scholarly journals 1239 Mind Blown: Exploding Head Syndrome as a Side Effect of Marijuana

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A472-A473
Author(s):  
Christopher Missak ◽  
Jenie George ◽  
Indira Gurubhagavatula
Keyword(s):  
Case Reports ◽  
Neuropsychiatric Symptoms ◽  
Epileptiform Activity ◽  
Temporal Correlation ◽  
Marijuana Use ◽  
The United States ◽  
Apnea Hypopnea Index ◽  
Previously Treated ◽  
Work Up ◽  
Smoking Marijuana

Abstract Introduction Marijuana use is increasing the United States and has been associated with increased sensory perception, euphoria, and altered cognition. Exploding head syndrome is a parasomnia characterized by loud explosion-like noises occurring prior to or during sleep. This the first report to link marijuana use with the occurrence of EHS. Report of Case A 45-year-old man with depression, anxiety and multisubstance abuse reported two years of neuropsychiatric symptoms including: “fireworks going off in my brain,” visual hallucinations, and sudden arousals characterized by panic and vertigo. He reported bouts of occupational stress and severe anxiety previously treated with clonazepam for six months, but discontinued it due to poor clinical response. Normal findings were reported on a previous work-up including: MRI, EEG, and head CT Scan. During his visit, he reported that he had been smoking marijuana three times a day for 24 years. One month prior to his visit he discontinued marijuana, stopped clonazepam, and started using mirtazapine with improvement in all aforementioned symptoms. During the same month, he relapsed and smoked marijuana once with a sudden return of all previously described symptoms on the night following its use. These symptoms then resolved and did not recur again until 9 months later, after another episode of weekend marijuana use. An in-lab polysomnogram revealed an apnea-hypopnea index 2.2 per hour, increased alpha intrusion throughout the study, and no epileptiform activity. No parasomnias were observed during rapid-eye-movement (REM) or non-REM sleep. Conclusion The etiology of EHS remains elusive. A review of the research has proposed five major theories and case reports suggest a complex etiology. Given the temporal correlation with marijuana use and symptom resolution with its cessation, we presume that EHS resulted from a complex interplay between neurons susceptible to cannabinoids and their derivatives.

458 The effect of cardioversion therapy for atrial fibrillation on AHI in obstructive sleep apnea patients

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A181-A181
Author(s):  
Nardine Zakhary ◽  
Reena Mehra ◽  
Ken Monahan ◽  
Jayakumar Sahadevan ◽  
Anna May
Keyword(s):  
Atrial Fibrillation ◽  
Sleep Apnea ◽  
Case Reports ◽  
The United States ◽  
Sign Test ◽  
Apnea Hypopnea Index ◽  
Small Series ◽  
Obstructive Sleep ◽  
Before And After ◽  
Mean Pressure

Abstract Introduction Sleep apnea (SA) is known to be associated with development of atrial fibrillation (AF), and therapy ameliorates this risk. Case reports and small series raise the possibility of a bidirectional effect of AF on SA burden. We hypothesize that SA control, demonstrated either by residual apnea-hypopnea index (AHI) or pressure during positive airway pressure (PAP) therapy, improves after successful cardioversion. Methods The cohort included VA patients with SA on PAP therapy who underwent successful outpatient direct-current AF cardioversion. Only patients with good adherence in the peri-procedural period, defined as use most days in the week before and after procedure, were included in the study (n=17). We compared AHI prior to and after cardioversion using the sign test since values were not normally distributed. Since most participants were on auto-titrating PAP, the sign test was also used to compare mean pressure difference in the 7 days before and after the procedure. Results There was no statistical difference when comparing AHI before and after AF cardioversion therapy (AHI change = -0.45, 95% CI = [-0.94, 0.17]) There was also no difference between mean pressure used for PAP therapy before and after therapy (pressure change = 0.05, 95% CI = [-0.1, 0.33]). Conclusion This small study did not find an association between successful AF cardioversion and PAP residual AHI or pressure (for auto-titrating machines). A larger cohort may have improved power to detect subtle effects of AF therapy on SA burden. Support (if any) This study was supported by the Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service.

Thoracic Sarcoidosis Mimicking Metastatic Testicular Cancer: Three Case Reports

2007 ◽  
Vol 1 ◽  
pp. CMO.S403
Author(s):  
Joel R. Gingerich ◽  
Piotr M. Czaykowski ◽  
Ralph P. Wong ◽  
Andrew W. Maksymiuk
Keyword(s):  
Testicular Cancer ◽  
Case Reports ◽  
Pulmonary Nodules ◽  
Chest Imaging ◽  
Radiographic Evidence ◽  
Testicular Tumors ◽  
Young Males ◽  
Previously Treated ◽  
Work Up ◽  
Metastatic Testicular Cancer

Recurrence of testicular tumors in young males generally prompts rapid investigation and treatment. We report 3 patients with past histories of treated testicular cancer referred with radiographic evidence suggestive of intrathoracic metastases. In each case chest imaging demonstrated mediastinal/hilar lymphadenopathy. In one case pulmonary nodules were also identified. In all three patients further work-up revealed non-caseating granulomas consistent with sarcoidosis. All patients have since been followed and remain free of testicular cancer. No patient has required therapy for sarcoidosis. Although rare, new intra-thoracic lymphadenopathy in previously treated testicular cancer patients can represent sarcoidosis. Tissue diagnosis is essential when the clinical picture remains unclear.

scholarly journals Osteopathic empirical research: a bibliometric analysis from 1966 to 2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chantal Morin ◽  
Isabelle Gaboury
Keyword(s):  
Bibliometric Analysis ◽  
Empirical Research ◽  
Scientific Literature ◽  
Case Reports ◽  
Empirical Studies ◽  
Body Part ◽  
The United States ◽  
Mesh Terms ◽  
Research Designs ◽  
System Body

Abstract Background Despite the increasing use of osteopathy, a manipulative complementary and alternative medicine therapy, in the general population, its efficacy continues to be debated. In this era of evidence-based practice, no studies have previously reviewed the scientific literature in the field to identify published knowledge, trends and gaps in empirical research. The aims of this bibliometric analysis are to describe characteristics of articles published on the efficacy of osteopathic interventions and to provide an overall portrait of their impacts in the scientific literature. Methods A bibliometric analysis approach was used. Articles were identified with searches using a combination of relevant MeSH terms and indexing keywords about osteopathy and research designs in MEDLINE and CINAHL databases. The following indicators were extracted: country of primary author, year of publication, journals, impact factor of the journal, number of citations, research design, participants’ age group, system/body part addressed, primary outcome, indexing keywords and types of techniques. Results A total of 389 articles met the inclusion criteria. The number of empirical studies doubled every 5 years, with the United States, Italy, Spain, and United Kingdom being the most productive countries. Twenty-three articles were cited over 100 times. Articles were published in 103 different indexed journals, but more than half (53.7%) of articles were published in one of three osteopathy-focused readership journals. Randomized control trials (n = 145; 37.3%) and case reports (n = 142; 36.5%) were the most common research designs. A total of 187 (48.1%) studies examined the effects of osteopathic interventions using a combination of techniques that belonged to two or all of the classic fields of osteopathic interventions (musculoskeletal, cranial, and visceral). Conclusion The number of osteopathy empirical studies increased significantly from 1980 to 2014. The productivity appears to be very much in sync with practice development and innovations; however, the articles were mainly published in osteopathic journals targeting a limited, disciplinary-focused readership.

scholarly journals Exertional Heat Stroke Knowledge and Management among Emergency Medical Service Providers

2021 ◽  
Vol 18 (9) ◽  
pp. 5016
Author(s):  
Rebecca Hirschhorn ◽  
Oluwagbemiga DadeMatthews ◽  
JoEllen Sefton
Keyword(s):  
Service Providers ◽  
Heat Stroke ◽  
The United States ◽  
Knowledge Assessment ◽  
Years Of Experience ◽  
Exertional Heat Stroke ◽  
Emergency Medical ◽  
Previously Treated ◽  
Stroke Knowledge ◽  
Cooling Methods

This study evaluated emergency medical services (EMS) providers’ knowledge of exertional heat stroke (EHS) and assessed current EMS capabilities for recognizing and managing EHS. EMS providers currently practicing in the United States were recruited to complete a 25-item questionnaire. There were 216 questionnaire responses (183 complete) representing 28 states. On average, respondents were 42.0 ± 13.0 years old, male (n = 163, 75.5%), and white (n = 176, 81.5%). Most respondents were Paramedics (n = 110, 50.9%) and had ≥16 years of experience (n = 109/214, 50.9%) working in EMS. Fifty-five percent (n = 99/180) of respondents had previously treated a patient with EHS. The average number of correct answers on the knowledge assessment was 2.6 ± 1.2 out of 7 (~37% correct). Temporal (n = 79), tympanic (n = 76), and oral (n = 68) thermometers were the most prevalent methods of temperature assessment available. Chemical cold packs (n = 164) and air conditioning (n = 134) were the most prevalent cooling methods available. Respondents demonstrated poor knowledge regarding EHS despite years of experience, and over half stating they had previously treated EHS in the field. Few EMS providers reported having access to an appropriate method of assessing or cooling a patient with EHS. Updated, evidence-based training needs to be provided and stakeholders should ensure their EMS providers have access to appropriate equipment.

scholarly journals 354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S246-S246
Author(s):  
Kevin O’Laughlin ◽  
Jennifer R Cope ◽  
Zachary A Marsh
Keyword(s):  
United States ◽  
Case Reports ◽  
The United States ◽  
Severe Illness ◽  
People Living With Hiv ◽  
Cutaneous Lesions ◽  
Free Living ◽  
Organ Systems ◽  
Free Living Ameba ◽  
Soil And Water

Abstract Background Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States. Methods CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies. Results We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively. Conclusion Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment. Disclosures All Authors: No reported disclosures

Aflatoxin B1: Its Role in the Etiology of Reye's Syndrome

PEDIATRICS ◽  
1979 ◽  
Vol 64 (1) ◽  
pp. 71-75 ◽  
Author(s):  
Nell J. Ryan ◽  
Gwendolyn R. Hogan ◽  
A. Wallace Hayes ◽  
Peter D. Unger ◽  
Mohamed V. Siraj
Keyword(s):  
United States ◽  
Acute Phase ◽  
Aflatoxin B1 ◽  
Case Reports ◽  
The United States ◽  
Reye's Syndrome ◽  
Autopsy Specimens

Seven cases of Reye's syndrome in which aflatoxin B1 was isolated from the blood or liver or both are presented. In two cases aflatoxin B1 was found in the blood during the acute phase of the disease; a finding not previously reported. In six cases aflatoxin B1 was recovered from autopsy specimens of liver. A number of case reports linking aflatoxin B1 to Reye's syndrome have appeared in the literature but until now only one case has been reported from the United States. Aflatoxin B1 and its possible role in the etiology of Reye's syndrome is discussed. It is concluded that Reye's syndrome is the result of multiple interrelated factors.

Examining Impacts of COVID-19-Related Stay-At-Home Orders through a Two-Way Random Effects Model

2021 ◽  
pp. 036119812110469
Author(s):  
Anshu Bamney ◽  
Hisham Jashami ◽  
Sarvani Sonduru Pantangi ◽  
Jayson Ambabo ◽  
Megat-Usamah Megat-Johari ◽  
...  
Keyword(s):  
Random Effects ◽  
Local Governments ◽  
Case Reports ◽  
Health And Safety ◽  
The United States ◽  
Preliminary Evidence ◽  
Random Effects Model ◽  
Public Health And Safety ◽  
Over Time ◽  
At Home

The COVID-19 pandemic has had far-reaching impacts on public health and safety, economics, and the transportation system. To reduce the spread of this disease, federal and local governments around the world have introduced stay-at-home orders and other restrictions on travel to “non-essential” businesses to implement social distancing. Preliminary evidence suggests substantial variability in the impacts of these orders in the United States, both across states and over time. This study examines this issue using daily county-level vehicle miles traveled (VMT) data for the 48 continental U.S. states and the District of Columbia. A two-way random effects model is estimated to assess changes in VMT from March 1 to June 30, 2020 as compared with baseline January travel levels. The implementation of stay-at-home orders was associated with a 56.4 percent reduction in VMT on average. However, this effect was shown to dissipate over time, which may be attributable to “quarantine fatigue.” In the absence of full shelter-in-place orders, travel was also reduced where restrictions on select businesses were introduced. For example, restrictions on entertainment, indoor dining, and indoor recreational activities corresponded to reductions in VMT of 3 to 4 percent while restrictions on retail and personal care facilities showed 13 percent lower traffic levels. VMT was also shown to vary based on the number of COVID case reports, as well as with respect to other characteristics, including median household income, political leanings, and how rural the county was in nature.

Personal Experience

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 906-906
Author(s):  
RICHARD H. SCHWARTZ
Keyword(s):  
Young People ◽  
Drug Use ◽  
Personal Experience ◽  
Marijuana Use ◽  
Medical Community ◽  
Documented Information ◽  
The Many ◽  
Smoking Marijuana

I am pleased that Milman and Bennett continue to research and publicize the problems that frequent marijuana use by young people can cause. I am grateful to Dr Milman for her ceaseless efforts to educate the medical community about the many dangers to humans of all ages of smoking marijuana. As one who suffered greatly as a result of believing widely publicized but poorly documented information regarding the innocence of using cannabis, I hope that others will also be enlightened by Milman's findings, and by my own, showing the dangers of drug use by adolescents and the pain that such use can cause.

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