Unprovoked status epilepticus: the prognosis for otherwise normal children with focal epilepsy.

Objective: To document the effect of unprovoked status epilepticus (SE) on the prognosis for otherwise normal children with focal epilepsy.

Methods: From the Nova Scotia Childhood Epilepsy Study (population-based), we identified patients with focal epilepsy, normal intelligence, and neurologic examination and follow-up ≥ 10 years. We compared those with and without unprovoked SE.

Mental health and the school environment: secondary schools, promotion and pathways to care.

Purpose Of Review: Addressing youth mental health in secondary schools has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental health promotion, prevention, early identification and intervention/treatment.

Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease.

Background: A recent national practice guideline recommends the use of opioids for the treatment of refractory dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD). We conducted two qualitative studies to explore the experiences of patients and family caregivers with opioids for refractory COPD-related dyspnea and the perspectives and attitudes of physicians toward opioids in this context.

Methods: Patients (n = 8; 5 men, 3 women), their caregivers (n = 12; 5 men, 7 women) and physicians (n = 28, 17 men, 11 women) in Nova Scotia participated in the studies.

Scleromyxedema and the dermato-neuro syndrome: case report and review of the literature.

Scleromyxedema is a generalized form of lichen myxedematosus which is characterized by a papular and sclerodermoid skin eruption resulting from dermal fibroblast proliferation and mucin deposition. The majority of patients with scleromyxedema have a monoclonal gammopathy, and other systemic manifestations are common. Herein we describe a case of the 'dermato-neuro syndrome', a rare and sometimes fatal neurologic manifestation of scleromyxedema which consists of fever, convulsions and coma, often preceded by a flu-like prodrome.

Sinonasal seromucinous hamartoma: a review of the literature and a case report with focal myoepithelial cells.

Seromucinous hamartoma is a benign lesion of the sinonasal tract. Since its description in 1974, only a small number of additional cases have been reported. It is composed of a proliferation of seromucinous glands and ducts within a variable fibrous stroma.

Clinical and pathologic factors of prognostic significance in penile squamous cell carcinoma in a North American population.

Objective: To analyze, in a clinicopathologic correlation study, a small population of primarily white men with invasive squamous cell carcinoma of the penis for potential prognostic predictors. Penile squamous cell carcinoma is an uncommon cancer in North America. It has a wide spectrum of clinical behavior and an understudied pathogenesis.

Microsatellite instability status does not predict total lymph node or negative lymph node retrieval in stage III colon cancer.

The relationship between higher total lymph node resection number in colorectal cancer resection specimens and improved overall survival is well known. Recent studies describe an association between a high rate of microsatellite instability and a high total lymph node count in colorectal cancer. Higher lymph node retrieval may potentially explain the improved survival seen in cancers with microsatellite instability.

Diagnostic accuracy and safety of fine-needle aspiration biopsy of the parapharyngeal space.

Fine-needle aspiration (FNA) biopsy of the parapharyngeal space (PPS) is a diagnostic challenge and sampling is often done without image guidance, often trans-orally. Primary PPS tumors are rare, and there is a broad differential diagnosis. The accuracy of PPS FNA, in particular without CT-guidance and using liquid-based cytology (LBC), has not been well studied.

An incremental economic evaluation of targeted and universal influenza vaccination in pregnant women.

Objective: Pregnancy is associated with increased influenza hospitalizations and physician visits (events) in healthy women and those with co-morbidities. Annual influenza immunization is recommended for all pregnant women. Although vaccination is expected to reduce influenza-related events, the economic implications are unclear.

Loss of expression of DNA mismatch repair proteins is rare in pancreatic and small intestinal neuroendocrine tumors.

Context: Two recent studies have identified a high rate of microsatellite instability (MSI) in pancreatic neuroendocrine tumors (pNETs). Microsatellite instability is rare in small intestinal neuroendocrine tumors (NETs). It is unclear why there is discordance in the frequency of MSI in the 2 studies of pNETs and why this mechanism is comparatively rare in small intestinal tumors.

Consensus treatments for moderate juvenile dermatomyositis: beyond the first two months. Results of the second Childhood Arthritis and Rheumatology Research Alliance consensus conference.

Objective: To use consensus methods and the considerable expertise contained within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) organization to extend the 3 previously developed treatment plans for moderate juvenile dermatomyositis (DM) to span the full course of treatment.

Methods: A consensus meeting was held in Chicago on April 23-24, 2010, involving 30 pediatric rheumatologists and 4 lay participants. Nominal group technique was used to achieve consensus on treatment plans that represented typical management of moderate juvenile DM.

Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis.

Objective: Most children with mental health disorders do not receive timely care because of access barriers. These initial trials aimed to determine whether distance interventions provided by nonprofessionals could significantly decrease the proportion of children diagnosed with disruptive behavior or anxiety disorders compared with usual care.

Method: In three practical randomized controlled trials, 243 children (80 with oppositional-defiant, 72 with attention-deficit/hyperactivity, and 91 with anxiety disorders) were stratified by DSM-IV diagnoses and randomized to receive the Strongest Families intervention (treatment) or usual care (control).

Anxiety and separation disorders.

• Based on strong research evidence, anxiety disorders are the most common psychiatric illness in children and adolescents. • Based on some research evidence, the neurobiology of anxiety disorders is linked to dysregulation in the fear and stress response system in the brain. • Based on strong research evidence, separation anxiety disorder is one of the most common causes of school refusal, and addressing both the function of the behavior and returning to school as soon as possible is recommended.

Persistent pigmented purpuric dermatitis: granulomatous variant.

The persistent pigmented purpuric dermatitides (PPPD) are a spectrum of dermatologic disorders characterized by petechial and pigmented macules usually confined to the lower limbs. Their etiology is unknown and several clinical variants are recognized. At the microscopic level they are characterized by angiocentric lymphocytic inflammation, red blood cell extravasation and hemosiderin deposition.

Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus.

Objective: Neuropsychiatric events occur unpredictably in systemic lupus erythematosus (SLE) and most biomarker associations remain to be prospectively validated. This study examined a disease inception cohort of 1047 SLE patients to determine which autoantibodies at enrolment predicted subsequent neuropsychiatric events.

Methods: Patients with a recent SLE diagnosis were assessed prospectively for up to 10 years for neuropsychiatric events using the American College of Rheumatology case definitions.

Barriers to assessing fitness to drive in dementia in nova scotia: informing strategies for knowledge translation.

Background And Purpose: Over half a million Canadians have a diagnosis of dementia, approximately 25-30% of whom continue to drive. Individuals with dementia have a risk of motor vehicle collision up to eight times that of drivers without dementia. In Nova Scotia, the responsibility of reporting unsafe drivers is discretionary, but national survey data indicate that many physicians do not feel comfortable assessing driving safety.

Risk of coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in Nova Scotia.

Background: The frequency of Chlamydia trachomatis and Neisseria gonorrhoeae coinfection can vary depending on their individual incidence and prevalence rates.

Objective: To determine the frequency of C trachomatis and N gonorrhoeae coinfections by evaluating the results of testing in 2007 and 2008 to better inform testing and treatment decisions.

Methods: Specimens from the same patient submitted on the same day served as the basis for the present study.

Dose-sparing H5N1 A/Indonesia/05/2005 pre-pandemic influenza vaccine in adults and elderly adults: a phase III, placebo-controlled, randomized study.

Background: Highly pathogenic avian influenza H5N1 viruses remain a threat to human health, with potential to become pandemic agents.

Methods: This phase III, placebo-controlled, observer-blinded study evaluated the immunogenicity, cross-reactivity, safety, and lot consistency of 2 doses of oil-in-water (AS03(A)) adjuvanted H5N1 A/Indonesia/05/2005 (3.75 μg hemagglutinin antigen) prepandemic candidate vaccine in 4561 adults aged 18-91 years.

Development and preliminary testing of a scale to assess pain-related fear in children and adolescents.

Unlabelled: It is assumed that pain-related fear, a present response to an immediate danger or threat such as pain, plays a significant role in the experience of pediatric pain. However, there are no measures to adequately measure this construct in children and adolescents. The purpose of this study was to develop and test the psychometric properties of a scale to assess pain-related fear to be used with Catalan-speaking children and adolescents between 7- and 16-years-old.

Immunohistochemical expression and prognostic value of ER, PR and HER2/neu in pancreatic and small intestinal neuroendocrine tumors.

Background And Aims: There has been limited study of estrogen and progesterone receptor (ER/PR) expression in gastrointestinal neuroendocrine tumors (GINETs) despite emerging evidence of hormone receptor regulation of pancreatic islet cells. Beta cells express PR and progesterone has been implicated in the pathogenesis of gestational diabetes. There is conflicting information regarding HER2/neu protein overexpression in GINETs.