Quality of life in epilepsy-31 inventory (QOLIE-31) scores: A global comparison.

Quality of life is a pragmatic endpoint for understanding the experience of people with epilepsy (PWE) in low- and middle-income countries (LMICs), where>80% of PWE reside. However, the literature is bereft of QOL in epilepsy (QOLIE) studies among LMICs and knowledge of the variation in QOLIE globally. We therefore performed a Medline search of original research studies using the quality of life in epilepsy-31 inventory (QOLIE-31) in a recent fifteen-year period (2000-2015).

Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice: A Multicenter Observational Study.

Background: About half of the United States has legislation requiring radiology facilities to disclose mammographic breast density information to women, often with language recommending discussion of supplemental screening options for women with dense breasts.

Objective: To examine variation in breast density assessment across radiologists in clinical practice.

Design: Cross-sectional and longitudinal analyses of prospectively collected observational data.

Posterior reversible encephalopathy syndrome is not associated with mutations in aquaporin-4.

Posterior reversible encephalopathy syndrome (PRES) is characterized by acute reversible subcortical vasogenic edema that is typically bilateral and self-limiting. It preferentially affects posterior regions of the brain. Clinical manifestations include encephalopathy, seizures, headache, and cortical blindness.

Association of Antenatal Depression Symptoms and Antidepressant Treatment With Preterm Birth.

Objective: To evaluate the association of antenatal depression symptoms with preterm birth and small for gestational age (SGA).

Methods: This was an observational cohort study conducted among women who completed Edinburgh Postnatal Depression Scale screening and delivered at 20 weeks of gestation or greater. The primary outcomes were preterm birth and an SGA neonate at birth (less than 10th percentile for gestational age); the primary predictor was an Edinburgh Postnatal Depression Scale antepartum score of 10 or greater, indicating symptoms of depression.

Rapidly-progressive catatonia responsive to zolpidem in a patient with ovarian teratoma-associated paraneoplastic encephalitis.

Psychiatric symptoms and catatonia are key components of the clinical presentation of paraneoplastic encephalitis; additionally symptoms can be long-lasting and often difficult to treat. We report a 73-year-old patient with rapidly progressive catatonia not responsive to immunotherapy, tumor resection, electroconvulsive therapy, or benzodiazepines who had significant improvement after zolpidem administration. This report suggests that zolpidem is an option in the treatment of patients with refractory catatonia and paraneoplastic encephalitis.

A National Evaluation of the Scholarly Activity Requirement in Residency Programs: A Survey of Emergency Medicine Program Directors.

Objectives: The Review Committee for Emergency Medicine (RC-EM) requirement for scholarly activity, which programs may define as an original research project or some other form of scholarly activity, applies to all EM residents. The objectives of this study were to: 1) describe the percentage of residency programs that require an original research project to meet the RC-EM requirement for scholarly activity, 2) describe specific challenges and resources for residents completing the RC-EM scholarly activity requirement, and 3) identify associations between the interpretation of the requirement and early career outcomes.

Methods: This was a cross-sectional online survey of program or research directors from all U.

Malignant EEG patterns in cardiac arrest patients treated with targeted temperature management who survive to hospital discharge.

Background And Purpose: Cardiac arrest patients treated with targeted temperature management (TTM) have improved neurological outcomes, however mortality remains high. EEG monitoring improves detection of malignant EEG patterns (MEPs), however their prevalence in patients surviving to hospital discharge is unknown.

Design/methods: We examined consecutive cardiac arrest subjects who received TTM and continuous EEG monitoring at one academic center.

Racial variation in the use of life-sustaining treatments among patients who die after major elective surgery.

Background: Although various studies have documented increased life-sustaining treatments among racial minorities in medical patients, whether similar disparities exist in surgical patients is unknown.

Methods: A retrospective cohort study using the Nationwide Inpatient Sample (2006 to 2011) examining patients older than 39 years who died after elective colectomy was performed. Primary predictor variable was race, and main outcome was the use of life-sustaining treatment.

Variation in Aptitude of Trainees in Endoscopic Ultrasonography, Based on Cumulative Sum Analysis.

Background & Aims: Studies have reported substantial variation in the competency of advanced endoscopy trainees, indicating a need for more supervised training in endoscopic ultrasound (EUS). We used a standardized, validated, data collection tool to evaluate learning curves and measure competency in EUS among trainees at multiple centers.

Methods: In a prospective study performed at 15 centers, 17 trainees with no prior EUS experience were evaluated by experienced attending endosonographers at the 25th and then every 10th upper EUS examination, over a 12-month training period.

Neuro-Behçet disease and autoinflammatory disorders.

Misregulation of innate immunity leads to autoinflammation. Behçet disease is an autoinflammatory condition involving recurrent attacks of inflammation in skin, eyes, joints, and even the nervous system. The etiology may involve vascular inflammation.

Fungal infections of the central nervous system.

Fungal infections of the central nervous system have manifold presentations and courses that depend largely on both host and organism characteristics. Although subjects with impaired immunity are generally at higher risk for severe disease, several fungal organisms are considered primary pathogens and can also cause disease in otherwise immunocompetent individuals. Herein, we describe the epidemiology, presentation, diagnosis, and management of central nervous system complications of several fungal pathogens.

Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans.

Purpose: Higher levels of acculturation among Latinos have been shown to be associated with a higher prevalence of cardiovascular (CV) risk factors in some studies of middle-age persons. The association of acculturation and prevalence of CV risk factors in elderly Latinos is less well established.

Methods: Acculturation was measured using the validated bidimensional Acculturation Rating Scale for Mexican Americans-II.

The spectrum of FBN1, TGFβR1, TGFβR2 and ACTA2 variants in 594 individuals with suspected Marfan Syndrome, Loeys-Dietz Syndrome or Thoracic Aortic Aneurysms and Dissections (TAAD).

Introduction: In this study, patients suspected of having a clinical diagnosis of Marfan Syndrome (MFS), Loeys-Dietz Syndrome (LDS) and Thoracic Aortic Aneurysms and Dissections (TAAD) were referred for genetic testing and examined for mutations in the FBN1, TGFβR1, TGFβR2 and ACTA2 genes.

Methods: We examined 594 samples from unrelated individuals and different combinations of genes were sequenced, including one or more of the following: FBN1, TGFβR1, TGFβR2, ACTA2, and, in some cases, FBN1 was analyzed by MLPA to detect large deletions.

Results: A total of 112 patients had a positive result.

The relationship between parental stress and postpartum depression among adolescent mothers enrolled in a randomized controlled prevention trial.

Given the high co-occurrence of depression and parental stress among adolescent mothers, we evaluated the relationship between parental stress and postpartum depression among primiparous adolescent mothers. We conducted an observational analysis among a cohort of 106 adolescent mothers at 289 postpartum visits who were enrolled in a randomized controlled trial to prevent postpartum depression. Parental stress was measured using the Parenting Stress Index, short form.

Educational objectives for international medical electives: a literature review.

Purpose: Although most medical schools and residency programs offer international medical electives (IMEs), little guidance on the educational objectives for these rotations exists; thus, the authors reviewed the literature to compile and categorize a comprehensive set of educational objectives for IMEs.

Method: In February and July 2012, the authors searched SciVerse Scopus online, which includes the Embase and MEDLINE databases, using specified terms. From the articles that met their inclusion criteria, they extracted the educational objectives of IMEs and sorted them into preelective, intraelective, and postelective objectives.

11C-methionine PET for grading and prognostication in gliomas: a comparison study with 18F-FDG PET and contrast enhancement on MRI.

Unlabelled: The aim of this study was to compare the grading and prognostic value of l-[methyl-(11)C]-methionine ((11)C-MET) PET in glioma patients with (18)F-FDG PET and contrast-enhanced MRI.

Methods: Patients (n = 102) with histopathologically confirmed gliomas were followed up for an average of 34.6 ± 3.

Restricted diffusion in the splenium of the corpus callosum after cardiac arrest.

The value of MRI findings for coma prognostication is a question of great clinical and pathological relevance. We describe MRI evidence of restricted diffusion in the splenium in 5 patients with coma after cardiopulmonary resuscitation following cardiac arrest. The most common clinical presentation of corpus callosum lesions (of any cause) is altered mental status, consistent with the global importance of these extensive inter-hemispheric fibers.

Incorporating uncertainty into medical decision making: an approach to unexpected test results.

The utility of diagnostic tests derives from the ability to translate the population concepts of sensitivity and specificity into information that will be useful for the individual patient: the predictive value of the result. As the array of available diagnostic testing broadens, there is a temptation to de-emphasize history and physical findings and defer to the objective rigor of technology. However, diagnostic test interpretation is not always straightforward.

The emerging crisis of drug-resistant tuberculosis in South Africa: lessons from New York City.

Multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis have emerged as important infections in South Africa among patients infected with human immunodeficiency virus (HIV). In the face of this new epidemic, South Africa must rededicate itself to the task of tuberculosis control and treatment with a rapid, multifaceted approach. Priorities include expansion of second-line treatment capacity, investment in clinical laboratories, a system to ensure supervised treatment for all patients, and enhancement of infection control procedures.

Desiderata or dogma: what the evidence reveals about physician attire.

Introduction: Physician-patient interactions are complex and depend on multiple factors including common cultural definitions and evolving social norms. The once purely philosophical debate over what constitutes appropriate physician attire can benefit from a growing evidence base in the literature.

Discussion: Although this literature is commonly regarded as supporting traditional attire, the data actually represent a more balanced distribution of opinions held by patients and by physicians.

Non-serotonin anti-depressant actions: direct ion channel modulation by SSRIs and the concept of single agent poly-pharmacy.

Medical therapies targeting infections and neoplasms often involve a multi-pronged strategy sometimes called "rational poly-pharmacy", while other disorders such as Parkinson's disease emphasize targeting a single neurotransmitter system (dopamine). Although the clinical literature favors a "serotonin hypothesis" for depression, a growing basic science literature suggests that selective serotonin reuptake inhibitors (SSRIs) directly modulate neurotransmitter- and voltage-gated neuronal ion channels. In addition, biosynthesis of neurosteroids (themselves promiscuous ion channel modulators), is activated by SSRIs.