BACKGROUND AND OBJECTIVES

Epilepsy is a very common pediatric neurologic disorder, and the mainstay of treatment is the use of anti-seizure medication. Several factors may cause inadequate adherence leading to uncontrolled seizures, lower quality of life, and neurodevelopmental consequences. This study aimed to determine medication adherence of adolescents with epilepsy and identify factors that may be associated in medication adherence.

This is a prospective cross-sectional study involving adolescents with epilepsy. A self-reported survey was used to measure adherence. Data on demographics and epilepsy were then assessed for presence of association with adherence.

Fifty-one participants were included. Of these, 19.6% were non-adherent, 35.3% had medium adherence, and 45.1% had high adherence. Simple logistic regression analysis showed that unemployed primary caregiver is associated with 7.0 times higher odds of having moderate-high adherence and consuming at least three drugs is associated with 0.3 lower odds of having moderate-high adherence.

As high as 80.4% of adolescents were adherent to their medications. The presence of a caregiver who can closely monitor the patient is associated with adherence while intake of several drugs is associated with nonadherence. Future studies may need larger sample size and explore knowledge, attitude, and other social factors that may influence medication adherence.

We describe an unusual case of hypoxic ischemic encephalopathy in a preterm female of 36 weeks who presented with status epilepticus and atypical abdominal myoclonus. The seizures were confirmed electrographically using video electroencephalography (EEG), while the abdominal myoclonus was demonstrated to be nonepileptic, as it had no EEG correlate. Other possible causes of neonatal seizures were excluded. The infant then responded to a gamut of antiseizure medications but the myoclonus persisted. To the best of our knowledge, this is the first report of atypical myoclonus in a preterm baby caused by hypoxic ischemic encephalopathy.

Electrical status epilepticus during sleep (ESES) is an electrographic pattern associated with specific genetic disorders, brain malformations, and use of some antiseizure medications. This case report aims to present the management of ESES in Sotos syndrome (SoS) on carbamazepine. A nine-year-old Filipino male with clinical features suggestive of overgrowth syndrome presented with febrile seizure at one year old. Cranial imaging showed cavum septum pellucidum, corpus callosal dysgenesis, and ventriculomegaly. He was on carbamazepine monotherapy starting at three years old. A near continuous diffuse spike–wave discharges in slow wave sleep was recorded at nine years old hence shifted to valproic acid. Follow-up study showed focal epileptiform discharges during sleep with disappearance of ESES. Next generation sequencing tested positive for rare nonsense mutation of nuclear receptor binding set-domain protein 1 confirming the diagnosis of SoS. Advanced molecular genetics contributed to determination of ESES etiologies. To date, this is the first documented case of SoS developing ESES. Whether an inherent genetic predisposition or drug-induced, we recommend the avoidance of carbamazepine and use of valproic acid as first-line therapy.
Sotos Syndrome ; Carbamazepine

Introduction: Patient education is integral in the management of gestational diabetes mellitus (GDM), a common pregnancy complication that may cause adverse perinatal outcomes. This study evaluated the effect of diabetes education on the knowledge and attitude among patients with GDM, comparing pre- vs post-diabetes session scores and determining pregnancy outcomes. Methodology: A one-group pre-test and post-test experimental design study was conducted on 75 patients after one- session diabetes counseling using the Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) and the third version of the Diabetes Attitude Scale (DAS-3). Results: Of the 75 subjects, 84% exhibited adequate knowledge of diabetes. Post-education, a significant increase in the total scores was seen among those less than 35 years of age (p-value: 0.003), both employed and unemployed (p-value: 0.0.026, 0.047, respectively), with a secondary level of education (p-value: 0.014) and multigravid (p-value: 0.015). An overall median positive attitude score of 3.6 was documented. For neonatal outcomes, no adverse events existed. For maternal outcomes, 17.9% had elevated fasting blood glucose while 7.1% had elevated 2-hour post-glucose tolerance test. Conclusion Diabetes education improves patient’s knowledge but not their attitude. Hence, improvement in attitude interventions should be incorporated into the current diabetes education program.
Diabetes, Gestational ; Knowledge ; Attitude

Background and Objectives: Epilepsy is a very common pediatric neurologic disorder, and the mainstay of treatment is the use of anti-seizure medication. Several factors may cause inadequate adherence leading to uncontrolled seizures, lower quality of life, and neurodevelopmental consequences. This study aimed to determine medication adherence of adolescents with epilepsy and identify factors that may be associated in medication adherence. Methods: This is a prospective cross-sectional study involving adolescents with epilepsy. A self-reported survey was used to measure adherence. Data on demographics and epilepsy were then assessed for presence of association with adherence. Results: Fifty-one participants were included. Of these, 19.6% were non-adherent, 35.3% had medium adherence, and 45.1% had high adherence. Simple logistic regression analysis showed that unemployed primary caregiver is associated with 7.0 times higher odds of having moderate-high adherence and consuming at least three drugs is associated with 0.3 lower odds of having moderate-high adherence. Conclusion As high as 80.4% of adolescents were adherent to their medications. The presence of a caregiver who can closely monitor the patient is associated with adherence while intake of several drugs is associated with nonadherence. Future studies may need larger sample size and explore knowledge, attitude, and other social factors that may influence medication adherence.
adolescents ; epilepsy

Purpose: One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS. Methods: We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group. Results: A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P<0.0001). Conclusion Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

The mammalian carboxylesterase 1 (Ces1/CES1) family comprises several enzymes that hydrolyze many xenobiotic chemicals and endogenous lipids. To investigate the pharmacological and physiological roles of Ces1/CES1, we generated Ces1 cluster knockout (Ces1 ^-/- ) mice, and a hepatic human CES1 transgenic model in the Ces1 ^-/- background (TgCES1). Ces1 ^-/- mice displayed profoundly decreased conversion of the anticancer prodrug irinotecan to SN-38 in plasma and tissues. TgCES1 mice exhibited enhanced metabolism of irinotecan to SN-38 in liver and kidney. Ces1 and hCES1 activity increased irinotecan toxicity, likely by enhancing the formation of pharmacodynamically active SN-38. Ces1 ^-/- mice also showed markedly increased capecitabine plasma exposure, which was moderately decreased in TgCES1 mice. Ces1 ^-/- mice were overweight with increased adipose tissue, white adipose tissue inflammation (in males), a higher lipid load in brown adipose tissue, and impaired blood glucose tolerance (in males). These phenotypes were mostly reversed in TgCES1 mice. TgCES1 mice displayed increased triglyceride secretion from liver to plasma, together with higher triglyceride levels in the male liver. These results indicate that the carboxylesterase 1 family plays essential roles in drug and lipid metabolism and detoxification. Ces1 ^-/- and TgCES1 mice will provide excellent tools for further study of the in vivo functions of Ces1/CES1 enzymes.

Bacterial Infections ; Humans ; Lymphoma, Large B-Cell, Diffuse/diagnosis* ; Mucormycosis/diagnosis* ; Respiratory Sounds ; Thyroid Gland

Background. Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative disease caused by prolonged persistent infection of the central nervous system with a measles virus mutant. Though various treatment modalities have been tried, there is no effective treatment to completely cure SSPE and new therapeutic strategies are needed.

Objective. This is a prospective uncontrolled observational open label trial to describe the short-term outcomes and safety of intraventricular ribavirin in combination with oral isoprinosine in Filipino SSPE patients.

Methods. Sixteen (16) unrelated SSPE patients between ages 3-26 years and in various clinical stages were included in this study. Demographic data were described. Intraventricular instillation of ribavirin (1-3 mg/kg/dose) through an Ommaya reservoir was given for a duration of 3-6 months in 13 patients. The duration of follow-up was 48 weeks. The clinical outcome was assessed before, during, and after treatment using the Neurological Disability Index (NDI), Brief Assessment Examination (BAE), and clinical staging using the Jabbour Classification. Adverse side effects from intraventricular ribavirin were enumerated.

Results. Six of 13 (46.15%) patients mostly in Stage III illness had clinical improvement showing decreasing NDI and BAE scores during treatment and the clinical improvement was maintained or improved further during the 48-week follow-up period. Clinical improvement manifested as improved mental alertness, decrease in spasticity and reduction of seizures. The clinical staging of those who improved remained stable during and after treatment was discontinued. Five (38.46%) patients in Stage II disease worsened and progressed to Stage III despite ribavirin therapy including 1 (7.6%) patient who died after the treatment phase due to pneumonia and brainstem failure. The clinical course of two (15.38%) patients remained unchanged. Minor adverse side effects of ribavirin included transient fever, rash, oral sores, seizure episodes, drowsiness, bladder retention and mild increase in transaminases. Ommaya reservoir infection was a serious adverse event in 5 (31.25%) patients.

Conclusion. There is still no definitive cure for SSPE. Although ribavirin may help alleviate some of the symptoms of SSPE and prolong life, it may not reverse or halt the progression of the disease. Long term follow-up of these patients and continuous use of intraventricular ribavirin will better clarify its role in modifying the fatal course of SSPE. The role of ribavirin in Stage I patients and a controlled clinical trial in Stage II SSPE needs further studies.

INTRODUCTION: Salba-chia (Salvia hispanica L.) is a popular functional food containing high levels of protein, total dietary fiber, and is an excellent source of α-linolenic acid. Chia seeds significantly decreases weight, suppresses appetite, and has a potential benefit in the management of Type 2 diabetes mellitus (T2DM). This study aimed to determine the effectiveness of chia seeds as an adjuvant treatment for T2DM. METHODS: Randomized controlled trials from 1990 onwards involving Type 2 diabetic patients given chia seed were included. PubMed, Cochrane, ClinicalKey, Google Scholar, and Hinari were searched systematically using MeSH terms “chia”, “Salvia hispanica”, “dietary supplement”, and “diabetes”. The quality of trials was assessed using the Cochrane Collaboration tool. Data on the study design, blinding status, characteristics of participants, medications taken by participants, chia seed intervention, comparator, duration of intake, and interval of assessment were extracted. The percent change of outcome from baseline was compared between the chia and control groups. RESULTS: Four randomized trials with a total of 213 diabetic patients were enrolled in the treatment group using ground salba-chia or the control group using bran. The supplementation of chia resulted in a statistically significant decrease in fasting glucose (-2.90 mmol/L; 95% CI, -3.08, -2.72; p < 0.001), waist circumference (-2.49 cm; 95% CI -2.81, -2.17; p < 0.001), total cholesterol (-2.72 mmol/L; 95% CI -3.68, -1.74; p < 0.001), HDL (-3.69 mmol/L; 95% CI -3.95, -3.42; p < 0.001), LDL (-3.22 mmol/L; 95% CI -4.08, -2.36; p < 0.001); and an increase adiponectin levels (6.50 mg/L; 95% CI 6.25, 6.25; p < 0.001). CONCLUSION Intake of chia seeds resulted in a statistically significant decrease in fasting blood glucose, waist circumference, total cholesterol levels, HDL and LDL cholesterol levels, and increased adiponectin. Chia seeds are generally safer and have lesser side effects compared to the placebo. Chia is effective as adjunctive treatment for Type 2 diabetic patients.