LSN MS guidelines for the management of multiple sclerosis.

OBJECTIVE: The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guidelines for diagnosis, treatment, follow-up and management of patients with MS in Lebanon. Another objective is to discuss and participate in research projects based on epidemiology, clinical trials and more fundamental aspects of the disease in the future. METHODS: Under the authority of the Lebanese Society of Neurology (LSN), a group of neurologists took the initiative to participate in this LSN MS committee with the purpose of establishing a consensus for the management of patients with MS, and under the supervision of a Coordinator (A.T.) designed by the LSN board. RESULTS: Diagnostic and therapeutic, follow-up and research recommendations were proposed with special emphasis on the specific needs and circumstances of Lebanon. The experts highlighted the importance of considering particular needs, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, and cost-effective control of treatment efficacy, as well as global assessment of disability. CONCLUSIONS: The experts established guidelines concerning diagnosis, treatment, and follow-up of patients with MS in Lebanon. Furthermore, they recommended some clinical and fundamental research projects.

Chlorpyrifos and atrazine removal from runoff by vegetated filter strips: experiments and predictive modeling.

Runoff volume and flow concentration are hydrological factors that limit effectiveness of vegetated filter strips (VFS) in removing pesticides from surface runoff. Empirical equations that predict VFS pesticide effectiveness based solely on physical characteristics are insufficient on the event scale because they do not completely account for hydrological processes. This research investigated the effect of drainage area ratio (i.e., the ratio of field area to VFS area) and flow concentration (i.e., uniform versus concentrated flow) on pesticide removal efficiency of a VFS and used these data to provide further field verification of a recently proposed numerical/empirical modeling procedure for predicting removal efficiency under variable flow conditions. Runoff volumes were used to simulate drainage area ratios of 15:1 and 30:1. Flow concentration was investigated based on size of the VFS by applying artificial runoff to 10% of the plot width (i.e., concentrated flow) or the full plot width (i.e., uniform flow). Artificial runoff was metered into 4.6-m long VFS plots for 90 min after a simulated rainfall of 63 mm applied over 2 h. The artificial runoff contained sediment and was dosed with chlorpyrifos and atrazine. Pesticide removal efficiency of VFS for uniform flow conditions (59% infiltration; 88% sediment removal) was 85% for chlorpyrifos and 62% for atrazine. Flow concentration reduced removal efficiencies regardless of drainage area ratio (i.e., 16% infiltration, 31% sediment removal, 21% chlorpyrifos removal, and 12% atrazine removal). Without calibration, the predictive modeling based on the integrated VFSMOD and empirical hydrologic-based pesticide trapping efficiency equation predicted atrazine and chlorpyrifos removal efficiency under uniform and concentrated flow conditions. Consideration for hydrological processes, as opposed to statistical relationships based on buffer physical characteristics, is required to adequately predict VFS pesticide trapping efficiency.

Effectiveness of vegetative filter strips in reducing pesticide loading: quantifying pesticide trapping efficiency.

Pesticide trapping efficiency of vegetated filter strips (VFS) is commonly predicted with low success using empirical equations based solely on physical characteristics such as width and slope. The objective of this research was to develop and evaluate an empirical model with a foundation of VFS hydrological, sedimentological, and chemical specific parameters. The literature was reviewed to pool data from five studies with hypothesized significant parameters: pesticide and soil properties, percent reduction in runoff volume (i.e., infiltration) and sedimentation, and filter strip width. The empirical model was constructed using a phase distribution parameter, defined as the ratio of pesticide mass in dissolved form to pesticide mass sorbed to sediment, along with the percent infiltration, percent sedimentation, and the percent clay content (R(2) = 0.86 and standard deviation of differences [STDD] of 7.8%). Filter strip width was not a statistically significant parameter in the empirical model. For low to moderately sorbing pesticides, the phase distribution factor became statistically insignificant; for highly sorbing pesticides, the phase distribution factor became the most statistically significant parameter. For independent model evaluation datasets, the empirical model based on infiltration and sediment reduction, the phase distribution factor, and the percent clay content (STDD of 14.5%) outperformed existing filter strip width equations (STDD of 38.7%). This research proposed a procedure linking a VFS hydrologic simulation model with the proposed empirical trapping efficiency equation. For datasets with sufficient information for the VFS modeling, the linked numerical and empirical models significantly (R(2) = 0.74) improved predictions of pesticide trapping over empirical equations based solely on physical VFS characteristics.

Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a preliminary study.

BACKGROUND: The diagnostic advantage of methylene blue (MB) chromoendoscopy in Barrett's esophagus is unclear. METHODS: Patients with columnar-lined esophagus (CLE) were enrolled into a prospective, randomized crossover trial of MB-directed biopsy versus conventional biopsy. RESULTS: Forty-seven patients (19 long-segment CLE; 28 short-segment CLE) were enrolled and underwent MB-directed biopsy. Sensitivity and specificity of MB for specialized intestinal metaplasia were 53% and 51%, respectively. Sensitivity and specificity of MB for dysplasia were 51% and 48%, respectively. Thirty-five patients (15 long-segment CLE; 20 short-segment CLE) completed the crossover trial. Relative frequencies for specialized intestinal metaplasia were 73% and 71% from MB-directed and conventional biopsy specimens, respectively (p = 0.73). Relative frequencies for dysplasia were 20% and 18% from MB-directed and conventional biopsy specimens, respectively (p = 0.65). In patients with long-segment CLE, dysplasia was diagnosed in 10 patients with MB and 7 patients with conventional biopsy methods (p = 0.25). The number of biopsy specimens per EGD was greater with MB, which may have influenced the diagnosis. Histologically, the grade of dysplasia was indefinite/low in nearly all of the dysplastic specimens. CONCLUSIONS: Results of MB-directed biopsy were similar to conventional biopsy in detecting specialized intestinal metaplasia and indefinite/low-grade dysplasia. MB was not useful in short-segment Barrett's esophagus.

Supraesophageal manifestations of gastroesophageal reflux disease.

An increasing amount of evidence indicates that gastroesophageal reflux disease (GERD) is a contributing factor to hoarseness, throat clearing, throat discomfort, chronic cough, and shortness of breath. The association between GERD and these supraesophageal symptoms may be elusive. Heartburn and regurgitation are absent in more than 50% of patients. Acid reflux should be considered if signs of GERD are present, symptoms are unexplained, or symptoms are refractory to therapy. The diagnosis of GERD may be unclear, despite a careful history and initial evaluation. A high index of suspicion is required to make the diagnosis. An empiric trial of antireflux therapy is appropriate when GERD is suspected. Multiprobe ambulatory pH monitoring is currently the diagnostic test of choice, but the level of sensitivity and specificity for supraesophageal manifestations of GERD is uncertain. Response to antireflux therapy is less predictable than typical GERD. More intensive acid suppression and longer treatment duration are usually required.

[Reflex epilepsy with seizures induced by mental calculation, playing chess and scrabble]. / Epilepsie réflexe avec crises induites par le calcul mental, le jeu d'échecs et le jeu de scrabble.

Reflex seizures induced by higher mental activity is rare. We report the case of a young man with myoclonic jerks and generalized tonico-clonic convulsion precipitated by calculation, playing chess and scrabble. Routine EEG, including hyperventilation and photic stimulation, showed no abnormality. Tests stimulation procedures, including spatial tasks, induced focal and generalized EEG spike-wave complex and myoclonic jerks. Valproate was effective in reducing epileptic seizures during a follow-up period of three years. Comparison of our case with previously reported reflex epilepsy with seizures induced by higher mental activity is discussed.