A self-administered screening instrument for psychogenic nonepileptic seizures.

BACKGROUND: Delay in distinguishing psychogenic nonepileptic seizures (PNES) from epilepsy may result in significant health and economic burdens. Screening tools are needed to facilitate earlier identification of patients with PNES, thereby maximizing cost-effective use of video electroencephalography (VEEG), the expensive gold standard for differentiating PNES from epilepsy. We developed and prospectively validated a self-administered PNES screening questionnaire using variables known to distinguish PNES from epilepsy patients. METHODS: Adults referred for inpatient VEEG monitoring at two epilepsy centers were prospectively invited to complete a preliminary 209-item questionnaire assessing demographic, clinical, seizure-related, and psychosocial information that appeared in the literature as potentially useful indicators of PNES. A hybrid neural-bayesian classifier was trained to predict PNES using a sample at one center, and was prospectively validated on a separate set of naive patients from both centers. RESULTS: Of 211 enrolled subjects from the training center, 181 met the study criteria for either PNES (n = 48, 27%), epilepsy (n = 116, 64%), or coexisting PNES and epilepsy (n = 17, 9%). Variable reduction procedures identified 53 questionnaire items that were necessary to accurately predict PNES diagnosis. The hybrid classifier predicted PNES diagnosis with 94% sensitivity and 83% specificity at the training center, and 85% sensitivity and 85% specificity at the second center (n = 46; 17 PNES, 26 epilepsy, 3 with coexisting PNES and epilepsy). CONCLUSIONS: We developed and prospectively validated a self-administered psychogenic nonepileptic seizure screening questionnaire that could hasten referral for video electroencephalography and reduce the health and economic burdens from delayed diagnosis or misdiagnosis.

Intra-abdominal obesity and metabolic risk factors: a study of young adults.

OBJECTIVE: To assess the relative importance of the extent and regional distribution of fat for metabolic risk factors in young adults. DESIGN: Cross-sectional study of findings from a hospital-based case-control study. SUBJECTS: A total of 46 adult Danish Caucasian patients (40 men and six women, aged 34-54 y). Of these, 22 had had non fatal acute myocardial infarction before 41 y of age and 24 were age- and gender-matched controls without coronary heart disease. MEASUREMENTS: Four measurements of fat: body mass index (BMI, kg/m(2)), body fat percentage measured using a dual energy X-ray absorptiometry (DEXA) scanner, waist/hip circumference ratio (WHR), and intra-abdominal adipose tissue area measured using computed tomography (CT) scanning, and eight metabolic risk factors: systolic and diastolic blood pressure, HbA(1c) percentage, fasting concentrations of capillary whole blood glucose, high-density lipoprotein (HDL) cholesterol, serum triglyceride, plasma plasminogen activator inhibitor 1 (PAI-1), and urinary albumin:creatinine excretion ratio. RESULTS: Of 46 participants, 10 were obese (BMI >30 kg/m(2)), 12 were abdominally obese (WHR >0.90 for men and >0.85 for women), and 20 were intra-abdominally obese (intra-abdominal adipose tissue area >135 cm(2)). Men had a higher intra-abdominal adipose tissue area than women (P=0.0053, Mann-Whitney U-test). In multiple regression analyses of the four fat variables, only intra-abdominal adipose tissue area significantly predicted the levels of six metabolic risk factors: systolic blood pressure, diastolic blood pressure, fasting concentrations of capillary whole blood glucose, serum HDL cholesterol, serum triglyceride, and PAI-1. The intra-abdominal adipose tissue area had a linear relation with the six metabolic risk factors. CONCLUSIONS: For young individuals, intra-abdominal fat is the important component of the body fat for six of the eight metabolic risk factors. Intra-abdominal fat might contribute to that most patients with acute myocardial infarction at a young age are men.

Interdependent chemical-electrochemical steps in retrometabolism-based drug and safer chemical design.

An extension of the retrometabolic based drug (chemical) design concept, specifically the soft drug approach, to the family of nitrone compounds is presented. Nitrones oppose oxidative challenges by virtue of their ability to very rapidly trap free radical species that are more stable and biochemically less harmful than the original molecular fragments. Moreover, the spin adducts may undergo further transformations including reaction with a second radical and decomposition (hydrolysis) to hydroxylamines and carbonyl compounds. Nitrones and their spin adducts may generate nitric oxide in vivo, which, like nitrones themselves, exerts a number of diverse activities in phylogenetically distant species as well as opposing effects in related biological systems. It was described as a major messenger in the cardiovascular, immune, and nervous systems, in which it plays regulatory, signaling, cytoprotective, and cytotoxic effects. Nitrones play an important role in the synthesis of drugs belonging to chemically and pharmacologically very different classes. A combined chemical-electrochemical synthesis of nitrones has been elaborated. These compounds may be obtained from aldehydes or ketones and N-substituted hydroxylamines. These reactions were performed directly, in situ in the electrochemical cell, where phenylhydroxylamine obtained by electroreduction of nitrobenzene derivatives reacts with the carbonyl compound introduced in the cell. The kinetic and thermodynamic parameters of the processes were determined by analyzing the adequate polarographic curves. Differences between purely chemical and mixed chemical-electrochemical methods are discussed. Analysis of the experimental data permits optimization of the investigated process from a preparative point of view. Effects of structural factors were systematically evaluated. The proposed method may be useful for combinatorial chemistry as well.

[Pharmaceutical preparations from plant products employed in stomatologic diseases]. / Preparate farmaceutice din produse vegetale utilizate în afectiuni stomatologice.

Two preparations for stomatological use have been introduced, obtained from vegetal extracts of Ocimum basilicum L., Tilia sp., and Symphytum officinalis L. Their stability in time was evaluated, and the microbiological activity was assessed in vitro on microbial strains involved in stomatological affections. In clinical experiments good results were obtained in parodonthopathies, in the therapy of lesions developing under prostheses, and in other affections.