High Dosage Metolazone in Chronic Renal Failure

Metolazone is a modified quinazolinesulphonamide and in a dose of between 4 and 7·5 mg is an effective diuretic in man with normal renal function. Fourteen patients with non-oedematous stable chronic renal failure (creatinine clearance ranging from 1·2 to 12 ml/min) were given metolazone in doses ranging from 20-150 mg. A noticeable increase in urine flow and sodium excretion occurred, free water clearance increased, and there was a small but significant increase in potassium excretion. No side effects were noted.     

Evaluation of the Epidemic Potential of Western Equine Encephalitis Virus in the Northeastern United States

The problem of evaluating the epidemic potential of western equine encephalitis in the northeastern United States is presented and possible reasons are discussed for the present lack of human and horse cases of this disease even though increased numbers of isolations of the virus have been obtained in the East during recent years. Epidemiologic factors of vector bionomics and virus strain variations are considered. It is concluded that while this virus strain can no longer be regarded as uncommon in the Northeast, the evidence indicates there is little potential for epidemic expression of this agent in the human and horse population. This appears to be due to differences in the bionomics of the mosquito Culiseta melanura, which serves as the primary enzootic vector in the northeastern United States and in the bionomics of Culex tarsalis that is the vector in the western region of the United States. Other limiting factors in the epidemic potential may be variations between virus strains located in the East and West.     

Effect of Antiepileptic Drugs for Acute and Chronic Seizures in Children with Encephalitis

BackgroundEncephalitis presents with seizures in the acute phase and increases the risk of late unprovoked seizures and epilepsy. This study aimed to evaluate the effect of antiepileptic drugs in pediatric patients with acute seizures due to encephalitis and epilepsy.ResultsDuring the study period, 1038 patients (450 girls, 588 boys) were enrolled. Among them, 44.6% (463) had seizures in the acute phase, 33% had status epilepticus, and 26% (251) developed postencephalitic epilepsy. At one year of follow-up, 205 of the 251 patients with postencephalitic epilepsy were receiving antiepileptic drugs while 18% were seizure free even after discontinuing the antiepileptic drugs. Among those with postencephalitic epilepsy, 67% had favorable outcomes and were using <2 anti-epileptic drugs while 15% had intractable seizures and were using ≥ 2 antiepileptic drugs. After benzodiazepines, intravenous phenobarbital was preferred over phenytoin as treatment of postencephalitic seizures in the acute phase. For refractory status epilepticus, high-dose topiramate combined with intravenous high-dose phenobarbital or high-dose lidocaine had less side effects.ConclusionsChildren with encephalitis have a high rate of postencephalitic epilepsy. Phenobarbital and clonazepam are the most common drugs used, alone or in combination, for postencephalitic epilepsy.     

Gross Oedema in the Nephrotic Syndrome Treated with Frusemide in High Dosage

Five grossly oedematous patients with nephrotic syndrome required frusemide in doses of 250 mg/day or more. Two cases needed albumin infusions to initiate the diuresis. As oedema was removed renal function improved in four cases. There were no side effects. It is concluded that frusemide in the high doses used is a safe and effective diuretic.     

High Intensity Light Increases Olfactory Bulb Melatonin in Venezuelan Equine Encephalitis Virus Infection

In mice infected with the Venezuelan equine encephalomyelitis (VEE) virus and exposed to high intensity light (2500 lux) with a 12 h light: 12 h dark photoperiod, a significant increase in the levels of melatonin in the olfactory bulb was observed. The significance of these findings deserves further studies to understand the mechanisms involved in this effect since the olfactory bulbs have been proposed as first portal for VEE virus entry into the CNS. The increase in melatonin content could represent one of the mechanisms of defense against the viral attack.