, we observed that amplitude-integrated EEG monitoring is a forthcoming prognostic tool. Future approaches may include a wider use of amplitude-integrated EEG monitoring, being crucial for timely seizure identification and prompt treatment

Partial rootzone drying: regulation of stomatal aperture and carbon assimilation in field-grown grapevines (Vitis vinifera cv. Moscatel).

The effects of 'partial rootzone drying' (PRD) irrigation compared with other irrigation systems, namely non-irrigated (NI), full irrigation (FI) and deficit irrigation (DI), on stomatal conductance and carbon assimilation were evaluated in field-grown grapevines (Vitis vinifera L. cv. Moscatel). At the end of the growing season, pre-dawn leaf water potential was highest in FI (-0.18 ± 0.01 MPa; mean ± s.e.), intermediate in PRD (-0.30± 0.01 MPa) and DI (-0.36 ± 0.02 MPa), and lowest in NI vines (-0.64 ± 0.03 MPa). Stomatal conductance measured under controlled conditions of light and temperature was reduced in NI (ca 60%) and PRD (ca 30%) vines compared with DI and FI vines. Under ambient conditions, NI vines had lower rates of stomatal conductance (ca26%), net CO2 assimilation (ca 28%) and light-adapted PSII quantum yields (ca 47%) than PRD, DI and FI vines. No significant differences were found among the three irrigated treatments. Both maximum electron transport rate (Jmax; ca 30%) and triose-phosphate utilization rates (TPU; ca 20%) were significantly lower in NI and PRD vines than in DI and FI vines. Carbon isotope composition (δ13C) of grape berries was highest in NI vines (-24.3), followed by PRD (-25.4) and DI (-25.8) and lowest in FI (-26.4) vines, suggesting a long-term increase in the efficiency of leaf gas exchange in NI compared with PRD, DI and FI vines. Sap-flow data and estimates of relative stomatal limitation are in accordance with the observed stomatal closure in PRD vines. In this study, we show that PRD irrigation was able to maintain a vine water status closed to FI, but with double water use efficiency, which was due to a reduction of stomatal conductance with no significant decrease in carbon assimilation.

Partial rootzone drying: effects on growth and fruit quality of field-grown grapevines (Vitis vinifera).

A study to assess the effects of the Partial Rootzone Drying (PRD) irrigation strategy in comparison to other irrigation systems was carried out in southern Portugal in two field-grown grapevines varieties, Moscatel and Castelão. We addressed the question of whether by regulating growth and plant water use, the PRD system would enable an equilibrated vegetative development, leading to a favourable capture of solar radiation for photoassimilate production and, at the same time to provide an optimum environment for fruit maturation. Three irrigation schemes were applied in addition to the non-irrigated (NI) vines: partial root drying (PRD), 50% of crop evapotranspiration (ETc), supplied to only one side of the root system while the other one was allowed to dry, alternating sides every 15 days; deficit irrigated (DI), 50% ETc supplied, half to each side of the root system and full irrigated (FI, 100% ETc). During the whole season FI plants of both varieties exhibited a high leaf predawn water potential (ψpd , ca-0.2MPa) while a progressive decline was observed in NI plants, reaching ψpd values near -0.7 MPa at the end of August. PRD and DI presented intermediate values. PRD vines exhibited a stronger control over vegetative growth as compared with DI and FI plants. This was expressed by lower values of total leaf area at harvest, leaf layer number, canopy wideness and water shoots number, allowing a higher light interception at the cluster zone that induced an improvement in some berry quality characteristics. Watering had no significant effects on sugar accumulation in the berries but led to a favourable increase in the must titratable acidity, mainly in Castelão. Whereas in DI and FI treatments berry skin anthocyanins and phenols content were always lower than in NI, in PRD there was either no reduction or the reduction was much lower than in the other irrigation treatments. Water use efficiency (WUE) was increased by about 80% in PRD and DI when compared with FI, as a result of almost similar yields in the three treatments. Yield gains of irrigated plants in relation to NI were modest, explained by the rainy spring in both years.