BackgroundThe prevalence of epilepsy added to inadequate treatment results in chronic morbidity and considerable mortality in poor populations. Neurocysticercosis (NCC), a helminthic disease of the central nervous system, is a leading cause of seizures and epilepsy in most of the world.MethodsTaking advantage of a cysticercosis elimination program, we performed two community-based cross-sectional studies between 2006 and 2007 in 58 rural communities (population 20,610) to assess the prevalence and characteristics of epilepsy and epileptic seizures in this endemic region. Serological and computed tomography (CT) data in individuals with epilepsy were compared to previous surveys in general population from the same region.Principal findingsIn two surveys, 17,450 individuals were evaluated. Lifetime prevalence of epilepsy was 17.25/1000, and prevalence of active epilepsy was 10.8/1000 inhabitants. The prevalence of epilepsy increased after age 25 years and dropped after age 45. Only 24% (45/188) of patients with active epilepsy were taking antiepileptic drugs, all at sub-therapeutic doses. Antibodies to cysticercosis were found in approximately 40% of individuals with epilepsy in both studies. In one survey only individuals presenting strong antibody reactions were significantly associated with having epilepsy (OR 5.74; p<0.001). In the second, the seroprevalence as well as the proportion presenting strong antibody reactions were both significantly higher in individuals with epilepsy (OR 2.2 and 4.33, respectively). Brain CT showed NCC-compatible images in 109/282 individuals with epilepsy (39%). All individuals with viable parasites on CT were seropositive.ConclusionThe prevalence of epilepsy in this cysticercosis endemic region is high and NCC is an important contributor to it.

The main aim of this paper was to assess the in vitro response of healthy and coeliac human faecal microbiota to gluten-friendly bread (GFB). Thus, GFB and control bread (CB) were fermented with faecal microbiota in pH-controlled batch cultures. The effects on the major groups of microbiota were monitored over 48 h incubations by fluorescence in situ hybridisation. Short-chain fatty acids (SCFAs) were measured by high-performance liquid chromatography (HPLC). Furthermore, the death kinetics of Lactobacillus acidophilus, Bifidobacterium animalis subsp. lactis, Staphylococcus aureus, and Salmonella Typhimurium in a saline solution supplemented with GFB or CB were also assessed. The experiments in saline solution pinpointed that GFB prolonged the survival of L. acidophilus and exerted an antibacterial effect towards S. aureus and S. Typhimurium. Moreover, GFB modulated the intestinal microbiota in vitro, promoting changes in lactobacilli and bifidobacteria members in coeliac subjects. A final multivariate approach combining both viable counts and metabolites suggested that GFB could beneficially modulate the coeliac gut microbiome; however, human studies are needed to prove its efficacy.

La neurocisticercosis (NCC) es la parasitosis humana más frecuente del sistema nervioso central y es causada por las larvas del céstodo Taenia solium. La NCC es endémica en prácticamente todos los paises en vías de desarrollo. En general se presenta como formas intraparenquimales asociadas con convulsiones o formas extraparenquimales asociadas con hipertensión endocraneana. La sospecha clínica y epidemiológica es importante pero el diagnóstico se realiza primariamente por imágenes y se confirma con serología. La tomografía axial computarizada y la resonancia magnética son las pruebas imagenológicas usadas. Como prueba confirmatoria se usa el diagnóstico inmunológico a través de western blot, que actualmente se pude realizar en el Instituto Nacional de Ciencias Neurológicas tanto en suero como en líquido cefalorraquídeo. El tratamiento involucra medidas sintomáticas (control de convulsiones o hipertensión endocraneana según sea el caso) y tratamiento antiparasitario (albendazol o praziquantel). El tratamiento antiparasitario debe hacerse bajo condiciones de hospitalización y en hospitales de tercer nivel.

Orsola and colleagues question our statistical analyses. We were unable to present all our data in our letter to the editor. When patients were enrolled, we assessed age, date of diagnosis of cancer, tumor grade and pathological T-stage category after transurethral resectioning, presence or absence of concomitant carcinoma in situ, number of recurrences during the first year after diagnosis and total number of recurrences, pathological T-stage progression, time to cystectomy, and time to the appearance of distant metastases. We compared the outcomes for patients who were taking statins during BCG immunotherapy and those who were not by using univariate and multivariate logistic-regression analyses that included age and cholesterol level but that were not adjusted for the specific statin, given the small number of patients in the various statin groups. The adjusted odds ratio for older age and progression to more aggressive disease in the statin group was 5.02 (95% confidence interval [CI] Medical Mystery -Paradoxical EmbolismTo the Editor: With regard to Mathura and Jampol's answer to the Medical Mystery about the visual-field defect (Dec. 7 issue), 1 we would like to raise a small point about the path taken by the paradoxical embolism to a left retinal artery branch in the patient with Eisenmenger's syndrome associated with ventriculoseptal defect and a patent ductus arteriosus. Although the embolism is attributed to the clot passing through the patent ductus arteriosus, it is more likely that it passed through the septal defect. The ductus enters the aorta distal to the left common carotid artery and subclavian artery. A clot passing through the ductus would be more likely to travel downstream to the thoracic and abdominal aortas than upstream to the left common carotid artery, whereas a clot passing from right to left across the septum would flow downstream through the ascending and transverse portions of the aorta into the left common carotid artery.

EITB antibody banding patterns correlate with brain imaging findings and complement imaging information for the diagnosis of NCC and for staging NCC patients.