Misdiagnoses of Epilepsy as Ekbom Syndrome, Mood Instability, and Nocturnal Visual Hallucinations.

Epileptic seizures may be misdiagnosed if they manifest as psychiatric symptoms. We report three female patients with no preexisting history of epilepsy that were unsuccessfully treated as primary psychiatric disorder: one patient was initially diagnosed with somatization and Ekbom syndrome; the second was referred to psychiatrist due to mood instability and visual hallucinations; and the third one was referred for anxiety and hallucinations related to sleep. A carefully taken medical history clarified diagnoses of epilepsy. None of the patients responded to medications aimed at treating psychiatric symptoms, and all the patients had favorable response to antiepileptic treatment. These cases illustrate that epileptic patients may experience nonconvulsive seizures that might be misdiagnosed as primary psychiatric disorder.

Experts' perspectives on the role of medical marijuana in oncology: A semistructured interview study.

BACKGROUND: Expansion of medical marijuana (MM) laws in the United States may offer oncology new therapeutic options. However, the scientific evidence for MM remains in infancy. This study qualitatively explored professional opinion around the role of MM in cancer care. METHODS: Semistructured interviews were administered to a sample of individuals with expertise at the interface of MM and oncology nationally. Key informant criteria included an oncologic clinical or research background and any of the following: publications, research, or lectures on cannabinoids or cancer symptoms; involvement in the development of MM dispensaries or legislation; and early adoption of state MM certification procedures. A gold standard, grounded, inductive approach was used to identify underlying themes. RESULTS: Participants (N = 15) were predominantly male, in their sixth decade, working in academic settings. Themes ranged from strong beliefs in marijuana's medical utility to reservations about this notion, with calls for expansion of the scientific evidence base and more stringent MM production standards. All participants cited nausea as an appropriate indication, and 13 of 15 pain. Over one-third believed MM to have a more attractive risk profile than opioids and benzodiazepines. CONCLUSIONS: Expert opinion was divided between convictions in marijuana's medicinal potential and guardedness in this assertion, with no participant refuting MM's utility outright. Emergent themes included that MM ameliorates cancer-related pain and nausea and is safer than certain conventional medications. Participants called for enhanced purity and production standards, and further research on MM's utility.

The Enigma of Rapid Repeat Pregnancy: A Qualitative Study of Teen Mothers.

STUDY OBJECTIVE: Rapid repeat pregnancy accounts for 18% of teen pregnancies and leads to adverse health, economic, and developmental outcomes for teen mothers and their children. Few interventions have been successful in reducing rapid repeat pregnancy. In this qualitative study we examined adolescent mothers' perceptions of their decision-making and behaviors that helped prevent or promote a rapid repeat pregnancy. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Semistructured interviews were conducted with 31 adolescent mothers, aged 16-21 years; 15 of these subjects experienced a repeat pregnancy within a year of their first child's birth and 16 had not. Two researchers used a grounded, inductive technique to identify emergent themes; interviews were subsequently coded accordingly. Counts were tabulated of the number of times themes were endorsed among those with or without a repeat pregnancy. RESULTS: Four overarching themes emerged from the interviews: intentionality regarding pregnancy planning, patients' degree of independence in making contraceptive choices, sense of control over life experience, and barriers to follow-through on contraceptive planning. Teens who had not experienced a rapid repeat pregnancy more often endorsed themes of intentionality in preventing or promoting a pregnancy, independence in decision-making, and feelings of control over their experience. Ambivalence and lack of decision-making about seeking another pregnancy were frequently endorsed by mothers who had experienced a second pregnancy. CONCLUSION: Decision-making regarding seeking or preventing a rapid repeat pregnancy is complex for teen mothers; techniques to help support decision-making or to delay pregnancy until decision-repeat making is complete might be important in reducing rapid pregnancy.

Autoimmunity, phospholipid-reacting antibodies and malaria immunity.

Several questions regarding the production and functioning of autoantibodies (AAb) during malaria infection remain open. Here we provide an overview of studies conducted in our laboratory that shed some light on the questions of whether antiphospholipid antibodies (aPL) and other AAb associated with autoimmune diseases (AID) can recognize Plasmodia antigens and exert anti-parasite activity; and whether anti-parasite phospholipid antibodies, produced in response to malaria, can inhibit phospholipid-induced inflammatory responses and protect against the pathogenesis of severe malaria. Our work showed that sera from patients with AID containing AAb against dsDNA, ssDNA, nuclear antigens (ANA), actin, cardiolipin (aCL) and erythrocyte membrane antigens recognize plasmodial antigens and can, similarly to monoclonal AAb of several specificities including phospholipid, inhibit the growth of P. falciparum in vitro. However, we did not detect a relationship between the presence of anti-glycosylphosphatidylinositol (GPI) antibodies in the serum and asymptomatic malaria infection, although we did register a relationship between these antibodies and parasitemia levels in infected individuals. Taken together, these results indicate that autoimmune responses mediated by AAb of different specificities, including phospholipid, may have anti-plasmodial activity and protect against malaria, although it is not clear whether anti-parasite phospholipid antibodies can mediate the same effect. The potential effect of anti-parasite phospholipid antibodies in malarious patients that are prone to the development of systemic lupus erythematosus or antiphospholipid syndrome, as well as the (possibly protective?) role of the (pathogenic) aPL on the malaria symptomatology and severity in these individuals, remain open questions.

Salinity and temperature variations reflecting on cellular PCNA, IGF-I and II expressions, body growth and muscle cellularity of a freshwater fish larvae.

The present study assessed the influence of salinity and temperature on body growth and on muscle cellularity of Lophiosilurus alexaxdri vitelinic larvae. Slightly salted environments negatively influenced body growth of freshwater fish larvae and we observed that those conditions notably act as an environmental influencer on muscle growth and on local expression of hypertrophia and hypeplasia markers (IGFs and PCNA). Furthermore, we could see that salinity tolerance for NaCl 4gl(-)(1) diminishes with increasing temperature, evidenced by variation in body and muscle growth, and by irregular morphology of the lateral skeletal muscle of larvae. We saw that an increase of both PCNA and autocrine IGF-II are correlated to an increase in fibre numbers and fibre diameter as the temperature increases and salinity diminishes. On the other hand, autocrine IGF-I follows the opposite way to the other biological parameters assessed, increasing as salinity increases and temperature diminishes, showing that this protein did not participate in muscle cellularity, but participating in molecular/cellular repair. Therefore, slightly salted environments may provide adverse conditions that cause some obstacles to somatic growth of this species, suggesting some osmotic expenditure with a salinity increment.

Increasing response rates from physicians in oncology research: a structured literature review and data from a recent physician survey.

Although the physician survey has become an important tool for oncology-focused health services research, such surveys often achieve low response rates. This mini-review reports the results of a structured review of the literature relating to increasing response rates for physician surveys, as well as our own experience from a survey of physicians as to their referral practices for suspected haematologic malignancy in the United States. PubMed and PsychINFO databases were used to identify methodological articles assessing factors that influence response rates for physician surveys; the results were tabulated and reviewed for trends. We also analysed the impact of a follow-up telephone call by a physician investigator to initial non-responders in our own mailed physician survey, comparing the characteristics of those who responded before vs after the call. The systematic review suggested that monetary incentives and paper (vs web or email) surveys increase response rates. In our own survey, follow-up telephone calls increased the response rate from 43.7% to 70.5%, with little discernible difference in the characteristics of early vs later responders. We conclude that in addition to monetary incentives and paper surveys, physician-to-physician follow-up telephone calls are an effective method to increase response rates in oncology-focused physician surveys.

[Anatomy for the bronchologist: a prospective study of the normal endobronchial anatomic variants]. / Anatomia endobrônquica: estudo prospectivo das variações anatómicas da árvore traqueobrônquica.

A comprehensive knowledge of the normal pattern of endobronchial branching is essential to any pulmonologist. The classification systems available are predominantly static descriptions and only seldom do they refer to possible variations within the normal spectrum. To evaluate all possible anatomical variants of the tracheobronchial tree we conducted a prospective study in our endoscopy unit between February, 1st and July, 10th (2009). A total of 181 individuals were included in the study. Anatomical variants were found to be present in 79 individuals (43% of total). Overall we found 20 different anatomical variants. Variations were more frequently found within the right upper lobe (16.6% of individuals). Middle lobe and lingula presented no variations. The variant most frequently found was the presence of a bifurcate pattern of the right upper bronchus (13.8%). The present study revealed a relatively high frequency of anatomical alternatives to the normal endobronchial branching pattern. Recognition of these variants and the frequency of their expression are fundamental for the bronchologist in establishing the limits of normal anatomy and preparing endobronchial techniques or surgical procedures.

Artemether and artesunate show the highest efficacies in rescuing mice with late-stage cerebral malaria and rapidly decrease leukocyte accumulation in the brain.

The murine model of cerebral malaria (ECM) caused by Plasmodium berghei ANKA (PbA) infection in susceptible mice has been extensively used for studies of pathogenesis and identification of potential targets for human CM therapeutics. However, the model has been seldom explored to evaluate adjunctive therapies for this malaria complication. A first step toward this goal is to define a treatment protocol with an effective antimalarial drug able to rescue mice presenting late-stage ECM. We evaluated the efficacy of artemisinin, artemether, artesunate, and quinine given intraperitoneally once a day, and combinations with mefloquine, in suppressing PbA infection in mice with moderate parasitemia. Artemether, artesunate, and quinine were then evaluated for efficacy in rescuing PbA-infected mice with ECM, strictly defined by using objective criteria based on the presentation of clinical signs of neurological involvement, degree of hypothermia, and performance in a set of six motor behavior tests. Artemether at 25 mg/kg presented the fastest parasite killing ability in 24 h and fully avoided recrudescence in a 5-day treatment protocol. Artemether and artesunate were equally effective in rescuing mice with late-stage ECM (46 and 43% survival, respectively), whereas quinine had a poor performance (12.5% survival). Artemether caused a marked decrease in brain leukocyte accumulation 24 h after the first dose. In conclusion, artemether and artesunate are effective in rescuing mice with late-stage ECM and decrease brain inflammation. In addition, the described protocols for more strict clinical evaluation and for rescue treatment provide a framework for studies of CM adjunctive therapies using this mouse model.

Human food choices: an examination of the factors underlying acceptance/rejection of novel and familiar animal and nonanimal foods.

Two studies, aimed at increasing our knowledge of the factors that contribute to acceptance of novel foods were conducted. In Study 1, male and female participants were presented with familiar and novel animal and nonanimal foods and were asked to rate these foods on a variety of measures including: beliefs about the foods, feelings to the thought of ingesting the foods, and willingness to try the foods. Results demonstrated that willingness to try familiar nonanimal foods was predicted by beliefs about the negative sensory properties of the foods and joy elicited by the thought of eating them. Willingness to try familiar animal foods was predicted by beliefs about the sensory properties of the foods and beliefs about the anticipated negative consequences of eating them. Conversely, willingness to try novel foods, of both animal and nonanimal origin was predicted by beliefs about the disgusting properties of these foods and the interest evoked at the thought of consuming them. Study 2 used a qualitatively different sample from that used in Study 1 and perfectly replicated the previous results pertaining to the novel foods. Implications for our understanding of food-related disgust rejections are considered.

Restrained eating among vegetarians: does a vegetarian eating style mask concerns about weight?

The present study explored the relationships among dietary style (ranging from meat eating to veganism), cognitive restraint and feminist values. Two-hundred and twenty-seven participants with varying dietary styles completed the restraint subscale of the Three Factor Eating Questionnaire (TFEQ) and Attitudes Towards Feminism Scale (ATFS). Results indicated that among males, those who are high in cognitive restraint are more likely to exhibit a vegetarian dietary style than those low in cognitive restraint. Among women who are high in feminist values, those with high cognitive restraint are more likely to exhibit a vegetarian dietary style than those with low cognitive restraint, whereas for women low in feminist values those with high and low cognitive restraint are equally likely to exhibit vegetarian and non-vegetarian dietary styles. It is suggested that for some individuals, adoption of a vegetarian dietary style is an attempt to mask their dieting behaviour from others.

"Try it; it's good and it's good for you": effects of taste and nutrition information on willingness to try novel foods.

In an attempt to understand the effects of information on willingness to taste foods, we presented college students with a variety of familiar and novel foods of animal and vegetable origin. Participants received one of four types of information about the foods: none, they tasted good, they were high in vitamins, or they were high in vitamins and might soon be available in the college cafeteria. The information manipulation had no effect on willingness to taste familiar foods. Willingness to taste novel non-animal foods was increased by both taste and vitamin-plus-availability information, while willingness to taste animal foods was not affected by information. Willingness to taste novel foods was also predicted by a measure of trait neophobia. The results suggest that (a) emotional reactions to animal foods may block information effects, and (b) nutrition information is more effective in a context where the food is believed to be available.