Christos Panteliadis

Oxcarbazepine monotherapy in benign childhood epilepsy with centrotemporal spikes: A clinical and cognitive evaluation

We report on 70 patients (aged 5.2-11.6 years) newly diagnosed with benign childhood epilepsy with centrotemporal spikes (BECTS) who were assigned to oxcarbazepine (OXC) monotherapy. All of them underwent clinical and electroencephalographic examination at baseline and at 3- to 6-month intervals during the study. Psychometric assessment was performed at baseline and after 18 months of treatment with the WISC-III, Illinois Test of Psychomotor Abilities, DSM-IV, and Bender-Santucci test. The Mann-Whitney U test was used to describe differences in the frequency of abnormal findings: (1) at initial evaluation, comparing patients with a matched group of 45 healthy controls, and (2) after 18 months of OXC monotherapy, as an individual follow-up in the patient group. Cognitive assessment at baseline revealed mild learning disabilities in 9% of patients and 7% of controls; all participants had a normal intelligence quotient. During the follow-up, sustained cessation of seizures under medication was observed in 53% of patients; an additional 21% had some relapse but were subsequently rendered seizure free, 21% experienced a >50% improvement, and 5% showed no improvement. Normalization of interictal epileptiform activity was observed in 58% of patients, 35% showed an improvement in the grade of electroencephalographic pathology, and 7% manifested no change at all. The initial mildly weak scores in isolated cognitive domains did not deteriorate, and even improved in some cases, during the course of the study, with concomitant electroencephalographic improvement or normalization and effective seizure control. The results of this study suggest that OXC is effective in preventing seizures and normalizing electroencephalograms and seems to preserve cognitive functions and behavioral abilities as long-term monotherapy in children with typical BECTS.

Suppressive Effects of Interleukin-10 on Human Mononuclear Phagocyte Function against Candida albicans and Staphylococcus aureus

The effects of interleukin (IL)-10, a potent antiinflammatory cytokine, on human monocyte functions against two medically important pathogens, Candida albicans and Staphylococcus aureus, were studied. Incubation with 20-100 ng/mL IL-10 for 2-3 days decreased the fungicidal activity of monocytes against serum-opsonized C. albicans blastoconidia (P</=.04), reduced their capacity to damage unopsonized hyphae (P</=.006), and suppressed superoxide anion production in response to phorbol myristate acetate (P=.019) and N-FMLP (P=.04) but not to serum-opsonized blastoconidia. Paradoxically, IL-10 enhanced phagocytic activity of monocytes against serum-opsonized blastoconidia (P<.01). In addition, IL-10-treated monocytes demonstrated decreased bactericidal activity (P=.046) but no change in bacterial phagocytosis. These findings demonstrate an overall suppressive role of IL-10 on human monocyte function against C. albicans and S. aureus and may have important implications in the use of this cytokine.

Femoral Osteomyelitis Due to Aspergillus nidulans in a Patient with Chronic Granulomatous Disease

Abstract.13 cases of osteomyelitis caused by Aspergillus nidulans have been previously reported in patients with chronic granulomatous disease (CGD). All of them have been associated with simultaneous pulmonary infection and have had an extremely poor outcome. We report an unusual case of femoral osteomyelitis due to A. nidulans in a 16-year-old male with CGD, without pulmonary involvement. Treatment with liposomal amphotericin B and granulocyte colonystimulating factor as well as extensive surgical debridement followed by prolonged treatment with itraconazole resulted in an excellent clinical response.

Neurocutaneous Melanosis: Report of Three Cases and Up-to-date Review

Neurocutaneous melanosis is a rare noninherited embryonic neuroectodermal dysplasia, which is observed sporadically and never affects the entire integument. The hallmark of neurocutaneous melanosis in the neonatal period is the presence of a large bilateral hairy dark nevus with satellite nevi over the trunk and neck. The diagnosis should be considered in neonates with large pigmented nevi and in those with more than 3 hairy dark nevi regardless of their size. Neonates with neurocutaneous melanosis are at risk of developing neurological problems. The most common neurological complications are hydrocephalus, seizures, cranial nerve dysfunction, and signs of spinal cord and root involvement. The authors report 3 cases of histologically confirmed neurocutaneous melanosis and describe the course of neurological symptoms and clinical findings including cognitive tests and neuroimaging. The case reports are complemented by an up-to date review on this clinical entity.

Effectiveness of intermittent diazepam prophylaxis in febrile seizures : Long-term prospective controlled study

The efficacy of intermittent rectal diazepam prophylaxis is assessed in the prevention of febrile seizures. In a prospective randomized cohort trial, 139 children (77 girls, 62 boys) who experienced a first febrile seizure were allocated to two groups: group A, which received intermittent diazepam (n = 68), and group B, which received no prophylaxis (n = 71). All children had a 3-year follow-up. The inclusion criteria were no personal history of afebrile seizures, normal neurodevelopment, no previous anticonvulsant therapy, and age between 6 months and 3 years. Each group was stratified to low, intermediate, and high risk according to the available clinical data. The 36-month recurrence rates in the no-prophylaxis group were 83% in high-risk patients, 55% in intermediate-risk patients, and 46% in low-risk patients. In the prophylaxis group, the recurrence rates were reduced in all risk groups: 38%, 35%, and 33%, respectively. Intermittent diazepam prophylaxis reduces the recurrence rate mainly in high-risk children provided that sufficient doses are given on time and adequately.

Amphotericin B formulations variably enhance antifungal activity of human neutrophils and monocytes against Fusarium solani : comparison with Aspergillus fumigatus

OBJECTIVES Lipid formulations of amphotericin B (AMBF) are widely used in the treatment of life-threatening infections caused by Aspergillus fumigatus and Fusarium solani. We aimed to compare the immunomodulatory effects of four AMBF, deoxycholate (DAMB), liposomal (LAMB), lipid complex (ABLC) and colloidal dispersion (ABCD), on the oxidative antifungal activities of human neutrophils (PMNs) and monocytes (MNCs) against hyphae of A. fumigatus and F. solani. METHODS Human PMNs and MNCs were pre-incubated with 1 or 5 mg/L DAMB and 5 or 25 mg/L for each of LAMB, ABLC and ABCD. Hyphal damage was then assessed by XTT assay, and O2- production was assessed by cytochrome c assay. RESULTS All agents resulted in increased hyphal damage induced by phagocytes against both A. fumigatus and F. solani (P < 0.05). The high concentrations of AMBF elicited higher phagocyte-induced hyphal damage of both fungi than the low concentrations. There was, however, no consistent superiority of any of the AMBF or substantial effector cell:target ratio-dependent differences in the degree of hyphal damage enhancement. By comparison, O2- produced by PMNs or MNCs upon hyphal challenge was not generally affected by any of the AMBF. F. solani hyphae were significantly more resistant to H2O2 than A. fumigatus. CONCLUSIONS These findings suggest that AMBF have enhancing effects of variable degree on phagocyte-induced hyphal damage of A. fumigatus and F. solani. Other fungicidal mechanisms, perhaps non-oxidative, are more likely to mediate these immunomodulatory effects of AMBF on host defence against the two medically important filamentous fungi.

Gemella morbillorum endocarditis in a child.

Gemella morbillorum, formerly called Streptococcus morbillorum, is a catalase-negative, facultatively anaerobic Gram-positive coccus. It was transferred from the genus S. morbillorum in 1988 on the basis of DNA hybridization, physiologic properties and 16S ribosomal RNA gene sequence analysis. It is part of the commensal flora of the gastrointestinal and genitourinary tracts in humans and is a potential pathogen. Infections caused by this organism are uncommon. In adults endocarditis is the most frequent infection reported to be caused by G. morbillorum. Bacteremia and localized infections such as meningitis, 3 arthritis, 5 sinusitis and intracranial and other abscesses 7 also have been reported. Septic shock caused by this organism has been usually observed in immunocompromised patients. We describe a case of endocarditis caused by G. morbillorum in a child. We also review G. morbillorum infections in children.

Cerebral aspergillosis in an infant with corticosteroid-resistant nephrotic syndrome

Abstract.Cerebral aspergillosis is a devastating disease in patients with a compromised immune system. A unique case of a male infant with corticosteroid-resistant nephrotic syndrome complicated by pulmonary and cerebral aspergillosis is described. The patient rapidly developed coma and neurological symptoms and died soon thereafter. Central nervous system aspergillosis was diagnosed radiologically and by detection of Aspergillus DNA and antigen (galactomannan) in blood and cerebrospinal fluid. Moderate immunosuppressive therapy and antifungal phagocytic dysfunction due to nephrotic syndrome per se may have contributed to the occurrence of invasive aspergillosis in our patient. Awareness of this serious complication and early application of diagnostic procedures and antifungal therapy may improve the dismal outcome.

Prognostic factors for subsequent epilepsy in children with febrile seizures

Epilepsy following febrile seizures (FS) has been estimated between 2% and 7%. It concerns a prospective study in a large sample of children with a long‐term follow‐up. The aim of this study is to identify the prognostic factors that can lead children with FS to epilepsy.

Hallmarks in the History of Enteral and Parenteral Nutrition From Antiquity to the 20th Century

Parenteral nutrition (PN) and enteral nutrition (EN) have a very long history, emerging in the ancient world and developing throughout the common epoch. This history dates back as far as 3500 bc to the ancient Egyptians, Indians, and Chinese. Their medical practices were the first reports of enteral feeding therapy, provided via rectum with enemas of wine, milk, whey, wheat, and barley. Hippocrates and Plato, in ancient Greece, were the first personalities to emphasize the importance of diet on health. In the following centuries, Erasistratus and Herophilus described the first notion of the circulatory system, and Oribasius and Celsus described the role of nutrition and disease. There is a great historical gap between the times of Galen (2nd century), who elaborated on the circulatory system; Ibn Zuhr (12th century), who constructed the first model of PN; and Capivacceus (16th century), who placed the first tube for EN. The 17th-19th centuries showed major developments in modern nutrition elements. Steps toward artificial nutrition began in 1628 with the detailed description of blood circulation by William Harvey; however, most of the advances in enteral and parenteral feeding techniques, solutions, and formulas took place in the 20th century. Over the last decade of the 20th century, research focused on metabolic control, multitude formulas, timing and the combination of EN and PN for intensive care patients.