Pediatric Teleneurology: A Model of Epilepsy Care for Rural Populations.

BACKGROUND: Approximately 2.7 million individuals in the United States are affected by epilepsy. It is the fourth most common neurological disorder and affects people of all ages, races, and economic backgrounds. In many rural states, the few pediatric neurologists commonly practice in the metropolitan areas. The inadequate resources present challenges for families residing in rural areas or with limited transportation resources. One remedy for this situation is to deliver pediatric neurology services to rural areas through videoconferencing. METHODS: The University of Kansas Center for Telemedicine and Telehealth has been providing telemedicine consultations in various clinical specialties for 25 years, including mental health and teleneurology. On the basis of the telemedicine models provided at the University of Kansas Center for Telemedicine and Telehealth and other programs, we explain how to provide teleneurology services to rural communities while maintaining high quality care, including direction for assessing need, technology, privacy, administrative and clinical support, credentialing and legality, and sustainability. CONCLUSIONS: We provide a protocol for teleneurology development, outlining examples of needed staff, and measures to ensure a smooth implementation and execution, ending with an example of the current teleneurology clinic provided at the University of Kansas Center for Telemedicine and Telehealth.

Clara Maass, yellow fever and human experimentation.

Clara Louise Maass, a 25-year-old American nurse, died of yellow fever on August 24, 1901, following experimental inoculation by infected mosquitoes in Havana, Cuba. The human yellow fever experiments were initially conducted by MAJ Walter Reed, who first used written informed consent and proved the validity of Finlay's mosquito-vector hypothesis. Despite informed consent form and an incentive of $100 in U.S. gold, human subjects were exposed to a deadly virus. The deaths of Clara Maass and two Spanish immigrants resulted in a public outcry and the immediate cessation of yellow fever human experiments in Cuba.

Cooling and hemodynamic management in heatstroke: practical recommendations.

INTRODUCTION: Although rapid cooling and management of circulatory failure are crucial to the prevention of irreversible tissue damage and death in heatstroke, the evidence supporting the optimal cooling method and hemodynamic management has yet to be established. METHODS: A systematic review of all clinical studies published in Medline (1966 to 2006), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to 2006), and Cochrane Database was performed using the OVID interface without language restriction. Search terms included heatstroke, sunstroke, and heat stress disorders. RESULTS: Fourteen articles reported populations subjected to cooling treatment for classic or exertional heatstroke and included data on cooling time, neurologic morbidity, or mortality. Five additional articles described invasive monitoring with central venous or pulmonary artery catheters. The four clinical trials and 15 observational studies covered a total of 556 patients. A careful analysis of the results obtained indicated that the cooling method based on conduction, namely immersion in iced water, was effective among young people, military personnel, and athletes with exertional heatstroke. There was no evidence to support the superiority of any one cooling technique in classic heatstroke. The effects of non-invasive, evaporative, or conductive-based cooling techniques, singly or combined, appeared to be comparable. No evidence of a specific endpoint temperature for safe cessation of cooling was found. The circulatory alterations in heatstroke were due mostly to a form of distributive shock associated with relative or absolute hypovolemia. Myocardial failure was found to be rare. CONCLUSION: A systematic review of the literature failed to identify reliable clinical data on the optimum treatment of heatstroke. Nonetheless, the findings of this study could serve as a framework for preliminary recommendations in cooling and hemodynamic management of heatstroke until more evidence-based data are generated.

A pediatric neurologist's clinical experiences in Saudi Arabia.

From 1996 to 2002, I was head of a pediatric neurology section and helped develop a fellowship training program in Saudi Arabia. This was a most rewarding learning experience because of an abundance of neurometabolic and neurodegenerative diseases in a population with a high rate of consanguinity. In addition to inborn errors of metabolism, other prevalent disorders included late-infantile neuronal ceroid-lipofuscinosis, hyperekplexia, focal cortical dysplasias, sarcoglycanopathies, familial spastic paraplegia, demyelinating diseases, and dysmorphic syndromes. These patient experiences were a rich source of stimulation for clinical teaching and research.

Griffiths-Wheeler geometrical picture of critical phenomena: experimental testing for liquid-liquid critical points.

An experimental approach to the verification of specific relations between thermodynamic properties as predicted from the Griffiths-Wheeler theory of critical phenomena in multicomponent systems is developed for the particular case of ordinary liquid-liquid critical points of binary mixtures. Densities rho(T) , isobaric heat capacities per unit volume C(p)(T) , and previously reported values of the slope of the critical line (dT/dp)c for five critical mixtures are used to check the thermodynamic consistency of C(p) and rho near the critical point. An appropriate treatment of rho (T) data is found to provide the key solution to this issue. In addition, various alternative treatments for C(p)(T) data provide values for both the critical exponent alpha and the ratio between the critical amplitudes of the heat capacity A+/A- that are in agreement with their widely accepted counterparts, whereas two-scale-factor universality is successfully verified in one of the systems studied.

Carlos Finlay and yellow fever: triumph over adversity.

The eradication of yellow fever in Havana, Cuba, was achieved by a fruitful collaboration between American and Cuban physicians. Carlos Finlay, a Cuban physician who proposed the mosquito-vector theory in 1881, shared his ideas, his publications, and a sample of mosquito eggs with the U.S. Army Yellow Fever Commission. The commission, headed by MAJ Walter Reed, used human volunteers to confirm Finlay's theory. MAJ William Gorgas adopted mosquito-control measures in his sanitation program and, within 6 months, yellow fever was controlled in Havana for the first time. Finlay held fast to his ideas despite incredulity and ridicule. His tenacity and scientific honesty vindicated his ideas about yellow fever.

Treatment of status epilepticus in children.

Status epilepticus is a medical emergency that requires prompt recognition and urgent treatment. Successful management of status epilepticus in children depends upon implementation of a treatment protocol modified according to current practices as well as availability of antiepileptic medications, out of hospital emergency services and intensive-care facilities. We propose a treatment protocol for status epilepticus in children in the Kingdom of Saudi Arabia.

Treatment of status epilepticus in children.

Status epilepticus is a medical emergency that requires prompt recognition and urgent treatment. Successful management of status epilepticus in children depends upon implementation of a treatment protocol modified according to current practices as well as availability of antiepileptic medications, out of hospital emergency services and intensive-care facilities. We propose a treatment protocol for status epilepticus in children in the Kingdom of Saudi Arabia.

Deletion mutations in the dystrophin gene of Saudi patients with Duchenne and Becker muscular dystrophy.

OBJECTIVE: The deletion in the dystrophin gene has been reported for many ethnic groups, but until now the mutations in this gene have not been thoroughly investigated in Saudi patients with Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). We examined the deletion pattern in the dystrophin gene of the Saudi patients applying multiplex-polymerase chain reaction (PCR). The aim of this study is to describe the outcome of our initial effort to identify mutations in the dystrophin gene in a representative group of Saudi patients with DMD and BMD. METHODS: Genomic deoxyribose nucleic acid was isolated from 41 patients with DMD and BMD (27 patients confirmed by muscle biopsy and 14 patients with clinical suspicion), 3 patients with limb girdle muscular dystrophy, 12 male relatives of the patients, and 5 healthy Saudi volunteers. A total of 25 exons around the deletion prone regions (hot spots) of the dystrophin gene were amplified. The study was carried out at the King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia between 2000 and 2002. RESULTS: The deletion of one or more exons was found in 21 of 27 DMD and BMD patients confirmed by muscle biopsy. The deletion in the gene was detected in 5 of 14 patients with DMD diagnosis, but not confirmed by dystrophin staining of muscle biopsy. No deletion in the dystrophin gene was detected in control Saudi volunteers, the limb girdle dystrophy patients, and the relatives of patients, as expected. CONCLUSION: The present study suggests that intragenic dystrophin gene deletions occur with the same frequency in Saudi patients compared with other ethnic groups. The PCR-based deletion analysis provides a reasonable first step in the diagnostic care of Saudi patients who may be afflicted with DMD and BMD.