Safety and seizure control in patients with mesial temporal lobe epilepsy treated with regional superselective intra-arterial injection of autologous bone marrow mononuclear cells.

Temporal lobe epilepsy (TLE) is a highly prevalent syndrome among people with epilepsy, and is usually refractory to drug treatment. Structural and physiological changes, such as hippocampal sclerosis, are often present in TLE patients. The objective of this study is to evaluate the feasibility and safety of intra-arterial infusion of autologous bone marrow mononuclear cells (BMMC) in adults with medically refractory mesial TLE (MTLE) and unilateral hippocampal sclerosis (HS). We enrolled 20 patients who had been diagnosed with MTLE-HS and were refractory to medical treatment. All patients underwent a neurological evaluation, magnetic resonance imaging with hippocampal volumetry, video-electroencephalography (EEG) with ictal recording, and a neuropsychological test battery focusing on verbal and nonverbal memory domains. After bone marrow aspiration and subsequent cell preparation, the BMMC were infused by selective posterior cerebral artery catheterization. Patients were followed for 6 months. Safety of the procedure, seizure frequency, neuropsychological evaluation, EEG variables, routine brain magnetic resonance imaging and hippocampal volumetry were considered measurements of outcome. Any serious intercurrent clinical event or adverse effects related to the procedure were reported. No additional lesions and no significant hippocampal volumetric changes were observed. EEG recordings showed a decrease in theta activity and spike density. At 6 months, eight patients (40%) were seizure free. A significant increase in the memory scores over time was observed. The BMMC autologous transplant for the treatment of temporal lobe epilepsy is feasible and safe. The seizure control achieved in this novel study supports the therapeutic potential of stem cell transplants in MTLE-HS patients. Copyright © 2016 John Wiley & Sons, Ltd.

Características epidemiológicas e influência da coinfecção por vírus respiratórios na gravidade da bronquiolite aguda em lactentes / Epidemiological surveillance and influence of co-infection by respiratory virusesin the severity of acute bronchiolitis in infants

Porto Alegre e comparar a gravidade da doença entre pacientes com um ou mais agentes virais.Métodos: um estudo transversal, realizado entre setembro de 2009 e setembro de 2010, incluiu lactentes de até 12 meses de idade com diagnóstico de bronquiolite viral aguda, que estavam internados nas unidades pediátricas do Hospital São Lucas da PUCRS e haviam iniciado com sintomas de vias aéreas inferiores até 72 horas antes da inclusão. A pesquisa de vírus respiratórios foi realizada em amostras de secreção nasofaríngea, por imunofluorescência direta.Resultados: foram coletadas 71 amostras de um total de 73 pacientes, cuja média de idade foi de 3,3 meses. Do total das amostras coletadas, 61,97% (44/71) foram positivas para vírus. Destas, 70,46% (31/44) foram positivas para apenas um vírus e 29,54% (13/44) para dois ou mais vírus. O vírus sincicial respiratório foi o mais comum (86,36%), seguido pelo influenza (27,27%). Utilizando os desfechos tempo de internação e tempo de uso de oxigênio, não foi observada associação entre presença de coinfecção e gravidade da bronquiolite.Conclusões: o estudo demonstrou uma positividade geral elevada para vírus, com a predominância do vírus sincicial respiratório. Foi demonstrado também um alto índice de coinfecção viral. Não houve efeito adicional, pela presença de mais de um tipo de vírus, na gravidade da bronquiolite. Não se pode excluir a possibilidade de que a combinação com outros vírus, não identificados neste estudo, possa influenciar a gravidade da bronquiolite viral aguda.

Aims: To evaluate the epidemiologic characteristics and to compare the seriousness of the infection between one or more than one viral agents in infants hospitalized with acute viral bronchiolitis.Methods: A cross-sectional study conducted between September 2009 and September 2010 included infants up to 12 months of age diagnosed with acute viral bronchiolitis, who were admitted to the pediatric units of the Hospital São Lucas da PUCRS and had started with lower airways symptoms to 72 hours before inclusion. Testing for respiratory viruses was performed on nasopharyngeal specimens by direct immunofluorescence.Results: Seventy one samples were collected from a total of 73 patients, whose mean age was 3.3 months. Of the total samples collected, 61,97% (44/71) were positive for virus. Of these, 70,46% (31/44) were positive for one virus and 29,54% (13/44) for two or more viruses. Respiratory syncytial virus was the most common (86,36%), followed by parainfluenza (27,27%). Using the outcomes length of hospital stay and time of use of oxygen, there was no association between the presence of coinfection and severity of bronchiolitis.Conclusions: The study demonstrated a high overall positivity for viruses, with the predominance of respiratory syncytial virus. A high rate of viral coinfection was also showed. There was no additional effect of the presence of more than one type of virus on the severity of bronchiolitis. We can not exclude the possibility that the combination with other viruses, unidentified in this study, may influence the severity of acute viral bronchiolitis.