Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy.

BACKGROUND AND AIM: People with epilepsy are at increased risk of sudden cardiac arrest (SCA) due to ECG-confirmed ventricular tachycardia/fibrillation, as seen in a community-based study. We aimed to determine whether ECG-risk markers of SCA are more prevalent in people with epilepsy. METHODS: In a cross-sectional, retrospective study, we analysed the ECG recordings of 185 people with refractory epilepsy and 178 controls without epilepsy. Data on epilepsy characteristics, cardiac comorbidity, and drug use were collected, and general ECG variables (heart rate (HR), PQ and QRS intervals) assessed. We analysed ECGs for three markers of SCA risk: severe QTc prolongation (male >450 ms, female >470 ms), Brugada ECG pattern, and early repolarisation pattern (ERP). Multivariate regression models were used to analyse differences between groups, and to identify associated clinical and epilepsy-related characteristics. RESULTS: People with epilepsy had higher HR (71 vs 62 bpm, p<0.001) and a longer PQ interval (162.8 vs 152.6 ms, p=0.001). Severe QTc prolongation and ERP were more prevalent in people with epilepsy (QTc prolongation: 5% vs 0%; p=0.002; ERP: 34% vs 13%, p<0.001), while the Brugada ECG pattern was equally frequent in both groups (2% vs 1%, p>0.999). After adjustment for covariates, epilepsy remained associated with ERP (ORadj 2.4, 95% CI 1.1 to 5.5) and severe QTc prolongation (ORadj 9.9, 95% CI 1.1 to 1317.7). CONCLUSIONS: ERP and severe QTc prolongation appear to be more prevalent in people with refractory epilepsy. Future studies must determine whether this contributes to increased SCA risk in people with epilepsy

The Identification of Manure Spreading on Bare Soil through the Development of Multispectral Indices from Sentinel-2 Data: The Emilia-Romagna Region (Italy) Case Study

Satellite remote sensing is currently an established, effective, and constantly used tool and methodology for monitoring agriculture and fertilisation. At the same time, in recent years, the need for the detection of livestock manure and digestate spreading on the soil is emerging, and the development of spectral indices and classification processes based on satellite multispectral data acquisitions is growing. However, the application of such indicators is still underutilised and, given the polluting impact of livestock manure and digestate on soil, groundwater, and air, an in-depth study is needed to improve the monitoring of this practice. Additionally, this paper aims at exposing a new spectral index capable of detecting the land affected by livestock manure and digestate spreading. This indicator was created by studying the spectral response of bare soil and livestock manure and digestate, using Copernicus Sentinel-2 MSI satellite acquisitions and ancillary datasets (e.g., soil moisture, precipitation, regional thematic maps). In particular, time series of multispectral satellite acquisitions and ancillary data were analysed, covering a survey period of 13 months between February 2022 and February 2023. As no previous indications on fertilisation practices are available, the proposed approach consists of investigating a broad-spectrum area, without investigations of specific test sites. A large area of approximately 236,344 hectares covering three provinces of the Emilia-Romagna Region (Italy) was therefore examined. A series of ground truth points were also collected for assessing accuracy by filling in the confusion matrix. Based on the definition of the spectral index, a value of the latter greater than three provides the most conservative threshold for detecting livestock manure and digestate spreading with an accuracy of 62.53%. Such results are robust to variations in the spectral response of the soil. On the basis of these very encouraging results, it is considered plausible that the proposed index could improve the techniques for detecting the spreading of livestock manure and digestate on bare ground, classifying the areas themselves with a notable saving of energy compared to the current investigation methodologies directly on the ground

Efficacy of Perampanel in Refractory and Super-Refractory Status Epilepticus with Suspected Inflammatory Etiology: A Case Series

(1) Background: Increasing evidence supports the anti-inflammatory and neuroprotective role of perampanel (PER), mediated by decreased expression of pro-inflammatory cytokines and by interference with apoptosis processes. Therefore, the use of PER to treat status epilepticus (SE) with suspected inflammatory etiology is appealing and deserves further investigation. (2) Methods: We retrospectively analyzed seven patients (five F, two M; median age: 62 years) with refractory and super-refractory SE due to a probable or defined inflammatory etiology and treated with PER. (3) Results: PER was administered as the third (4/7) or fourth drug (3/7), with a median loading dose of 32 mg/day (range: 16–36 mg/day) and a median maintenance dose of 10 mg/day (range: 4–12 mg/day). In five cases, SE was focal, while in two patients, it was generalized. SE was caused by systemic inflammation in three patients, while in the other four subjects, it was recognized to have an autoimmune etiology. SE resolution was observed after PER administration in all cases, particularly within 24 h in the majority of patients (4/7, 57.1%). (4) Conclusions: Our data support the efficacy of PER in treating SE when first- and second-line ASMs have failed and suggest a possible earlier use in SE cases that are due to inflammatory/autoimmune etiology

Late-life terminal seizure freedom in drug-resistant epilepsy: "Burned-out epilepsy"

The course of established epilepsy in late life is not fully known. One key question is whether the resolution of an epileptic diathesis is a natural outcome in some people with long-standing epilepsy. We investigated this with a view to generating a hypothesis. We retrospectively explored whether terminal seizure-freedom occurs in older people with previous drug-resistant epilepsy at the Chalfont Centre for Epilepsy over twenty years. Of the 226 people followed for a median period of 52 years, 39 (17%) achieved late-life terminal seizure-freedom of at least two years before death, which occurred at a median age of 68 years with a median duration of 7 years. Multivariate analysis suggests that a high initial seizure frequency was a negative predictor (p < 0.0005). Our findings indicate that the 'natural' course of long-standing epilepsy in some people is one of terminal seizure freedom. We also consider the concept of "remission" in epilepsy, its definition challenges, and the evolving terminology used to describe the state of seizure freedom. The intersection of ageing and seizure freedom is an essential avenue of future investigation, especially in light of current demographic trends. Gaining mechanistic insights into this phenomenon may help broaden our understanding of the neurobiology of epilepsy and potentially provide targets for therapeutic intervention

Do borrão às aguadas: os engenheiros militares e a representação da Capitania de São Paulo

A análise do papel dos engenheiros militares perpassa as discussões sobre regiões específicas, mesmo quando eles, aparentemente, estão ausentes delas. Sua presença ou ausência sempre foi sinônimo de interesse e de projeto colonizador mais ou menos dirigido. Este ensaio tem como objeto de estudo a cartografia dos engenheiros militares atuantes na Capitania de São Paulo, território comumente visto como economicamente periférico e mais autônomo face aos desígnios da Coroa portuguesa. Com foco no corpus cartográfico de alguns profissionais que aqui atuaram, trata indiretamente da multifacetada atuação desses engenheiros, bem como do processo de feitura das cartas geográficas, corográficas e topográficas, do borrão às aguadas. Investigar a cartografia de alguns desses profissionais permite não apenas explorar a riqueza de suas biografias, como, também, acompanhar o processo de produção técnica dos mapas e os desígnios políticos envolvidos no devassamento e representação das terras descobertas no Novo Mundo.Analyzing the role of military engineers means venturing into discussions about specific regions, even those from which they are apparently absent. Their presence or absence has always been synonymous with interest and a more or less directed colonization project. This essay examines the maps produced by the military engineers working in the Captaincy of São Paulo, a territory often looked upon as one of little economic import and a rather autonomous area in light of the plans of the Portuguese Crown. By focusing on the cartographic corpus bequeathed by certain professionals serving in this region, we deal indirectly with the multifaceted role of these engineers as well as with the process of making geographic, chorographic and topographic charts - all the way from the sketch to watercolored maps. Perusing the charts constructed by some of these professionals enabled us not only to delve into the rich details of their biographies but also to observe the technical mapmaking process and to unravel the political designs behind the exploration and representation of the lands discovered in the New World

Dinâmica das áreas de agricultura anual a partir de dados temporais do projeto TerraClass para o município de Paragominas, PA.

Because of diversification of the production systems in Paragominas municipality (Pará State, Brazil), the grain production and the agroindustry sector is expanding. This paper aims to analyze the spatiotemporal dynamics of areas associated with ?Annual Crop? class in the municipality of Paragominas. We considered, in the analyses the Land Use and Land Cover mapping data of the TerraClass Project for the years 2004, 2008, 2010, 2012 and 2014. The results indicate that areas of the ?Annual Crop? in the study area, have been growing over the years and concentrate mainly near the municipality´s main roads. It was verified that a significant portion of these areas remained stable for consecutive periods considered. The new cropped areas come mainly from, the previously classified as "Clean Pasture" class, although there is also a significant conversion rates presented by "Not Observed Area" and ?Secondary Vegetation" classes

Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study

Background: COVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinical spectrum and immunological features of central nervous system (CNS) immune-related events following SARS-CoV-2 vaccination. Methods: Multicenter, retrospective, cohort study (December 1, 2020-April 30, 2022). Inclusion criteria were (1) de novo CNS disorders developing after SARS-CoV-2 vaccination (probable causal relationship as per 2021 Butler criteria) (2); evidence for an immune-mediated etiology, as per (i) 2016 Graus criteria for autoimmune encephalitis (AE); (ii) 2015 Wingerchuk criteria for neuromyelitis optica spectrum disorders; (iii) criteria for myelitis. Results: Nineteen patients were included from 7 tertiary referral hospitals across Italy and France (one of them being a national referral center for AE), over almost 1 year and half of vaccination campaign. Vaccines administered were mRNA-based (63%) and adenovirus-vectored (37%). The median time between vaccination and symptoms onset was 14 days (range: 2-41 days). CSF was inflammatory in 74%; autoantibodies were detected in 5%. CSF cytokine analysis (n=3) revealed increased CXCL-10 (IP-10), suggesting robust T-cell activation. The patients had AE (58%), myelitis (21%), acute disseminated encephalomyelitis (ADEM) (16%), and brainstem encephalitis (5%). All patients but 2 received immunomodulatory treatment. At last follow-up (median 130 days; range: 32-540), only one patient (5%) had a mRS>2. Conclusion: CNS adverse events of COVID-19 vaccination appear to be very rare even at reference centers and consist mostly of antibody-negative AE, myelitis, and ADEM developing approximately 2 weeks after vaccination. Most patients improve following immunomodulatory treatment

Dinâmica do uso e cobertura da terra em Projeto de Desenvolvimento Sustentável na região da rodovia Transamazônica, Pará.

A região da rodovia Transamazônica, no estado do Pará, constitui uma das áreas críticas de desflorestamento na Amazônia, visto as transformações socioeconômicas que tem atravessado. Este trabalho analisa mudanças espaço-temporais do uso da terra e seus impactos na cobertura vegetal no Projeto de Desenvolvimento Sustentável Virola-Jatobá, Anapu, Pará, no período de 1984 a 2015. Como suporte principal destas análises, foram utilizadas imagens Landsat, processadas e analisadas a partir da plataforma Spring. Nos primeiros anos de análise, registrou-se taxas de desflorestamento muito modestas, só atingindo um incremento mais expressivos sete anos após a criação do PDS, mas, mesmo assim, em um patamar muito baixo. Como reflexo, a paisagem desta área é dominada por áreas florestais, sendo as classes de uso da terra associadas principalmente às pastagens, já que as áreas agrícolas são muito modestas. Em geral, as áreas florestais apresentaram altas taxas de estabilidade. Dentre as classes de uso da terra, as pastagens apresentaram taxas de estabilidade expressivas, apesar de a classe Pasto Sujo ter registrado certa dinamicidade

Relações entre a paisagem e a dinâmica de uso da terra no município de Paragominas-PA. Uso de produtos SRTM e dados do Terraclass no mapeamento, distribuição e conversões entre sistemas de pecuária e agricultura anual.

This paper presents the preliminary results of the Environmental Monitoring by Satellites Project of the Amazon Biome, subproject 1 - Mapping of land use and cover in the Legal Amazon, through the field mission in the Eastern Amazon, in the state of Pará, during the period From May 23 to 25, 2016 in Paragominas-PA. Land use classes and validation of the past mapping of deforestation were recognized through mappings for the years 2004, 2008, 2010, 2012 and 2014, from which the land use dynamics were obtained, considering the annual agriculture classes And productive pasture, also referred to as clean pasture, degraded pastures, which included the regeneration classes with pasture, dirty pasture and exposed soil, as well as SRTM sensor products, through which a map of landscape compartments was produced, which allowed mapping The distribution of said land use classes in each of the four landscape units found in the municipality of Paragominas. The results show that there is a predominance of pastures in the lower areas that contain higher drainage densities and water courses that provide watering for livestock, while in the plateaus, where only the dry springs and gaps and flat relief are located in the larger ones altitudes, areas of agriculture predominate