Hyperammonemia during treatment with valproate in critically ill patients.

Introduction: Hyperammonemia (HA) is a potential side-effect of valproate (VPA) treatment, which has been described during long-term administration. The aim of this study was to evaluate the incidence, the impact and the risk factors of HA in critically ill patients.

Methods: We reviewed the data of all adult patients treated in our mixed 35-bed Department of Intensive Care over a 12-year period (2004-2015) who: a) were treated with VPA for more than 72 h and b) had at least one measurement of ammonium and VPA levels during the ICU stay; patients with Child-Pugh C liver cirrhosis were excluded.

Mass psychogenic illness (epidemic sociogenic attacks) in a village in Lebanon.

Mass psychogenic illness (epidemic sociogenic attacks/mass hysteria) refers to a rapid spread of well-described signs and symptoms affecting members of a group. It might be difficult to differentiate at first from illnesses due to infections, intoxications or "bio-terrorism." We investigated such an occurrence in a small village in Lebanon chronically under threat of war.