scholarly journals But I Need Marijuana to Function as a Mother!

2019 ◽  
pp. 190-215
Author(s):  
Sasikanth Gorantla ◽  
Madeleine Grigg-Damberger
Keyword(s):  
Substance Abuse ◽  
False Negative ◽  
Recreational Drugs ◽  
Sleep Logs ◽  
Urine Drug ◽  
Adolescents And Adults ◽  
History Of ◽  
Multiple Sleep Latency ◽  
Multiple Sleep Latency Testing

Polysomnography and multiple sleep latency testing (MSLT), along with detailed history and sleep logs and actigraphy, are essential for the diagnosis of narcolepsy with cataplexy (narcolepsy type 1). Interpreting polysomnography and MSLT data is challenging in patients with substance abuse. This chapter presents the case of a young woman with a history of substance abuse and confounding MSLT results due to covert use of recreational drugs. Recreational drugs affect sleep architecture, and the results of urine drug screening become a critical part of diagnostic evaluation in patients with substance abuse. Patients undergoing MSLT to characterize and confirm central hypersomnia need proper preparation to reduce false-positive, false-negative, and confounding results. Unexpected positive urine toxicology results are common in adolescents and adults undergoing MSLT and maintenance of wakefulness testing.

scholarly journals Addiction and Pain Medicine

2005 ◽  
Vol 10 (suppl a) ◽  
pp. 38A-43A ◽  
Author(s):  
Douglas Gourlay
Keyword(s):  
Substance Abuse ◽  
Health Care Professionals ◽  
Drug Testing ◽  
Abuse Liability ◽  
Cannabis Use ◽  
Increased Risk ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
History Of ◽  
Administration Methods

The adequate cotreatment of chronic pain and addiction disorders is a complex and challenging problem for health care professionals. There is great potential for cannabinoids in the treatment of pain; however, the increasing prevalence of recreational cannabis use has led to a considerable increase in the number of people seeking treatment for cannabis use disorders. Evidence that cannabis abuse liability is higher than previously thought suggests that individuals with a history of substance abuse may be at an increased risk after taking cannabinoids, even for medicinal purposes. Smoked cannabis is significantly more reinforcing than other cannabinoid administration methods. In addition, it is clear that the smoked route of cannabis delivery is associated with a number of adverse health consequences. Thus, there is a need for pharmaceutical-grade products of known purity and concentration using delivery systems optimized for safety. Another factor that needs to be considered when assessing the practicality of prescribing medicinal cannabinoids is the difficulty in differentiating illicit from prescribed cannabinoids in urine drug testing. Overall, a thorough assessment of the risk/benefit profile of cannabinoids as they relate to a patient’s substance abuse history is suggested.

scholarly journals 1232 Improvement in Excessive Daytime Sleepiness in Two Narcoleptic Patients on Oral Contraceptives

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A470-A470
Author(s):  
Maria Macias ◽  
Suprya Singh ◽  
Amee Patel
Keyword(s):  
Oral Contraceptives ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Onset ◽  
Sleep Onset Latency ◽  
Chronic Disorder ◽  
The Face ◽  
History Of ◽  
Multiple Sleep Latency

Abstract Introduction Narcolepsy is a chronic disorder characterized by excessive daytime sleepiness (EDS). We present two patients with narcolepsy with improvement in symptoms with the use of oral contraceptives. Report of Case Patient A is a 15-year-old female with a family history of narcolepsy who presents with excessive daytime sleepiness and cataplexic episodes (eye twitching, abnormal sensations of the face, drop attacks). Her pediatric daytime sleepiness scale score (PDSS) was 29. The polysomnography (PSG) did not record sleep disordered breathing. Multiple sleep latency test (MSLT) recorded 4 out 4 sleep onset rapid eye movement period (SOREMPS) and mean sleep onset latency (SOL) of 6.2 minutes. She was diagnosed with Narcolepsy Type 1 and started on stimulants as family was not interested in Xyrem. Over two years, her PDSS the doses of the stimulants were increased due to significant daytime sleepiness. Caregiver was not interested in Xyrem. Patient demonstrated increased sleepiness during menstrual cycles. She was treated with OCPs for menorrhagia. Her EDS improved, PDSS decreased from an average of 24.5 to 17.5 and the dose of the stimulants was decreased. Patient B is an 11-year-old female with excessive daytime sleepiness and fragmented sleep with multiple awakenings. She took frequent naps during the day. Her PDSS was 29. The PSG showed mild OSA and the MSLT recorded 3 out of 4 SOREMPS and SOL was less than 1 minute. She was diagnosed with Narcolepsy Type 2. During her treatment course, several medication regimens were trialed but were not effective including stimulants, Modafinil, and Armodafinil. Caregiver was not interested in Xyrem. At the age of 13 years, she started OCPs for dysmenorrhea. Her EDS improved and PDSS decreased from an average of 29 to 16.75. Conclusion We present two patients with narcolepsy who continued to have EDS in spite of treatment with wake promoting agents and daytime naps. Their EDS and PDSS improved after initiating OCP therapy Pubertal changes may have a significant influence on narcolepsy patients. The use of OCPs may be beneficial in conjunction to wake promoting agents.

LUNGRADS AND UPDATE OF LUNG NODULES SCREENING BY LOW DOSE COMPUTED TOMOGRAPHY

2015 ◽  
pp. 12-19
Author(s):  
Thi Ngoc Ha Hoang ◽  
Trong Khoan Le
Keyword(s):  
Lung Cancer ◽  
Low Dose ◽  
False Negative ◽  
Lung Nodule ◽  
Lung Cancer Mortality ◽  
Smoking History ◽  
Low Dose Ct ◽  
History Of ◽  
Chest X Ray ◽  
Low Dose Computed Tomography

Background: A pulmonary nodule is defined as a rounded or irregular opacity, well or poorly defined, measuring up to 3 cm in diameter. Early detection the malignancy of nodules has a significant role in decreasing the mortality, increasing the survival time and consider as early diagnosis lung cancer. The main risk factors are those of current or former smokers, aged 55 to 74 years with a smoking history of at least 1 pack-day. Low dose CT: screening individuals with high risk of lung cancer by low dose CT scans could reduce lung cancer mortality by 20 percent compared to chest X-ray. Radiation dose has to maximum reduced but respect the rule of ALARA (As Low as Resonably Archivable). LungRADS 2014: Classification of American College of Radiology, LungRADS, is a newly application but showed many advantages in comparison with others classification such as increasing positive predict value (PPV), no result of false negative and cost effectiveness. Key words: LungRADS, screening lung nodule, low dose CT, lung cancer

scholarly journals No evidence of false-negative Plasmodium falciparum rapid diagnostic results in Monrovia, Liberia

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mandella King ◽  
Alexander E. George ◽  
Pau Cisteró ◽  
Christine K. Tarr-Attia ◽  
Beatriz Arregui ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
False Negative ◽  
Malaria Diagnosis ◽  
Rapid Diagnostic Tests ◽  
Molecular Testing ◽  
False Negatives ◽  
Gene Deletions ◽  
History Of ◽  
Catholic Hospital ◽  
Or History

Abstract Background Malaria diagnosis in many malaria-endemic countries relies mainly on the use of rapid diagnostic tests (RDTs). The majority of commercial RDTs used in Africa detect the Plasmodium falciparum histidine-rich protein 2 (PfHRP2). pfhrp2/3 gene deletions can therefore lead to false-negative RDT results. This study aimed to evaluate the frequency of PCR-confirmed, false-negative P. falciparum RDT results in Monrovia, Liberia. Methods PfHRP2-based RDT (Paracheck Pf®) and microscopy results from 1038 individuals with fever or history of fever (n = 951) and pregnant women at first antenatal care (ANC) visit (n = 87) enrolled in the Saint Joseph’s Catholic Hospital (Monrovia) from March to July 2019 were used to assess the frequency of false-negative RDT results. True–false negatives were confirmed by detecting the presence of P. falciparum DNA by quantitative PCR in samples from individuals with discrepant RDT and microscopy results. Samples that were positive by 18S rRNA qPCR but negative by PfHRP2-RDT were subjected to multiplex qPCR assay for detection of pfhrp2 and pfhrp3. Results One-hundred and eighty-six (19.6%) and 200 (21.0%) of the 951 febrile participants had a P. falciparum-positive result by RDT and microscopy, respectively. Positivity rate increased with age and the reporting of joint pain, chills and shivers, vomiting and weakness, and decreased with the presence of coughs and nausea. The positivity rate at first ANC visit was 5.7% (n = 5) and 8% (n = 7) by RDT and microscopy, respectively. Out of 207 Plasmodium infections detected by microscopy, 22 (11%) were negative by RDT. qPCR confirmed absence of P. falciparum DNA in the 16 RDT-negative but microscopy-positive samples which were available for molecular testing. Among the 14 samples that were positive by qPCR but negative by RDT and microscopy, 3 only amplified pfldh, and among these 3 all were positive for pfhrp2 and pfhrp3. Conclusion There is no qPCR-confirmed evidence of false-negative RDT results due to pfhrp2/pfhrp3 deletions in this study conducted in Monrovia (Liberia). This indicates that these deletions are not expected to affect the performance of PfHRP2-based RDTs for the diagnosis of malaria in Liberia. Nevertheless, active surveillance for the emergence of PfHRP2 deletions is required.

scholarly journals Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Huiying Wu ◽  
Ning Zhou ◽  
Lianwei Lu ◽  
Xiwen Chen ◽  
Tao Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Predictive Value ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Left Portal Vein ◽  
History Of ◽  
Associated Malformations ◽  
Sensitivity Specificity

Abstract Background Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO. Results We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1–4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6–10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively. Conclusions Among the four types of Rex recesses on CT angiography, types 1–3 allow for the performance of MRB.

scholarly journals Informal psychiatric patients requesting discharge

1994 ◽  
Vol 18 (4) ◽  
pp. 209-211
Author(s):  
Robin McGilp ◽  
Brian Kidd ◽  
Cameron Stark ◽  
Tom Henderson
Keyword(s):  
Substance Abuse ◽  
Psychiatric Patients ◽  
Medical Advice ◽  
Psychotic Illness ◽  
Against Medical Advice ◽  
The Past ◽  
History Of ◽  
Self Harm ◽  
Discharge Against Medical Advice ◽  
Retrospective Investigation

A retrospective investigation of case-notes compared 54 incidents of informal psychiatric in-patients being detained in hospital on an emergency basis with 66 incidents of discharge against medical advice (AMA). The characteristics of the two groups were compared. Detained patients were more likely to have been detained previously, to be suffering from a psychotic illness, and to have threats of violence or self-harm mentioned in their case-notes. AMA patients were more likely to have a history of substance abuse but were no more likely than the detained group to have been discharged AMA in the past. The results suggest that psychiatrists in this hospital are using current legislation on detention appropriately.

scholarly journals EXPRESS: Pulmonary Hypertension Associated With Neurofibromatosis Type 2

2021 ◽  
pp. 204589402110295
Author(s):  
Hirohisa Taniguchi ◽  
Tomoya Takashima ◽  
Ly Tu ◽  
Raphaël Thuillet ◽  
Asuka Furukawa ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Neurofibromatosis Type ◽  
Pulmonary Vascular Remodeling ◽  
Life Threatening ◽  
History Of ◽  
Pulmonary Arterial ◽  
First Time

Although precapillary pulmonary hypertension (PH) is a rare but severe complication of patients with neurofibromatosis type 1 (NF1), its association with NF2 remains unknown. Herein, we report a case of a 44-year-old woman who was initially diagnosed with idiopathic pulmonary arterial hypertension (IPAH) and treated with PAH-specific combination therapy. However, a careful assessment for a relevant family history of the disease and genetic testing reveal that this patient had a mutation in the NF2 gene. Using immunofluorescence and Western blotting, we demonstrated a decrease in endothelial NF2 protein in lungs from IPAH patients compared to control lungs, suggesting a potential role of NF2 in PAH development. To our knowledge, this is the first time that precapillary PH has been described in a patient with NF2. The altered endothelial NF2 expression pattern in PAH lungs should stimulate work to better understand how NF2 is contributing to the pulmonary vascular remodeling associated to these severe life-threatening conditions.

scholarly journals Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002099
Author(s):  
Yuji Komorita ◽  
Masae Minami ◽  
Yasutaka Maeda ◽  
Rie Yoshioka ◽  
Toshiaki Ohkuma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Bone Fracture ◽  
Severe Hypoglycemia ◽  
Japanese Patients ◽  
Anatomic Site ◽  
Cross Sectional ◽  
History Of

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

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