The prognostic value of somatosensory evoked potentials in children after cardiac arrest:the SEPIA Study

Purpose: Absent cortical somatosensory evoked potentials (SSEPs) reliably predict poor neurologic outcome in adults after cardiac arrest (CA). However, there is less evidence to support this in children. In addition, targeted temperature management, test timing, and a lack of blinding may affect test accuracy.Methods: A single-center, prospective cohort study of pediatric (aged 24 hours to 15 years) patients in which prognostic value of SSEPs were assessed 24, 48, and 72 hours after CA. Targeted temperature management (33–34°C for 24 hours) followed by gradual rewarming to 37°C was used. Somatosensory evoked potentials were graded as present, absent, or indeterminate, and results were blinded to clinicians. Neurologic outcome was graded as “good” (score 1–3) or “poor” (4–6) using the Pediatric Cerebral Performance Category scale 30 days after CA and blinded to SSEP interpreter.Results: Twelve patients (median age, 12 months; interquartile range, 2–150; 92% male) had SSEPs interpreted as absent (6/12) or present (6/12) <72 hours after CA. Outcome was good in 7 of 12 patients (58%) and poor in 5 of 12 patients (42%). Absent SSEPs predicted poor outcome with 88% specificity (95% confidence interval, 53% to 98%). One patient with an absent SSEP had good outcome (Pediatric Cerebral Performance Category 3), and all patients with present SSEPs had good outcome (specificity 100%; 95% confidence interval, 51% to 100%). Absence or presence of SSEP was consistent across 24-hour (temperature = 34°C), 48-hour (t = 36°C), and 72-hour (t = 36°C) recordings after CA.Conclusions: Results support SSEP utility when predicting favorable outcome; however, predictions resulting in withdrawal of life support should be made with caution and never in isolation because in this very small sample there was a false prediction of unfavorable outcome. Further prospective, blinded studies are needed and encouraged

Influence of three diets on development and oviposition of the predatory mite, Amblyseius herbicolus (Acari: Phytoseiidae) under laboratory conditions

The predatory phytoseiid mite, Amblyseius herbicolus Chant has been collected from mulberry trees infested with two-spotted spider mite, Tetranychus urticae Koch and mulberry thrips, Pseudodendrothrips mori (Niwa) in Guilan province. Development and oviposition of this predatory mite was studied on two-spotted spider mite, mulberry thrips and date palm pollen as an alternative food in laboratory using the citrus excised leaf method in Petri dishes at 26 ± 1°C, 14L: 10D photoperiod and 70-80% RH. The results indicated that, mean duration of immature stages (day) of female predatory mite was the lowest on P. mori (4.86 ï± 0.19) and T. urticae (5.26 ï± 0.15) and the highest on date palm pollen (7.46 ï± 0.21). Fecundity (eggs/female) was the highest on P. mori (48.2 ï± 1.85) then on T. urticae (36.2 ï± 1.9) and the lowest on date palm pollen (19.13 ï± 1.72). Oviposition period (day) was the highest on P. mori (20.86 ï± 051) and T. urticae (20.33 ï± 1.19) and the lowest on date palm pollen (16.06 ï± .97). Lowest post-oviposition period (day) was on T. urticae (3.13 ï± 0.19) followed by date palm pollen (4.37 ï± 0.28) and then on P. mori (5.6 ï± 0.27). The mean generation time (day) of predatory mite was the longest on palm pollen (9.86 ï± 0.21), followed by mulberry thrips (7.13 ï± 0.21) and then two-spotted spider mite (6.86 ï± 0.16). Based on these results, A. herbicolus is a general predator. The date palm pollen may variously be used as an alternative food in absence of main food

Consensus-based guidelines for Video EEG monitoring in the pre-surgical evaluation of children with epilepsy in the UK

PURPOSE: Paediatric Epilepsy surgery in the UK has recently been centralised in order to improve expertise and quality of service available to children. Video EEG monitoring or telemetry is a highly specialised and a crucial component of the pre-surgical evaluation. Although many Epilepsy Monitoring Units work to certain standards, there is no national or international guideline for paediatric video telemetry. METHODS: Due to lack of evidence we used a modified Delphi process utilizing the clinical and academic expertise of the clinical neurophysiology sub-specialty group of Children’s Epilepsy Surgical Service (CESS) centres in England and Wales. This process consisted of the following stages I: Identification of the consensus working group, II: Identification of key areas for guidelines, III: Consensus practice points and IV: Final review. Statements that gained consensus (median score of either 4 or 5 using a five-point Likerttype scale) were included in the guideline. RESULTS: Two rounds of feedback and amendments were undertaken. The consensus guidelines includes the following topics: referral pathways, neurophysiological equipment standards, standards of recording techniques, with specific emphasis on safety of video EEG monitoring both with and without drug withdrawal, a protocol for testing patient’s behaviours, data storage and guidelines for writing factual reports and conclusions. All statements developed received a median score of 5 and were adopted by the group. CONCLUSIONS: Using a modified Delphi process we were able to develop universally-accepted video EEG guidelines for the UK CESS. Although these recommendations have been specifically developed for the pre-surgical evaluation of children with epilepsy, it is assumed that most components are transferable to any paediatric video EEG monitoring setting