Evaluation of a follow-up program for mild traumatic brain injury in schoolchildren.

INTRODUCTION: Mild traumatic brain injury is a common condition in childhood. Although classified as mild, post-concussive symptoms may persist and interfere with daily activities. Because no established guidelines exist with respect to follow-up medical care for these children, there may be a delay in receiving appropriate care. We developed a follow up program to screen for persistent symptoms and if necessary, refer patients for further medical assistance. METHODS: From July 2010 until December 2013, eligible children aged 4-18 years who presented after sustaining a mild traumatic brain injury were included. All patients received a phone call after 6 weeks. After a period of 3 months, both their schoolteacher and parents were asked to complete in a questionnaire. The results were discussed monthly by a multidisciplinary team. RESULTS: A total of 305 children were enrolled in our follow-up program. Headache was the most common acute symptom upon presentation (63%). Overall, 19% of all patients had problems, either at 6 weeks or 3 months. 14% of these patients were referred for special care. Most common persistent post-concussive symptoms were headache (32%), cognitive problems (23%) and behavioural problems (16%). After a period of two years, a review of patient charts revealed that all of the problems were resolved. CONCLUSION: One fifth of the children exhibit post-concussive symptoms after mild traumatic brain injury. Education of patients and caregivers and a follow up visit if needed applied appropriate care at an early stage to minimise physical and mental problems.

Relationship between auditory P300 amplitude and age of onset of schizophrenia in older patients.

Auditory P300 amplitude reductions are well-established in young adults with schizophrenia. Little is known, however, regarding the P300 in older schizophrenia patients, especially those with late onset. We studied 28 middle-aged and elderly (mean age = 62.7 years) patients [14 with early onset schizophrenia (EOS) and 14 with late onset schizophrenia (LOS)] and 14 normal comparison (NC) participants using an auditory oddball paradigm. Event-related potentials were recorded from 15 scalp electrodes and six non-scalp sites. There were no significant differences between EOS and LOS groups in neuroleptic dosage, symptom severity, reaction times, target-detection accuracy, or N100 and N200 ERP measures. The EOS, but not the LOS, group had significantly smaller auditory oddball P300 amplitudes than the NC group. Twelve of the 14 LOS patients had P300 amplitudes in the normal range. Smaller P300 amplitudes were associated with earlier age of onset (r = 0.48), longer duration of illness (r = -0.49) and more severe alogia (r = -0.50). We conclude that P300 abnormalities in schizophrenia may be a marker for a disease subtype with early onset and more severe information-processing deficits.

N400 abnormalities in late life schizophrenia and related psychoses.

The N400, an event-related brain potential (ERP) sensitive to semantic congruity, has been reported to have increased latency and/or reduced amplitude in young adults with schizophrenia. Little is known, however, regarding the N400 in older schizophrenia patients, especially those with late onset. We studied 18 middle-aged and elderly patients with schizophrenia and related psychoses (nine with early-onset psychosis (EOP) and nine with late-onset psychosis (LOP)), and nine normal comparison (NC) subjects. Subjects read words which were semantically incongruent (50%) or congruent (50%) with a preceding spoken phrase which defined either an antonymic or categorical relationship. The LOP group had a significantly later peak latency of the N400 congruity effect compared to the NC group. Seven of 18 psychosis patients, but none (0/9) of the normal subjects, had an abnormal latency or amplitude (p = 0.04), measured at T6 (right temporal). Smaller amplitudes were associated with more severe negative symptoms (rp = 0.58; p = 0.01). N400 abnormalities in older schizophrenia patients likely reflect abnormal processing of semantic information.

Collaborative study of the International Office of Cocoa, Chocolate and Sugar Confectionery on Salmonella detection from cocoa and chocolate processing environmental samples.

A comparative collaborative study was performed in 13 laboratories to evaluate the use of motility enrichment on Modified Semisolid Rappaport-Vassiliadis medium for rapid Salmonella detection from food-processing environmental samples. Artificially contaminated chocolate scrapings and naturally contaminated cocoa bean dust samples were used in the study. Pre-enrichment was performed in buffered peptone water with added casein and malachite green oxalate. Motility enrichment was compared with a conventional cultural procedure using Rappaport-Vassiliadis broth and selenite cystine broth as selective enrichment. The productivity of motility enrichment was 93.5% compared to a productivity of the cultural procedure of 92%. Statistical analysis showed that there was no significant difference between the two procedures. Modified Semisolid Rappaport-Vassiliadis medium is a sensitive and simple diagnostic tool for the microbiological safety evaluation of food-processing environments.

Computerized electroencephalography in the evaluation of early dementia.

In elderly patients presenting to an ambulatory practice with complaints of cognitive disturbance, early dementia must be differentiated from depression. The present paper describes the application of standard electroencephalography and evoked potential testing (EEG/EP) and computerized electroencephalography with evoked potential mapping (CEEG/EPM) in the analysis of 64 elderly patients complaining of cognitive disturbance. Although previous reports have claimed a sensitivity level of up to 80% for EEG in demented patients, it appears that a lower sensitivity (37% for EEG alone and 61% for EEG/EP) may be expected at the time of early presentation according to the present study. No EEG/EP abnormalities were detected in patients with depression. In demented patients, CEEG/EPM was abnormal in 85% (46 of 54) of cases compared to 10% (1 of 10) of cases with depression. Specific information was obtained from EEG/EP studies that helped differentiate the various causes of dementia in three cases. In CEEG/EPM studies, a pattern of relative suppression of alpha activity or suppressed auditory P300 amplitude in the posterior parietal regions was observed in 11 or 23 (48%) patients with Alzheimer's disease and 2 of 31 (6%) patients with other forms of dementia. None of the depressed patients demonstrated such changes. Based on the present study, it appears that computerized techniques may hold promise as an adjunct to standard EEG evaluation of patients with mild cognitive change in whom diagnosis of dementia or depression is in doubt. Although standard EEG rarely demonstrates characteristic changes that may help differentiate causes of dementia, CEEG/EPM appears to demonstrate, on occasion, abnormalities in the posterior temporal and parietal regions in patients with a diagnosis of probable Alzheimer's disease and rarely in other forms of dementia or depression.