The yield of routine EEG in geriatric patients: A prospective hospital-based study.

STUDY AIM: To study the yield of routine EEG in geriatric patients. PATIENTS AND METHODS: We examined standard EEG recordings of 701 patients aged 84.6±6.4 years. These were performed over a 15 month-period in a geriatric hospital. The majority of patients were hospitalized and 46.5% suffered from multiple medical problems. RESULTS: We found EEG abnormalities in 392/701 (56%) patients. These consisted of permanent diffuse slowing, either isolated (17.1%) or with intermixed epileptiform abnormalities (2.4%), focal slowing (15.4%), intermittent diffuse slowing (8.9%), triphasic waves (1.14%), periodic epileptiform discharges (0.57%), flat and inactive tracing (0.14%), status epilepticus (0.99%), seizures (0.42%), interictal epileptiform abnormalities (8.7%). Epileptiform abnormalities (both ictal and interictal) were observed in 92/701 (13.1%) patients. These were focal in the majority of cases (85.9%), most frequent in temporal regions (42%), followed by centroparietal (20.2%) and temporo-parieto-occipital carrefour regions (17.2%), but less frequent in frontal (6.3%) and occipital regions (3.8%). We found sleep activity without other EEG abnormalities in 13.7% of patients and subclinical rhythmic electrographic discharge in adult (SREDA) in 1% of cases. CONCLUSIONS: In this study, EEG abnormalities were very common, which reflects the high frequency of cerebral dysfunction in geriatric patients. These abnormalities are of various types, often suggestive of different aetiologies, and may be helpful in clinical management.

Effect of early postpartum use of the contraceptive implants, NORPLANT, on the serum levels of immunoglobulins of the mothers and their breastfed infants.

Ten breastfeeding women had the contraceptive implants NORPLANT inserted between days 30 and 39 postpartum. The immunoglobulins IgG, IgM and IgA were measured in the serum of the mothers and the infants before insertion and five months later. A control group of breastfeeding mothers who did not use any contraception or used local barrier methods were similarly studied. Although there were changes in the immunoglobulin levels with time in both mothers and infants, there were no group differences; this indicates that the use of NORPLANT does not influence these factors of humoral immunity.

PIP: This study measured major immunoglobulin levels in the serum of 10 breastfeeding mothers and their infants before insertion of the Norplant contraceptive implant (at 30-39 days postpartum) and again 5 months after insertion. 10 women who were also breastfeeding but either used no contraception or used barrier methods (diaphragm or condom) served as controls. Comparison of preinsertion and postinsertion mean serum concentrations revealed a significant rise in IgG and a significant decline in IgM in both groups of mothers. IgA concentrations declined after 6 months postpartum in both the study and control groups, but the difference was statistically significant only for women in the Norplant group. There were no significant differences between the 2 groups in changes occurring after 5 months. Similarly, there were no group differences, either at study admission or after 5 months, in the immunoglobulins of infants of Norplant-using women and controls. Overall, the changes in maternal and infant immunoglobulin levels noted in this study are similar to those expected during parturition and infancy. These results provide no evidence that use of hormonal contraception in the immediate postpartum period can make both mothers and infants more susceptible to infection. It is noted, however, that immunoglobulin levels are only 1 aspect of the immune system.

Effect of subdermal levonorgestrel contraceptive implants, Norplant, on liver functions.

Forty-seven normal health women were studied longitudinally for changes in liver functions during the use of the levonorgestrel contraceptive implant system, NORPLANT. Samples were collected before insertion of the implants and after one, three and six months of use. The enzymes studied were the transaminases (SGOT and SGPT), alkaline phosphatase and gamma-glutamyl transferase. Serum bilirubin and bile acid levels were also measured. The protein synthetic function of the liver was tested by estimation of total proteins, albumin, transferrin, hemopexin, ceruloplasmin and haptoglobin. The three main immunoglobulins, G, M and A, were also measured. There were no significant changes in the liver enzymes after NORPLANT use. Serum bilirubin and bile acid concentrations showed rises in the first month of use which ameliorated in subsequent months. Serum albumin was transiently increased during the first and third months. Ceruloplasmin decreased significantly at the sixth month. The concentrations of total serum proteins and the other individual proteins showed no significant change. The results point to safety of NORPLANT implant use, as regards hepatic functions.

Effect of subdermal levonorgestrel contraceptive implants, Norplant, on serum lipids.

Forty-seven normal non-smoking parous women were enrolled in a longitudinal study of the effect of use of the subdermal levonorgestrel implants, NORPLANT, on serum lipids. Blood samples were collected after an overnight fast before insertion and after three, six, nine and twelve months of use. The high-density lipoprotein cholesterol showed no change until the twelfth month when it was increased (P less than .05). Total cholesterol, low-density lipoprotein cholesterol and triglyceride levels decreased significantly during NORPLANT use.

Effect of levonorgestrel contraceptive implants, Norplant, on blood coagulation.

A longitudinal study of coagulation parameters was carried out on 47 women using the levonorgestrel subdermal implants, NORPLANT. The study comprised measurement of platelet count, prothrombin time, thrombin time, partial thromboplastin time with kaolin, clotting factors I, II, V and VI through XIII, plasminogen, antithrombin III (AT III), alpha 1 antitrypsin, alpha 2 macroglobulin and fibrinogen degradation products. The tests were done at admission and after one, three and six months of NORPLANT use. Parallel and similar studies were done on two groups of oral contraceptive users; the first group used a pill containing 1 mg norethisterone and 50 micrograms mestranol, and the second a pill consisting of 150 micrograms levonorgestrel and 30 micrograms ethinylestradiol. Results from this ongoing study have indicated that women using NORPLANT implants evidenced lack of effects on most of the parameters tested except for factor VII activity which was increased and AT III concentration which was decreased after six months of use. The combined pill users evidenced marked changes in the platelet count, the screening tests and in most of the coagulation-promoting factors; the changes were apparent after three months of use and became more pronounced after six months. The results demonstrate, with marked contrast, that the implants had less pronounced effects on the blood coagulation system than did the combined pills used in this study.

PIP: The effect of Norplant, a subdermal contraceptive implant containing levonorgestrel, on blood coagulation factors was investigated in 47 healthy women. Coagulation parameters were also measured in 55 subjects who were taking combination type oral contraceptives (OCs) (either a pill containing 1 mg norethisterone and 50 mcg mestranol or a preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol). Blood sampling was carried out at admission and after 1, 3, and 6 months of contraceptive use. Parameters measured included platelet count, prothrombin time, thrombin time, partial thromboplastin time with kaolin, clotting factors I, II, V, and VI-XIII, plasminogen, antithrombin III, alpha 1 antitrypsin, alpha 2 macroglobulin, and fibrinogen degradation products. Norplant users showed a lack of effect on the factors tested, except for factor VII activity, which was increased, and antithrombin III concentration, which was decreased after 3 months of use. In contrast, the combined OC users evidenced marked changes in platelet count, the screening tests, and most coagulation promoting factors. These changes became more pronounced after 6 months. Women taking the levonorgestrel-ethinyl estradiol OC evidenced less pronounced changes in some coagulation parameters than those taking the norethisterone-mestranol preparation; however, the high dropout rate among OC users limits the conclusions that can be drawn from these results. These results point to a relative lack of effect of Norplant implants on the blood coagulation-fibrinolytic system, presumably due to the absence of estrogen and the low dose of progestogen delivered to the body.

Production of penicillinases by certain penicillin-resistant bacteria. (C) factors affecting the activities of penicillinases produced by Staphylococcus aureus, S9.

The activities of penicillinases produced by Staphylococcus aureus, S9 were found to be affected by pH, temperature, substrate concentration and type of penicillin derivative used as a substrate. The optimal activities of penicillinases produced by S. aureus, S9 were obtained at pH 6, at 37 degrees C, 0.5-10 mu/ml penicillin G concentration, and by increasing the enzyme concentration.

Lipases production by Bacillus circulans under mesophilic and osmophilic conditions. Factors affecting lipases production.

A facultative osmophilic bacterium able to produce lipases (isolated from bee honey) was identified as Bacillus circulans. Factors affecting lipases production by such isolate were studied. Dox's liquid medium supplied with 2 and/or 30% sucrose was used as a basal medium, under static culture condition, for such a purpose. Results have showed that the optimal sucrose concentration at which the isolate produced its maximal yield of lipases was 30% after an incubation period of 24 hours at 40 degrees C, and this was corresponding to an incubation period of 48 hours at 40 degrees C in presence of 2% sucrose. The optimal pH value was 7 in the first case while, 6.5 in the second. Furthermore production of extracellular lipases by such isolate was achieved in presence and absence of tributyrin as a carbon source instead of sucrose when supplied to Dox's liquid medium. Also the production of extracellular lipases by such isolate was not enhanced in presence of tributyrin as a supplement to Dox's liquid medium when supplied with 2 and/or 30% sucrose as carbon sources. This might suggest that the extracellular lipases of such isolate is constitutive in nature.

Interaction of Salmonella paratyphi A and Schistosoma mansoni in hamsters.

It has previously been shown that Salmonella paratyphi A associates with adult Schistosoma mansoni worms in animal models and in patients with schistosomiasis, resulting in Salmonella infections that are difficult to manage unless the helminthic parasite is eliminated. In the present study, characteristics of this association were explored. In vitro, fresh serum, but not heat-inactivated (56 degree C, 30 minutes) serum, from normal hamsters (NH) and schistosome-infected hamsters (SIH) equally inhibited bacterial growth. When either group of animals was given S. paratyphi A intracardially, there was a decline in recoverable bacteria in the blood for 3 days, but after the third day, the number of bacteria increased in SIH whereas NH blood became sterile. Co-cultivation of S. paratyphi A in Earle's medium with live worms yielded more bacterial growth than occurred in the medium without worms, suggesting that nutritional factors are involved in the relationship. An intimate association in vivo of bacteria and trematodes was confirmed by culturing Salmonella from both worm surfaces and homogenized worms, with more bacteria being recovered from female worms. Although the bacterial infection induced a significant hepatic shift of adult worms in SIH, oogram analyses were normal and no lethal effect of bacteria on worms was noted.

Salmonella paratyphi A in hamsters concurrently infected with Schistosoma mansoni.

The present work deals with the development of an improved animal model to study the association of salmonellosis and schistosomiasis. The animal chosen was the hamster, Mesocricetus auratus, which can be readily infected with Schistosoma mansoni. Normal hamsters and schistosome-infected hamsters (SIH) were given approximately 2.0 x 10(7) Salmonella paratyphi A intracardially. It was found that S. mansoni infections enhanced and prolonged the growth of S. paratyphi A in hamsters. Animals with dual infections had increased mortality in comparison with those infected with just bacteria or parasite during the 50 days post-bacterial challenge. Further studies showed that in SIH, S. paratyphi A persisted in various organs for up to 8 weeks post infection. In contrast, concurrent Leishmania donovani infections have no effect on S. paratyphi A infections. Significant numbers of bacteria were cultured from well-washed schistosome worms recovered from SIH 6--8 weeks post-bacterial challenge. These findings suggest that a direct physical relationship between the bacteria and worms facilitates the establishment and growth of S. paratyphi A in vivo, and that a deficit in host immune response is not a major factor involved in the enhanced growth of S. paratyphi A.

Bacillus stearothermophilus from Saudi Arabian Soils.

Ten thermophilic Gram-positive bacteria were isolated from various soils of Saudi Arabia. The strains are spore-forming rods belonging to the species Bacillus stearothermophilus. The cells are motile, strictly aerobic, catalase and oxidase positive. The sporangia appear to be swollen and their position varies from terminal in some to sub-terminal in others. The thermal stability of some enzymes of these bacteria was investigated; extracellular alpha-amylase appears to be very sensitive to pH and temperature. The ultrastructure of these bacteria shows specific changes in the cell wall when grown at the maximum, minimum and optimum growth temperatures, respectively.

Sex steroids in women with liver cirrhosis.

Eighteen women with hepatic cirrhosis were examined for plasma levels of testosterone, estrone, estradiol, progesterone and sex hormone binding globulin. For eight who were amenorrheic, with advanced liver cirrhosis and ascites, the reduction of testosterone and rise in estrone and sex hormone binding globulin concentrations were significant. Plasma extradiol and progesterone were lower than normal levels, but the differences were not statistically significant. The other ten patients were menstruating (mostly irregularly), and their hormonal levels were assessed in different states of their cycles. All of them did not ovulate, had low levels of plasma progesterone and also showed consistent estrone concentration excess relative to estradiol and significant lowering of testosterone and elevation of sex hormone binding globulin. These findings are compared with previous reports on males with liver cirrhosis.

Behaviour of hepatitis B antigen in bilharzial patients infected with HBs positive viral hepatitis.

A TOTAL of 204 cases with acute viral hepatitis were studied: 93 bilharzial and 111 non-bilharzial. This study is concerned with the 106 cases showing positive HBS Ag test. Follow up of the cases after discharge from the Fever Hospital was carried out by repeated clinical and laboratory examinations 3 montly in the first year and 6 monthly subsequently. The bilharzial and non-bilharzial patients were found to be equally susceptible to HBS Ag positive hepatitis (p=0.25). However, antigenaemia tended to last longer as a whole in the bilharzial patients (p=0. 005) and was not affected by successful specific antibilharzial treatment. It seems that bilharzial infection predisposes to "retention" of HBs antigen, after subsidance of the acute attack, thus increasing the volume of reservoir for HB virus in our rural community.

Lipase productivity of a lipolytic strain of Thermoactinomyces vulgaris.

An attempt was made to evaluate the lipase productivity by Thermoactinomyces vulgaris with various nutritional and environmental factors. Results suggest optimum conditions for production, viz. age of inoculum 18 hours, 55 degrees C, pH 6.8, 0.2% yeast extract, specific substrates, and shaken cultures incubated for 24--36 hours. Lipases are induced by corn oil in presence of yeast extract or of certain substitutes; starch could replace these at 55 degrees C. A suggestion is given of a regulatory system of lipase synthesis, involving the supply of starch to initiate growth, allowing induction of lipase by the inductive substrate.

Identity and lipase activity of an isolate of Thermoactinomyces vulgaris.

An actinomycete with thermophilic nature and strong lipolytic activity was isolated by enrichment from an Egyptian soil. It proved to be Thermoactinomyces vulgaris. Variabilities justifying Adansonian systematics were reported and discussed. The potential relation of an occasional drop in successfully resumed activity to an auto-inhibition phenomenon has been notified. Optimum conditions for the activity of the extracellular lipase(s), including stability, suggest the practical importance of the enzyme(s) in the growth filtrates.

Relation of lipids to the action of streptomycin on Bacillus subtilis and Escherichia coli and griseofulvin and fungizone on Aspergillus niger.

An attempt was made to reveal the relation between the lipid content and components of B. subtilis and E. coli and the action of streptomycin, and those of A. niger and the action of griseofulvin and fungizone (Amphotericin B). Total lipids were extracted in CO2 atmosphere, dried, and weighed. Lipid components were analyzed by thin-layer chromatography. Complements to the growth medium of A. niger with extracted total lipids and phospholipids were made to verify the obtained results. It has been found that the action of streptomycin and griseofulvin was not correlated with lipids. On the other hand, fungizone action was manifested by the decrease in total lipids, free sterols, sterol esters, and triglycerides. Supplementation studies gave evidence of the role of total lipids and phospholipids in protecting A. niger cells against fungizone. Supplementation of 1 g of phospholipid per litre medium raised the M.I.D. of fungizone from 2.5 up to 25 microgram/ml. It was suggested to keep the fat level controlled at a minimum if it is required to increase fungizone activity.