Persistent Troponin Elevation in the Setting of an Elevated Rheumatoid Factor: When It Pays to Double Check.

A 78-year-old woman presented twice with high sensitivity troponin I (hs-TnI) elevation. Two cardiac catheterizations showed nonocclusive coronary artery disease, and 2 cardiac magnetic resonance imaging scans were normal. With these investigations unable to explain the troponin I (hs-TnI) elevation, alternate troponin samples were sent to check for assay interference. Results from these troponin assays were low. With the patient having elevated rheumatoid factor as a potential contributor to assay interference, the lab reanalyzed the samples using heterophile antibody blocking tubes, revealing lower hs-TnI levels. This case serves as a reminder to consider assay interference when the clinical picture is inconsistent with ischemia.

Une femme de 78 ans a eu deux fois une hausse de la troponine I à haute sensibilité (TnI hs). Deux cathétérismes cardiaques ont montré une coronaropathie non obstructive, et deux examens d'imagerie cardiaque par résonance magnétique se sont révélés normaux. Devant l'incapacité de ces examens à expliquer la hausse de la troponine I (TnI hs), d'autres échantillons de troponine ont été envoyés pour vérifier les interférences sur le dosage. Les résultats de ces dosages de la troponine étaient faibles. Puisque la présence d'un facteur rhumatoïde élevé chez la patiente a possiblement contribué à l'interférence du dosage, le laboratoire a soumis l'échantillon à une nouvelle analyse au moyen de tubes bloquant les anticorps hétérophiles. Cette dernière analyse a mis en évidence des concentrations plus faibles de TnI hs. Ce cas rappelle de tenir compte de l'interférence du dosage lorsque le tableau clinique n'est pas compatible avec l'ischémie.

Is Paternal Smoking at Conception a Risk for ADHD? A Controlled Study in Youth With and Without ADHD.

Objective: Based on emerging preclinical findings suggesting that paternal smoking at conception may be a risk for ADHD in the offspring, we investigated whether a similar effect can be observed in humans. Method: We analyzed data from an opportunistic dataset of girl probands with (N = 140) and without (N = 122) ADHD with available information on paternal smoking at conception. Data were analyzed using Pearson's chi-square tests and multiple logistic regression. Results: ADHD probands had a significantly higher rate of paternal smoking at conception than controls (35% vs. 23%, χ2 = 3.82, p = .05) with a significant odds ratio of 1.5. However, the association lost significance after controlling for paternal ADHD, most likely due to limited statistical power. Conclusion: While preliminary, findings suggest that paternal smoking at conception may be a risk factor for ADHD in the offspring.

A Comparison of Prenatal Exposures in Children with and without a Diagnosis of Autism Spectrum Disorder.

The current study was a case-control, focused on the presence of environmental exposures during pregnancy in mothers of children diagnosed with autism spectrum disorder (ASD) and children who were not. Exposures investigated included: acetaminophen/paracetamol use, air pollution, fever, smoking, parental age, maternal diabetes, prenatal vitamin use, workplace exposures, recreational drug use, seafood consumption, obesity, and maternal thyroid issues. Two-hundred and fifteen mothers of children (107 with ASD and 108 without ASD) aged 0-10 years participated in a telephone survey regarding prenatal exposures followed by a chart review. Data were analyzed with a series of univariate tests and a multivariate logistic regression. Univariate analyses showed correlation for the presence of siblings with ASD, presence of family members with ASD, maternal use of medications and maternal smoking during pregnancy; and child's gestational age at the start of prenatal vitamins with a diagnosis of ASD. Multivariate logistic regression analysis demonstrated an association with the use of medications (although specific medications could not be delineated due to small sample size), smoking, and gestational age at the start of prenatal vitamins. These preliminary results suggest that certain prenatal exposures (medication use, smoking, and gestational age at the start of prenatal vitamins) may be associated with a later diagnosis of ASD. Future research should be conducted with larger sample sizes and control for potentially confounding factors. Working towards an understanding of factors that come together to create or prevent a diagnosis of autism will be helpful for families, physicians, and allocating government resources.

Marijuana Lollipop-Induced Myocardial Infarction.

A 70-year-old man with known coronary artery disease presented with crushing chest pain, diaphoresis, and pallor after consuming a marijuana lollipop; the pain began within 30 minutes of consumption. His troponin T increased from 94 ng/L to 216 ng/L, with slight ST changes but no gross ST elevations. Discharge diagnosis was non-ST-elevation myocardial infarction, and subsequent nuclear medicine wall motion studies showed worsening ejection fraction (40% to 31%). He also described worsening functional status and exercise capacity after the event. The outcome of this case is important with new marijuana legalization-hopefully with marijuana use no longer criminalized, more research into the cardiovascular side effects will emerge.

Towards operationalising internal distractibility (Mind Wandering) in adults with ADHD.

OBJECTIVE: To investigate whether specific symptoms of attention deficit hyperactivity disorder (ADHD) can help identify ADHD patients with mind wandering. METHODS: Subjects were adults ages 18-55 of both sexes (n=41) who completed the Mind-Wandering Questionnaire (MWQ) and the ADHD module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children Epidemiologic Version. We used Spearman's rank correlation and Pearson's χ2 analyses to examine associations between the ADHD module and the MWQ and receiver operator characteristic (ROC) analyses to evaluate the diagnostic efficiency of the ADHD module. RESULTS: Out of the three ADHD domains, the inattentive ADHD scores had the strongest association with the MWQ (total: r s=0.34, df=39, p=0.03; inattentive: r s=0.38, df=39, p=0.02; Hyperactive: r s=0.17, df=39, p=0.28). Correlation analyses between individual items on the ADHD module and the MWQ showed that two inattention items ('failure to pay attention to detail' and 'trouble following instructions') were positively associated with total scores on the MWQ (p=0.02). These two inattention items had the strongest association with the MWQ (r s=0.45, df=38, p=0.004). ROC analyses showed that the combined score of the two significant inattention items had the highest efficiency (AUC=0.71) in classifying high-level mind wanderers as defined by scores greater than the median split on the MWQ. The combined score of the two inattention items best identified high-level mind wanderers. CONCLUSION: Results suggest a way to operationalise mind wandering using the symptoms of ADHD.

A Pilot Study: Cardiac Parameters in Children Receiving New-Generation Antidepressants.

OBJECTIVE: Because of concerns about potential associations between high doses of citalopram and QTc prolongation in adults, this study examined whether such associations are operant in children. We hypothesized that therapeutic doses of nontricyclic antidepressant medications (non-TCAs) prescribed to children would be cardiovascularly safe. STUDY DESIGN: The sample consisted of 49 psychiatrically referred children and adolescents 6 to 17 years old of both sexes treated with a non-TCA (citalopram, escitalopram, fluoxetine, paroxetine, sertraline, bupropion, duloxetine, venlafaxine, mirtazapine). To standardize the doses of different antidepressants, we converted doses of individual medicines into "citalopram equivalent doses" (CEDs) based on dosing recommendation for individual antidepressants. Correlation analysis was carried out to compare the continuous and weight-based CED to variables of interest. A QTc grouping was defined as normal, borderline, or abnormal, and CED was compared across QTc groupings using linear regression. An antidepressant dosage group was defined as low or high dose, and a t test compared variables of interest across dosage groups. RESULTS: No significant associations were found between total or weight-corrected CEDs of any antidepressant examined and QTc or any other electrocardiogram or blood pressure parameters. In patients taking citalopram or escitalopram, a significant correlation was found between PR interval and total daily dose, which disappeared when weight-based doses were used or when corrected by age. CONCLUSIONS: Although limited by a relatively small sample size, these results suggest that therapeutic doses of non-TCA antidepressants when used in children do not seem to be associated with prolonged QTc interval or other adverse cardiovascular effects.