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Sleep architectural dysfunction and undiagnosed obstructive sleep apnea after chronic ischemic stroke.

Sleep Med 2021 Apr 15;83:45-53. Epub 2021 Apr 15.

The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia.

Objective/background: Sleep-wake dysfunction is bidirectionally associated with the incidence and evolution of acute stroke. It remains unclear whether sleep disturbances are transient post-stroke or are potentially enduring sequelae in chronic stroke. Here, we characterize sleep architectural dysfunction, sleep-respiratory parameters, and hemispheric sleep in ischemic stroke patients in the chronic recovery phase compared to healthy controls. Read More

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Priapism in Sickle Cell Disease: An Evaluation of the Knowledge of an at Risk Population in Jamaica.

Sex Med 2021 May 11;9(3):100339. Epub 2021 May 11.

Sickle Cell Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica.

Introduction: Ischemic priapism is characterized by painful erections that may lead to erectile dysfunction. Men with sickle cell disease (SCD) are particularly prone to this condition, however, the knowledge among this population with respect to possible complications is not well known.

Aim: The objective of this study was to evaluate the knowledge of males with SCD about priapism and its possible consequences. Read More

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Spread of segmental/multifocal idiopathic adult-onset dystonia to a third body site.

Parkinsonism Relat Disord 2021 May 12;87:70-74. Epub 2021 May 12.

IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.

Background: Adult-onset focal dystonia can spread to involve one, or less frequently, two additional body regions. Spread of focal dystonia to a third body site is not fully characterized.

Materials And Methods: We retrospectively analyzed data from the Italian Dystonia Registry, enrolling patients with segmental/multifocal dystonia involving at least two parts of the body or more. Read More

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[Return rate to the Primary Care Emergency Service for elderly patients over 65 years old and their assistance requirements].

Aten Primaria 2021 May 12;53(8):102084. Epub 2021 May 12.

Grupo de Investigación Salud, Bienestar y Sostenibilidad Sociosanitaria (SALBIS), Departamento de Ingeniería Eléctrica y de Sistemas y Automática, Universidad de León , León, España.

Objective: To determine the unexpected return rate to the Primary Care Emergency Service of elderly patients over 65 years old within the following 72h of a previous visit, as well as to determine the clinical and assistance requirements of these patients.

Procedure: Retrospective and observational epidemiologic study.

Location: Cotolino's Primary Care Emergency Service in Cantabria, Spain. Read More

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Defining the natural history of rare genetic liver diseases: lessons learned from the NAPPED initiative.

Eur J Med Genet 2021 May 12:104245. Epub 2021 May 12.

Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, The Netherlands; NAtural course and Prognosis of PFIC and Effect of biliary Diversion (NAPPED) consortium; European Reference Network on Hepatological Diseases (ERN RARE-LIVER). Electronic address:

While rare diseases collectively affect ∼300 million people worldwide, the prevalence of each disease concerns a relatively small number of patients. Usually, only limited data with regard to natural history are available. Multicenter initiatives are needed to aggregate data and answer clinically relevant research questions. Read More

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A clinical prediction model to distinguish maturity-onset diabetes of the young from type 1 and type 2 diabetes in the Chinese population.

Endocr Pract 2021 May 12. Epub 2021 May 12.

Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical Collage Hospital, Chinese Academy of Medical Science; Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China. Electronic address:

Objective: Genetic detection for the diagnosis of maturity-onset diabetes of the young (MODY) in China has low sensitivity and specificity. Better gene detection is urgently needed to distinguish testing subjects. We proposed to use numerous and weighted clinical traits as key indicators for reasonable genetic testing to predict the probability of MODY in the Chinese population. Read More

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Basophil reactivity to BNT162b2 is mediated by PEGylated lipid nanoparticles in PEG allergic patients.

J Allergy Clin Immunol 2021 May 12. Epub 2021 May 12.

Senior Staff Immunologist and Immunopathologist, Immunology Department, Royal Adelaide Hospital, Adelaide, South Australia 5000, SA Pathology, Adelaide, South Australia 5000. Electronic address:

Background: The mechanisms underpinning allergic reactions to the BNT162b2 (Pfizer) COVID-19 vaccine remain unknown, with polyethylene glycol (PEG) contained in the lipid nanoparticle suspected as being the cause.

Objective: To evaluate the performance of skin testing and basophil activation testing to PEG, polysorbate 80, BNT162b2 and AZD1222 (Astra-Zeneca) COVID-19 vaccines in patients with a history of PEG allergy.

Methods: Three known PEG allergic participants and three healthy controls were recruited, and evaluated for hypersensitivity to the BNT162b2 and AZD1222 vaccines and related compounds by skin testing and basophil activation measured by CD63 upregulation using flow cytometry. Read More

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Lower urinary tract function in patients with inflammatory encephalomyelopathy: characteristics of urodynamics, neurological deficits and magnetic resonance imaging.

Urology 2021 May 12. Epub 2021 May 12.

Department of Urology, China Rehabilitation Research Center,; Department of Urology of Capital Medical University. Electronic address:

Objective: To report the clinical data in a large population of patients affected by inflammatory encephalomyelopathy.

Material And Methods: We retrospectively reviewed the medical history, imaging studies and urodynamic findings in a series of 87 consecutive patients with inflammatory encephalomyelopathy. Age at disease onset ranged from 3 to 76 years with an average of 35. Read More

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REM sleep latency as an independent risk for cardiovascular events in hemodialysis patients.

Physiol Rep 2021 May;9(9):e14837

Department of Nephrology, Shirasagi Hospital, Osaka, Japan.

Background: Clinical significance of objectively measured poor sleep quality (SQ) as a risk for cardiovascular disease (CVD) events is not well known in hemodialysis (HD) patients, independently of sleep-related breathing disorders (SRBDs) and sleep-related metabolic abnormality.

Methods: The present study investigated baseline levels of objective sleep architecture together with obstructive sleep apnea (OSA) and central sleep apnea (CSA) using polysomnography in 88 HD study participants (M/F, 56/32; age 68.4 ± 9. Read More

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Prevalence of liver injury in 445 patients with Corona Virus Disease-19-Single-centre experience from southern India.

Indian J Gastroenterol 2021 May 15. Epub 2021 May 15.

Department of Gastroenterology and Hepatology, MIOT International, 4/112, Mount Poonamalle High Road, Sathya Nagar, Manapakkam, Chennai, 600 089, India.

Background: Abnormal liver function tests (LFT) are common in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vary from 15% to 53%. There are scanty data  from India on the prevalence of liver injury in corona virus disease 2019 (COVID-19) patients.

Methods: We did this retrospective study in a tertiary care hospital, Chennai, India. Read More

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Factor Xa inhibitors: critical considerations for clinical development and testing.

Authors:
Richard C Becker

J Thromb Thrombolysis 2021 May 15. Epub 2021 May 15.

University of Cincinnati Heart, Lung and Vascular Institute, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.

The selection of factor (F) X and its activated protease FXa for targeted inhibition to prevent and treat thrombotic conditions is based on an understanding of coagulation biochemistry, sequential steps that occur on tissue factor bearing cells and the interface of coagulation proteins, platelets, mononuclear cells and the nuclear constituents of inflammatory cells. The goal for developing direct oral FXa inhibitors was to achieve rapid, selective, predictable, safe and effective anticoagulation across a broad group of patients expected to derive benefit. The history and development in patient care are exemplars of knowledge, translation and collaboration between the public and private sectors. Read More

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Is new daily persistent headache a fallout of somatization? An observational study.

Neurol Sci 2021 May 15. Epub 2021 May 15.

Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Objective: New daily persistent headache (NDPH) is characterized by daily, persistent headache with clearly remembered onset, preceding events or triggers and treatment refractoriness of headache. The pathophysiology of NDPH is still unresolved. NDPH has been associated with somatoform disorder (DSM 4 TR). Read More

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Early secondary repair of obstetric anal sphincter injuries (OASIs): experience and a review of the literature.

Int Urogynecol J 2021 May 15. Epub 2021 May 15.

Croydon University Hospital, Thornton Heath, CR7 7YE, UK.

Introduction And Hypothesis: Secondary anal sphincter repair for a dehisced obstetric anal sphincter injury (OASI) is required following 2.6% of primary repairs. There is growing evidence that instead of delaying repair for 3-6 months, early secondary repair of the anal sphincter can be completed within 14 days. Read More

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H3F3A-mutated Giant Cell Tumour of Bone without Giant Cells - Clinical Presentation, Radiology, and Histology of Three Cases.

Histopathology 2021 May 15. Epub 2021 May 15.

Bone Tumour Reference Center at the Institute of Pathology, University Hospital Basel, Basel, Switzerland.

Aims: Giant cell tumour of bone (GCTB) is histologically defined as a lesion containing reactive giant cells and a neoplastic mononuclear cell population; in up to 92% GCTB is characterized by a specific mutation of the histone gene H3F3A. The cellular composition ranges from giant cell-rich to giant cell-poor tumours. The diagnosis of GCTB can be challenging and several other lesions need to be excluded, e. Read More

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Eating disorder symptomatology in transgender patients: Differences across gender identity and gender affirmation.

Int J Eat Disord 2021 May 15. Epub 2021 May 15.

Gender Health Program, Eskenazi Health, Indianapolis, Indiana, USA.

Objective: Past studies have reported high rates of eating disorder (ED) symptomatology among transgender people, yet without consideration of gender affirmation. The primary objective of this study was to evaluate the relationship between gender identity, gender affirming interventions such as gender affirming hormones (GAH) and gender affirming surgeries (GAS), and ED symptomatology.

Method: Transgender patients at a primary care outpatient gender health program in the United States completed a survey consisting of demographics, medical history, and clinical variables, including the Eating Disorder Examination Questionnaire (EDE-Q). Read More

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Relationship of end-tidal oxygen partial pressure to the determinants of anaerobic threshold in post-myocardial infarction patients.

Heart Vessels 2021 May 14. Epub 2021 May 14.

Department of Cardiology, Sanda City Hospital, Sanda, Japan.

The anaerobic threshold (AT), obtained during cardiopulmonary exercise testing (CPET), is an important prognostic measure and can be used to develop an exercise prescription in patients after a myocardial infarction (post-MI). The purpose of this study was to examine the central and peripheral determinants of AT in post-MI patients end-tidal oxygen partial pressure (PETO) measures. We performed cardiopulmonary exercise testing (CPET) on 148 consecutively enrolled post-MI patients to determine PETO measured at the AT (AT PETO) and ΔPETO (difference between resting PETO and AT PETO). Read More

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Genetic causes of neonatal and infantile hypercalcaemia.

Pediatr Nephrol 2021 May 14. Epub 2021 May 14.

Institute of Metabolism and Systems Research and Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, B15 2TT, UK.

The causes of hypercalcaemia in the neonate and infant are varied, and often distinct from those in older children and adults. Hypercalcaemia presents clinically with a range of symptoms including failure to thrive, poor feeding, constipation, polyuria, irritability, lethargy, seizures and hypotonia. When hypercalcaemia is suspected, an accurate diagnosis will require an evaluation of potential causes (e. Read More

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Influence of Minimally Invasive Resection Technique on Sphincter Preservation and Short-term Outcome in Low Rectal Cancer in the Netherlands.

Dis Colon Rectum 2021 May 13. Epub 2021 May 13.

Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, Netherlands Department of Surgery, Amphia, Breda, Netherlands Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands. Department of Surgery, Amsterdam University Medical Centers, Free University Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands Department of Surgery, Gelderse Vallei Hospital, Ede, the Netherlands.

Background: Transanal and robotic-assisted total mesorectal excision are techniques that can potentially overcome challenges encountered with a pure laparoscopic approach in patients with rectal cancer.

Objective: The aim of this study was to evaluate the proportion and predictive factors of restorative procedures and subsequent short-term outcomes of three minimally invasive techniques to treat low rectal cancer.

Design: This is a nationwide observational comparative registry study. Read More

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Off-label postpartum use of domperidone in Canada: a multidatabase cohort study.

CMAJ Open 2021 Apr-Jun;9(2):E500-E509. Epub 2021 May 14.

Centre for Clinical Epidemiology (Moriello, Reynier, Aibibula, Filion), Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Que; ICES (Paterson); Institute of Health Policy, Management and Evaluation (Paterson), University of Toronto, Toronto, Ont.; Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Kuo), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology and Therapeutics (Fisher), University of British Columbia, Vancouver BC; School of Pharmacy (Gamble), University of Waterloo, Kitchener, Ont.; Department of Community Health Sciences (Ronksley), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Saskatchewan Health Quality Council (Winquist); Department of Community Health and Epidemiology (Winquist), College of Medicine, University of Saskatchewan, Saskatoon Sask.; Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (Filion), McGill University, Montréal, Que.

Background: Trends in off-label postpartum use of domperidone and the impact of safety advisories on its use remain unknown. Our objectives were to describe postpartum use of domperidone in Canada, to evaluate the impact of Health Canada advisories on prescribing patterns, and to describe the association between domperidone use and a composite end point of sudden cardiac death or ventricular tachycardia (VT) among postpartum patients.

Methods: We conducted a multidatabase cohort study involving pregnant patients with live births between 2004 and 2017 using administrative health databases from 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario). Read More

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Quality of care for tuberculosis and HIV in the private health sector: a cross-sectional, standardised patient study in South Africa.

BMJ Glob Health 2021 May;6(5)

Dahdaleh Institute of Global Health Research, York University, Toronto, Ontario, Canada

Background: South Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs).

Methods: Sixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1, typical TB symptoms, HIV-positive; case 2, TB-specified laboratory report, HIV-negative and case 3, history of incomplete TB treatment, HIV-positive. Read More

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Elevated sweat chloride test: is it always cystic fibrosis?

Ital J Pediatr 2021 May 14;47(1):112. Epub 2021 May 14.

Department of Translational Medical Sciences, Cystic Fibrosis Center, University Federico II, Naples, Italy.

Background: The sweat chloride test (ST) is the gold standard for cystic fibrosis (CF) diagnosis in symptomatic patients, within the newborn screening and in the follow-up of CF patients during molecular therapies. However, false positives have been reported in patients with different diseases. We describe and discuss 4 cases due to different clinical conditions in which we recorded false positive ST, and the test remained altered for a period of varying length. Read More

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Osteitis Fibrosa Cystica and pathological fractures-the classic but neglected skeletal manifestation of primary hyperparathyroidism: a case report.

BMC Musculoskelet Disord 2021 May 14;22(1):443. Epub 2021 May 14.

Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Background: Osteitis fibrosa cystica is the classic manifestation of primary hyperparathyroidism (PHPT), occurs after prolonged exposure of bone to high serum parathyroid hormone (PTH) level. It has become increasingly rare due to early detection of PHPT.

Case Presentation: A 37-year-old woman was referred to our institution for fixation of multiple fractures of upper and lower extremities that had been reoccurring in the past 5 years. Read More

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The risk factors of the progression of rhegmatogenous retinal detachment on patients with the fourteen-day quarantine in the early period of COVID-19 outbreak.

BMC Ophthalmol 2021 May 15;21(1):215. Epub 2021 May 15.

Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.

Backgrounds: The COVID-19 Pandemic has a great impact on hospitals and patients. The 14-day quarantine caused surgery of rhegmatogenous retinal detachment (RRD) postponed. We aimed to explore the risk factors of RRD progression in a group of patients whose surgery was postponed during the top-level emergency response of COVID-19. Read More

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Ultrasonic diagnosis of asymptomatic rupture of uterine in second trimester of pregnancy after laparoscopic surgery for interstitial pregnancy: a case report.

BMC Pregnancy Childbirth 2021 May 14;21(1):375. Epub 2021 May 14.

Department of Obstetrics and Gynecology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China.

Background: Uterine rupture is a rare, life-threatening event in obstetrics that may be fatal for the mother and fetus. Therefore, obstetricians need to pay attention to and should consider the antenatal diagnosis of uterine rupture in women having its risk factors. Successful conservative management for asymptomatic uterine rupture due to previous laparoscopic surgery for interstitial pregnancy has already been reported but remains understudied. Read More

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Stopping disease-modifying therapy in relapsing and progressive multiple sclerosis.

Curr Opin Neurol 2021 May 14. Epub 2021 May 14.

Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany Brain and Mind Centre, University of Sydney, Camperdown Department of Neurology, Medical University of Vienna, Wien, Austria Mellen Center Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA Università Vita Salute San Raffaele, Multiple Sclerosis Centre, Hospital of Gallarate, Italy.

Purpose Of Review: To assess the reasons for considering discontinuation of disease-modifying therapies (DMTs)in patients with multiple sclerosis (MS). Relevant aspects of the natural history, pathology, and immunology are analyzed.

Recent Findings: A number of retrospective observational studies in aggregate indicate that stopping DMTs may be attempted in older individuals with stable disease. Read More

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CDH1 germline mutations in families with hereditary lobular breast cancer.

Eur J Cancer Prev 2021 May 7. Epub 2021 May 7.

Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy Department of Breast Surgery, Athens Euroclinic Hospital, Athens, Greece Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Pathogenic CDH1 germline mutations are associated with lobular breast cancer in the so-called hereditary lobular breast cancer (HLBC) syndrome, without apparent correlation with the classic hereditary diffuse gastric cancer (HDGC). Recent international guidelines recommend CDH1 screening also in absence of diffuse gastric cancer (DGC) history. Genomic characteristics underlying gastric and breast tumorigenesis in this varied population of patients is still unclear. Read More

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Dandy's hemispherectomies: historical vignette.

J Neurosurg 2021 May 14:1-7. Epub 2021 May 14.

To better understand Walter Dandy's intentions and the historical context of his work on hemispherectomy, the authors reviewed his original 1928 publication. Gliomas were considered incurable at that time. Presuming that the loss of motor function denoted a lack of useful tissue in that hemisphere, he pioneered radical removal of the involved cerebral hemisphere. Read More

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Clinical, epidemiological, and laboratory features of Rickettsia parkeri rickettsiosis: A systematic review.

Ticks Tick Borne Dis 2021 May 1;12(4):101734. Epub 2021 May 1.

Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA; Committee of Tropical Medicine, Zoonoses and Travel Medicine, Asociación Colombiana de Infectología, Bogotá, Colombia. Electronic address:

Rickettsia parkeri rickettsiosis is recognized as the second most prevalent tick-borne disease caused by spotted fever group rickettsiae in the Americas, where two pathogenic strains (R. parkeri sensu stricto and R. parkeri strain Atlantic rainforest) have been related to human infections and transmitted by Amblyomma spp. Read More

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Variables that prolong total operative time for robotic-assisted laparoscopic myomectomy: A 10-year tertiary hospital study in Korea.

Eur J Obstet Gynecol Reprod Biol 2021 May 4;262:62-67. Epub 2021 May 4.

Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

Study Objective: To identify factors that prolong total operative time (TOT) in robotic-assisted laparoscopic myomectomy (RALM).

Design: Retrospective cohort study.

Setting: Tertiary university hospital. Read More

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Spontaneous remission of West syndrome associated with acute infection and fever in five patients.

Epilepsy Res 2021 May 8;174:106663. Epub 2021 May 8.

Department of Neurology, Hospital Materno Infantil Salta, Argentina. Electronic address:

Objective: We analyzed the records of 198 patients with West syndrome (WS) seen at a single pediatric neurology center in Argentina between June 2004 and June 2017. Five patients with infection-related spontaneous remission of the electroclinical manifestations were identified.

Methods: The following parameters were investigated: personal and family history, clinical characteristics of the seizures - mainly spasms - and EEG findings, type of treatment, and outcome. Read More

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