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Progress in the management of complex congenital heart disease (CHD) led to an improvement in survival rates of adults with a Fontan-like circulation. The objective of this study was to assess the subjective health status and quality of life of this population.
Methods and results:
Patients aged more than 18 years at the time of the study, who underwent a Fontan-like procedure. Subjective health status was assessed by the SF-36 questionnaire and a linear analog scale was used to score patients’ self-perception of their quality of life; cardiac and demographic parameters were collected.
Among 65 eligible patients, 60 (23 females; mean ± SD age: 25.7 ± 7.2 years) answered the SF-36 questionnaire and 46 of these were interviewed to evaluate their perceived quality of life. Among them, 20 (33.3%) were working full-time and 21 (35%) experienced arrhythmias. The physical SF-36 scores were lower in patients than in the general population (p ≤ 0.05). The New York Hear Association (NYHA) class and occupation were correlated with SF-36 scores of physical activity (respectively, p = 0.0001 and p = 0.025). SF-36 scores of psychological status were associated with the number of drugs and occupation (respectively, p = 0.0001 and p = 0.02). The mean ± SD quality of life score measured using a linear analog scale was 7.02 ± 1.6 and was linked to education and occupation (p ≤ 0.05) but not with cardiac parameters.
Adult Fontan patients perceive an impaired physical health but report a good overall quality of life. Education and occupation impacts significantly on Fontan patients’ quality of life.
Schistosomiasis is a neglected tropical disease, though it is highly prevalent in many parts of sub-Saharan Africa. While Schistosoma haematobium-bovis hybrids have been reported in West Africa, no data about Schistosoma hybrids in humans are available from Côte d'Ivoire. This study aimed to identify and quantify S. haematobium-bovis hybrids among schoolchildren in four localities of Côte d'Ivoire. Urine samples were collected and examined by filtration to detect Schistosoma eggs. Eggs were hatched and 503 miracidia were individually collected and stored on Whatman® FTA cards for molecular analysis. Individual miracidia were molecularly characterized by analysis of mitochondrial cox1 and nuclear internal transcribed spacer 2 (ITS 2) DNA regions. A mitochondrial cox1-based diagnostic polymerase chain reaction was performed on 459 miracidia, with 239 (52.1%) exhibiting the typical band for S. haematobium and 220 (47.9%) the S. bovis band. The cox1 and ITS 2 amplicons were Sanger sequenced from 40 randomly selected miracidia to confirm species and hybrids status. Among the 33 cox1 sequences analysed, we identified 15 S. haematobium sequences (45.5%) belonging to seven haplotypes and 18 S. bovis sequences (54.5%) belonging to 12 haplotypes. Of 40 ITS 2 sequences analysed, 31 (77.5%) were assigned to pure S. haematobium, four (10.0%) to pure S. bovis and five (12.5%) to S. haematobium-bovis hybrids. Our findings suggest that S. haematobium-bovis hybrids are common in Côte d'Ivoire. Hence, intense prospection of domestic and wild animals is warranted to determine whether zoonotic transmission occurs.
To evaluate resilience and frequency of behavioral symptoms in Haitian children internationally adopted before and after the earthquake of January 12, 2010.
We conducted a retrospective quantitative study in 40 Haitian children. Families were also asked to participate in a qualitative study (individual interview at 18-24 months after the earthquake) and to complete State-Trait Anxiety Inventory (STAI) and STAI for children (STAI-C) questionnaires.
Demographic and clinical characteristics were similar in the group who experienced the earthquake (n=22) and in the group who did not (n=18). The families of 30 adoptees were interviewed. There was no statistical difference between the two groups for the STAI (P=0.53) and STAI-C (P=0.75) or for the frequency of behavioral problems. Plenary adoption was pronounced for 84.6% and 33.3% of the children adopted in the pre- and post-earthquake group, respectively (P=0.02). Children rarely talked about the experience of the earthquake, which, by contrast, was a stressful experience for the adoptive families.
Haitian children adopted after the earthquake did not express more stress or behavioral problems than those adopted before it. However, the possibility of a resurgence of mental disorders after age 10 should be borne in mind. (Disaster Med Public Health Preparedness. 2018;12:450–454)
Rapid changes in agricultural systems call for profound changes in agricultural research and extension practices. The Diagnosis, Design, Assessment, Training and Extension (DATE) approach was developed and applied to co-design Conservation Agriculture-based cropping systems in contrasted situations. DATE is a multi-scale, multi-stakeholder participatory approach that integrates scientific and local knowledge. It emerged in response to questions raised by and issues encountered in the design of innovative systems. A key feature of this approach is the high input of innovative systems which are often although not exclusively based on conservation agricultural practices. Prototyping of innovative cropping systems (ICSs) largely relies on a conceptual model of soil–plant–macrofauna–microorganism system functioning. By comparing the implementation of the DATE approach and conservation agriculture-based cropping systems in Madagascar, Lao PDR, and Cambodia, we show that: (i) the DATE approach is flexible enough to be adapted to local conditions; (ii) market conditions need to be taken into account in designing agricultural development scenarios; and (iii) the learning process during the transition to conservation agriculture requires time. The DATE approach not only enables the co-design of ICSs with farmers, but also incorporates training and extension dimensions. It feeds back practitioners’ questions to researchers, and provides a renewed and extended source of innovation to farmers.
To compare the responsiveness of different anthropometric indicators for measuring nutritional stress among children in developing countries.
Growth was studied within 6-month intervals in a rural Senegalese community during one dry and two rainy (hungry) seasons. Responsiveness was defined as the change divided by the standard deviation of each anthropometric indicator. Contrast was defined as the difference in responsiveness between dry and rainy seasons.
The study was conducted in Niakhar, a rural area of Senegal under demographic surveillance, with contrasted food and morbidity situations between rainy and dry seasons.
Some 5000 children under 5 years of age were monitored at 6-month intervals in 1983–1984. The present analysis was carried out on a sub-sample of children aged 6–23 months with complete measures, totalling 2803 children-intervals.
In both univariate and multivariate analysis, mid-upper arm circumference was found to be more responsive to nutritional stress than the commonly used weight-for-height Z-score (contrast = −0·64 for mid-upper arm circumference v. −0·53 for weight-for-height Z-score). Other discriminant indicators were: muscle circumference, weight-for-height, BMI and triceps skinfold. Height, head circumference and subscapular skinfold had no discriminating power for measuring the net effect of nutritional stress during the rainy season.
The use of mid-upper arm circumference for assessing nutritional stress in community surveys should be considered and preferred to other nutritional indicators. Strict standardization procedures for measuring mid-upper arm circumference are required for optimal use.
The proton conducting perovskite MZr1−xLnxO3−δHz ceramics are promising electrolytic membranes for fuel cell and water steam electrolyser applications. Simultaneous elastic/quasielastic and diffraction neutron studies were performed in a wide temperature range (25–1150 °C) on protonated Yb-modified BaZrO3 ceramics: dense (97% of theoretical density) and ultradense (99%) using the triple axis spectrometers. The results allowed us to determine: (i) the real content of bulk protonic species ∼1–5 10−3 mol/mol, (ii) the structural modifications caused by the proton doping, and (iii) the bulk proton dynamics. The quasielastic neutron scattering (QNS) results are discussed in the light of neutron diffraction, conductivity, Raman, thermogravimetric, and thermal expansion measurements. The highest bulk proton motion appears in the temperature range where the structural modifications and the energy activation changes are detected. This allows defining the optimum temperature range for the proton dynamics between 400 and 560 °C.
Although epilepsy surgery is safe and effective, it is not free of complications. This type of surgery shows some peculiarities that are not common in other neurosurgical procedures. A unique feature is that removal or disconnection of functionally normal brain areas are often an essential part of surgical strategy, which may lead to functional deficits. Furthermore, patients prior to undergoing surgery frequently require invasive diagnostic procedures in order to lateralize and/or localize the epileptic focus, adding to the risk of complications. Potential complications from both invasive diagnostic and surgical treatment should be well recognized and the surgeon must inform the patient, family members, or caregivers. Although a low morbidity is reported for epilepsy surgery, a complication such as intracranial hemorrhage or direct injury to a highly functional area can be catastrophic and overshadow an otherwise successful surgery.
Definition of a complication
There is no universal definition of a complication after epilepsy surgery but based on a few previously published reports we have defined a complication as an unwanted, unexpected, and uncommon event after either a diagnostic or therapeutic procedure. In this chapter, the severity of surgical and neurological complications following surgery is graded as minor if transient and of no significant functional impact or major if causing significant disability that can be permanent. However, it should be noted that the definition of a complication is open for discussion because some postoperative disturbances may be considered acceptable side effects and not complications if they resolve completely within a few days. For example, brain edema may cause simple transient side effects such as dysphasia or mild hemiparesis that generally resolves after anti-edema medication and passage of time. Furthermore, a permanent or temporary visual (upper quadrantanopia) field defect should not be classified as a complication, because it may be unavoidable in temporal lobe surgery. In the same context, homonymous hemianopsia after occipital lobe resection is not a complication since the deficit would have been discussed in detail with the patient prior to surgery and would be expected after surgery. An expected paresis after a functional tissue removal in the sensorimotor area should not be considered a complication.
Techniques in Epilepsy Surgery presents the operative procedures used in the treatment of intractable epilepsy in a practical, clinically relevant manner. Founded by pioneering neurosurgeon Wilder Penfield, the Montreal Neurological Institute (MNI) is a leading global centre of epilepsy surgery and this volume reflects the Institute's approach, combining traditional techniques with modern neuronavigation-based approaches. There is an emphasis on mastering the important trilogy of topographic, vascular and functional anatomy of the brain. The basic anatomical and physiological mechanisms underlying epilepsy are presented in a practical manner, along with the clinical seizure evaluation that leads to a surgical hypothesis. The consultation skills and investigations necessary for appropriate patient selection are discussed, as well as pitfalls and the avoidance of complications. This is an invaluable resource not only for neurosurgeons, neurosurgical residents and fellows in epilepsy surgery, but also for neurologists, and others who provide medical care for patients with intractable epilepsy.
Epilepsy surgery is an effective treatment for reducing or eliminating seizures in patients with medically intractable epilepsy. Seizure control can be expected in 60–80% of patients with temporal and 50–80% with extra-temporal lobe epilepsy. However, the evaluation of seizure outcome alone is not sufficient in the assessment of surgical effectiveness. The final goals of epilepsy surgery are to reduce the frequency and intensity of seizures without catastrophic complications as well as improvement in quality of life (QOL). Seizure cessation is correlated with improved QOL and seizure-free patients have the potential to realize a normal life. Epilepsy leads to more psychosocial problems compared to those without epilepsy, most notably anxiety, depression, and low self-esteem. Stigma of epilepsy has a major negative impact on QOL. Additionally, people with epilepsy are more likely to be unemployed or under-employed, have lower rates of marriage, and greater social isolation.
In this chapter, we will summarize the impact of epilepsy surgery on QOL including psychosocial life in temporal and extra-temporal lobe epilepsy. The long-term results in patients with temporal and extra-temporal lobe epilepsies will be discussed with respect to seizure outcome, antiepileptic medication (AED) use, employment, and QOL pre- and postoperatively.
This chapter will discuss techniques that depart from the classical epilepsy surgery of seizure focus resection. The treatments vagus nerve stimulation and multiple subpial transection discussed below are currently being used and are generally accepted as standard surgical options, but brain stimulation and radiosurgery are continuing to be studied to define their roles in the treatment of intractable epilepsy. For the newer therapies, we cannot know at this time whether they will be embraced as a useful and efficacious treatment option for our patients. With that caveat in mind, the goal of this chapter is to serve as an introduction to the current state of knowledge for investigational approaches, as well as to describe the indications and surgical technique for alternative procedures that have become accepted for use in surgery for epilepsy.
Multiple subpial transections
Often the most difficult and complex treatment decisions are in patients with a seizure focus that involves important functioning areas. In some patients, a minor neurological deficit may be acceptable for a reasonable chance at seizure freedom. However, if the complete resection of a seizure focus poses an unacceptable risk to neurological function, an alternative technique such as multiple subpial transection (MST) can be considered. The technique of MST was refined in animals by Morrell and colleagues. It was first utilized in humans by John Handbery in three patients and later translated to a large series of patients by Whisler at the Rush Epilepsy Center in Chicago.
Epilepsy arising from the temporal lobe can be divided into two main types, lateral neocortical and mesial temporal lobe epilepsy (MTLE), based on the location of the seizure focus. In lateral epilepsy, the seizure focus is localized to the six-layered cortex of the temporal lobe found lateral to the collateral fissure. Several studies have attempted to identify features of the seizure pattern or history that can distinguish between these two types of epilepsy, but they share too many features to make a clear distinction in a single patient. In general, MTLE more commonly displays the typical temporal lobe seizure elements of an epigastric or cephalic aura, loss of awareness, automatisms, posturing, and postictal amnesia. Lateral temporal epilepsy often manifests signs related to perisylvian structures such as an auditory hallucination or postictal aphasia, in the dominant hemisphere. It should be suspected when a temporal seizure pattern is present without mesial temporal sclerosis. MTLE is more related to childhood febrile convulsions and its structural sequela, mesial temporal sclerosis. In a series of 878 patients operated on for temporal lobe epilepsy at the MNI (1928–1973), discrete focal lesions were identified in the lateral cortex of 202. More recent surgical series have identified even more lateral cortical lesions in temporal lobe epilepsy representing an increased recognition of dysplasia and benign tumors on preoperative imaging.
The two main modalities of temporal lobe surgery are the cortico-amygdalohippocampectomy (CAH) and the selective amygdalohippocampectomy (SelAH). These will be discussed separately. In this chapter we will address the surgical anatomy of the temporal lobe as well as describe the technique of CAH. In Chapter 10 the SelAH will be described in detail.
The purpose of this chapter is not to present an exhaustive review of the history of surgery of epilepsy from the beginning until today but rather to present a gallery of portraits of individual neurosurgeons who have contributed significantly in developing the field. The period covered extends from the late nineteenth century to the advent of magnetic resonance imaging (MRI) around 1984. This single event was to cause a revolution in the field and led to the creation of numerous comprehensive epilepsy centers as well as the advent of important international conferences such as the historical Palm Desert symposium organized by P. Engel in 1986. From that time onward, numerous workers from all branches of neurosciences have contributed to the development of this subspecialty that has had no equivalent in other fields of neurosurgery over the last 30 years. The reader will also note and forgive the strong emphasis on the role played by the Montreal Neurological Institute (MNI) in the development of epilepsy surgery and the creation of a diaspora that has had a widespread and continuous effect over the years.
Surgery for occipital lobe epilepsy has its own specific difficulties mainly related to the uncertainty of diagnosis and the visual loss associated with most resective surgery in the absence of an already existing visual deficit. In no other brain region is the patient and the surgical team confronted to such a degree with the possibility of a postoperative situation characterized by a poor result on the seizure tendency in addition to a new and permanent visual deficit. Consequently, all efforts must be made, often including SEEG intracranial recording, to prove the seizures are arising within a specific part of the occipital lobe and not for example within the temporal or parietal area.
The literature is sparse on the surgical treatment of occipital epilepsy and even more so on the modern surgical and technical aspects. In this chapter, a summary of the surgical anatomy of the occipital lobe and the clinical manifestations of occipital epilepsy, which are so crucial in establishing the hypothesis of the site of seizure onset, will be presented from a practical surgical perspective. Next, the technical aspects and various resection modalities will be addressed. The core of the presentation consists of an analysis of several representative cases with stress on the operative approaches, findings, and results.