Bipolar disorder: Diagnosis, treatment and future directions.

Bipolar disorder is a relatively common mental illness, characterised by recurrent episodes of mania (or hypomania) and major depression, and associated with a significant burden of morbidity and premature mortality. Physicians across all specialities are likely to encounter individuals with the condition within their clinical practice. This short review provides an up-to-date overview of the clinical features, epidemiology, pathophysiology, evidence-based management, prognosis and future directions for treatment and research in bipolar disorder.

Crowding in the Emergency Department: Challenges and Recommendations for the Care of Children.

Emergency department (ED) crowding results when available resources cannot meet the demand for emergency services. ED crowding has negative impacts on patients, health care workers, and the community. Primary considerations for reducing ED crowding include improving the quality of care, patient safety, patient experience, and the health of populations, as well as reducing the per capita cost of health care.

Crowding in the Emergency Department: Challenges and Best Practices for the Care of Children.

Emergency department (ED) crowding has been and continues to be a national concern. ED crowding is defined as a situation in which the identified need for emergency services outstrips available resources in the ED. Crowding is associated with higher morbidity and mortality, delayed pain control, delayed time to administration of antibiotics, increased medical errors, and less-than-optimal health care.

Towards personalised predictive psychiatry in clinical practice: an ethical perspective.

Personalised prediction models promise to enhance the speed, accuracy and objectivity of clinical decision-making in psychiatry in the near future. This editorial elucidates key ethical issues at stake in the real-world implementation of prediction models and sets out practical recommendations to begin to address these.

Lessons learned: using adverse incident reports to investigate the characteristics and causes of prescribing errors.

Introduction: Prescribing errors are a principal cause of preventable harm in healthcare. This study aims to establish a systematic approach to analysing prescribing-related adverse incident reports, in order to elucidate the characteristics and contributing factors of common prescribing errors and target multifaceted quality improvement initiatives.

Methods: All prescribing-related adverse incident reports submitted across one NHS board over 12 months were selected.

More than just filler: an empirically informed ethical analysis of non-surgical cosmetic procedures in body dysmorphic disorder.

Objectives: To identify and analyse ethical considerations raised when individuals with body dysmorphic disorder (BDD) consult for non-surgical cosmetic procedures.

Methods: Ethical analysis was conducted addressing the issues of best interests and capacity to consent for non-surgical cosmetic procedures in individuals with BDD. Analysis was informed by the findings of semistructured interviews with non-surgical cosmetic practitioners and mental health professionals.

The benefit of foresight? An ethical evaluation of predictive testing for psychosis in clinical practice.

Risk prediction for psychosis has advanced to the stage at which it could feasibly become a clinical reality. Neuroimaging biomarkers play a central role in many risk prediction models. Using such models to predict the likelihood of transition to psychosis in individuals known to be at high risk has the potential to meaningfully improve outcomes, principally through facilitating early intervention.

Purpura fulminans associated with acute West Nile virus encephalitis.

Purpura fulminans is a progressive thrombotic disorder that presents with widespread purpura due to deficiency or dysfunction of protein C or protein S. Lesions present as well-demarcated erythematous macules that progress to irregular areas of hemorrhagic necrosis.West Nile virus is a member of the Flaviviridae family transmitted to humans through the bite of various mosquito species.

The development and delivery of a female chronic pelvic pain management programme: a specialised interdisciplinary approach.

Context/background: Chronic pelvic pain (CPP) is a physically and psychologically debilitating condition. European Association of Urology (EAU) Guidelines (2013) and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines (2012) place strong emphasis upon multi-speciality assessment and liaison, as well as interdisciplinary assessment and intervention in reference to the management of CPP.

Objectives: The aim was to introduce and describe the development and delivery of an interdisciplinary pain management programme (PMP), at a Specialised Pain Management Centre in Liverpool, United Kingdom, for women diagnosed with CPP.

Disseminated nocardiosis in a patient on infliximab and methylprednisolone for treatment-resistant Sweet's syndrome.

A 62-year-old white man with a 10-year history of treatment-refractory Sweet's syndrome was admitted to the hospital with the onset of purpuric lesions. Methylprednisolone and infliximab were administered. Our patient developed disseminated Nocardia infection and eventually succumbed.

IgG/IgA pemphigus.

IgG/IgA pemphigus has recently been described in the literature as an overlap of pemphigus vulgaris or pemphigus foliaceus with IgA pemphigus. There has also been some postulation that this IgG/IgA pemphigus may be associated with internal malignancy as well. Our case demonstrates the unique clinical, histopathological, and direct immunofluorescence findings of IgG/IgA pemphigus and further highlights the possibility of association of this disease with internal malignancy.

Decidual-secreted factors alter invasive trophoblast membrane and secreted proteins implying a role for decidual cell regulation of placentation.

Inadequate or inappropriate implantation and placentation during the establishment of human pregnancy is thought to lead to first trimester miscarriage, placental insufficiency and other obstetric complications. To create the placental blood supply, specialized cells, the 'extravillous trophoblast' (EVT) invade through the differentiated uterine endometrium (the decidua) to engraft and remodel uterine spiral arteries. We hypothesized that decidual factors would regulate EVT function by altering the production of EVT membrane and secreted factors.

Leukemia inhibitory factor enhances endometrial stromal cell decidualization in humans and mice.

Adequate differentiation or decidualization of endometrial stromal cells (ESC) is critical for successful pregnancy in humans and rodents. Here, we investigated the role of leukemia inhibitory factor (LIF) in human and murine decidualization. Ex vivo human (H) ESC decidualization was induced by estrogen (E, 10(-8) M) plus medroxyprogesterone acetate (MPA, 10(-7) M).

JAAD grand rounds quiz*: Dusky intertriginous plaques and acral erythema after bone marrow transplant.

Learning Objectives: At the conclusion of this learning activity, physician participants should be able to assess their own diagnostic and patient management skills and use the results of this exercise to help determine personal learning needs that can be addressed through subsequent CME involvement. Instructions for claiming CME credit appear in the front advertising section. See last page of Contents for page number.

Bradykinin stimulates endothelial cell fatty acid oxidation by CaMKK-dependent activation of AMPK.

Endothelial cell lipotoxicity mediated by accumulation of free fatty acids is an early event in the pathogenesis of atherosclerosis. The energy-sensor AMP-activated protein kinase (AMPK) is a key regulator of endothelial cell lipid metabolism. To test the hypothesis that bradykinin (BK) regulates AMPK and fatty acid oxidation in endothelium, stimulations of bovine aortic endothelial cells (BAECs) with bradykinin were performed.

Phosphorylation of neuronal and endothelial nitric oxide synthase in the kidney with high and low salt diets.

Background: Renal nitric oxide (NO) synthesis increases with increasing salt intake, however, the mechanisms underlying this are poorly understood. We hypothesized that activating or inhibitory phosphorylation of neuronal and endothelial nitric oxide synthase (nNOS, eNOS) regulates renal NO production in response to altered dietary salt.

Methods: Sprague-Dawley rats were fed low, normal or high salt diets for 12 h or 2 weeks, and kidney NOS phosphorylation was analyzed by Western blot using phosphopeptide antibodies against the sites nNOS-Ser(1412), nNOS-Ser(847), eNOS-Ser(1176) and eNOS-Thr(494).

Enhanced replicative capacity and pathogenicity of HIV-1 isolated from individuals infected with drug-resistant virus and declining CD4+ T-cell counts.

Virologic failure on continuous antiretroviral therapy (ART) is associated with variable changes in CD4 T-cell counts: peripheral CD4 T-cell counts decrease in conjunction with a resurgence of plasma virus (nonresponders) or remain stable or continue to increase despite ongoing virus replication (discordant responders). This study found that HIV-1 isolated from nonresponders had significantly greater replicative capacity in activated peripheral blood mononuclear cells (PBMCs) as well as an enhanced ability to induce apoptosis in both HIV-1-infected and HIV-1-uninfected CD4 T cells compared with virus isolated from discordant responders. Enhanced replicative capacity in PBMCs of virus isolated from nonresponders was inhibited by AMD3100, a CXCR4 antagonist.

A clinical trial to compare double-arch and complete-arch impression techniques in the provision of indirect restorations.

Statement Of Problem: Anecdotal reports of use of double-arch impressions for indirect restorations suggest time and materials savings, but there is little clinical evidence to support their use.

Purpose: To establish whether a double-arch impression technique could produce restorations comparable with those produced by use of the complete-arch technique and to investigate reported time and material savings.

Material And Methods: Five practitioners each recruited 10 adult patients requiring a single complete veneer crown into the study.