Marijuana’s Changing Legal Landscape and Its Implications for Adolescent Psychiatrists: A Report from California

2021 ◽  
Vol 11 ◽  
Author(s):  
Lynn Ponton ◽  
Samuel L. Judice ◽  
Theodore Petti
Keyword(s):  
Mental Health Professionals ◽  
Clinical Training ◽  
Case Reports ◽  
District Of Columbia ◽  
Potential Harm ◽  
Clinical Observations ◽  
Regulatory Guidelines ◽  
Practice Review ◽  
Case Presentations ◽  
Recreational Use

Background Objectives: Thirty-three states and the District of Columbia (DC) have enacted some form of legalized cannabis or cannabinoid for medical conditions (MMJ), 11 of them and DC for recreational use. It has become critical for psychiatrists and other mental health professionals working with adolescents to be aware of diversion of marijuana (MJ) to youth and subsequent potential adverse effects in environments with widely different regulations. The experience of two office-based psychiatrists in California (the first state to legalize MMJ) through case presentations and an informal practice review illustrate the role that diverted MMJ plays in the clinical presentation of youth for psychiatric care, highlighting clinical implications and guidelines for treators as states legalize MJ for adult recreational use. Methods: Two child and adolescent psychiatrists practicing in California over the last twenty years report on their experiences working with adolescent patients and their families during the period of legalized MMJ. After a comprehensive literature review, they report their clinical observations and make recommendations for treators of adolescents. Discussion: There is general confusion among adolescents and their parents about MJ and MMJ. There is a lack of clear regulatory guidelines and a need for better clinical training for prescribing physicians. Diversion of MMJ to teens during periods of legalization of medical marijuana is common in states where it has been not legislated or regulated sufficiently to provide effective safeguards. This lax approach is demonstrated by our case reports and clinical review. Similar experiences have been reported elsewhere. Increased problems with diversion are expected as legalization efforts continue. Professionals and their organizations need to become more active in advocating policies to protect youth from potential harm related to cannabis use and abuse and carefully evaluate its use among their teen patients.

scholarly journals Newly detected rapid eye movement associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Andreas Rembert Koczulla ◽  
Antje Stegemann ◽  
Rainer Gloeckl ◽  
Sandra Winterkamp ◽  
Bernd Sczepanski ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Eye Movement ◽  
Case Reports ◽  
White Male ◽  
Chronic Fatigue ◽  
White Female ◽  
Rapid Eye Movement ◽  
Pressure Therapy ◽  
Fatigue Syndrome ◽  
Case Presentations

Abstract Background Coronavirus disease 2019 has become a health problem spreading worldwide with pandemic characteristics since March 2020. Post coronavirus disease 2019 symptoms are more frequent than initially expected, with fatigue as an often-mentioned issue. Case presentations We describe a 32-year-old white male and a 55-year-old white female who suffered from post coronavirus disease 2019 fatigue syndrome. On polysomnography, rapid eye movement associated sleep apnea with an increased hypopnea index during rapid eye movement phases of 36.8 and 19.5 events per hour was found. Based on the patients’ burdensome fatigue symptoms, we initiated automatic positive airway pressure therapy, which diminished sleep apnea (rapid eye movement index: 0.0 in both patients) and, consequently, also the fatigue symptoms. Conclusions Since sleep apnea and coronavirus disease 2019 are both associated with fatigue, a screening for sleep apnea might be considered in coronavirus disease 2019 patients with fatigue syndrome.

Mycoplasma pneumoniae Meningoencephalitis and Transverse Myelitis in Association with Low Cerebrospinal Fluid Glucose

PEDIATRICS ◽  
1976 ◽  
Vol 58 (1) ◽  
pp. 133-135
Author(s):  
Joseph J. Klimek ◽  
Barry S. Russman ◽  
Richard Quintiliani
Keyword(s):  
Cerebrospinal Fluid ◽  
Mycoplasma Pneumoniae ◽  
Case Reports ◽  
Transverse Myelitis ◽  
Serum Samples ◽  
Clinical Observations ◽  
Central Nervous System Dysfunction ◽  
Serial Serum ◽  
Serological Data ◽  
Etiologic Relationship

Awareness of the neurologic complications of Mycoplasma pneumoniae is increasing as is indicated by two recent review articles on this subject1,2 and by the appearance of more frequent isolated case reports on the same subject.3-6 The association of M. pneumoniae with central nervous system dysfunction has been based mainly on clinical observations and serological data from serial serum samples. Direct evidence of an etiologic relationship is still lacking, for attempts at isolation of this organism from the cerebrospinal fluid (CSF) of brain tissue have been uniformly unsuccessful. In fact, most of the serological support for this association has been established from serum samples rather than from studies of the CSF.

scholarly journals 130 Temporal Lobe Epilepsy: Is It in Your Differential Diagnosis? Two Case Reports

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 282-282
Author(s):  
Debra K Avery ◽  
Julie Brann D. Min.
Keyword(s):  
Differential Diagnosis ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mental Health Professionals ◽  
Psychiatric Care ◽  
Negative Impact ◽  
Case Reports ◽  
Adult Population ◽  
The Other ◽  
Post Traumatic Stress

Abstract:Temporal Lobe Epilepsy:Is it in your differential diagnosis? Two Case ReportsObjective:Temporal Lobe Epilepsy (TLE), also referred as Complex Partial Seizures, is a medical diagnosis that must be considered in the pediatric, adolescent, and adult population presenting for psychiatric care. Mood disorders are common in people with epilepsy, with a prevalence rate of 20 to 50%. Scant literature exists that seeks specifically to enhance our knowledge of the similarities and subtle differences between TLE, Bipolar Disorder (BD) and Post Traumatic Stress Disorder (PTSD). Our objective is to describe an adolescent and adult case; one initially diagnosed as BD, the other PTSD, when in fact, it was TLE. We aim to illustrate that misdiagnosis and failure to diagnose are common. The provider must engage in a thorough review of systems and consider TLE in the differential diagnosis. A delay in the appropriate diagnosis and treatment can lead to a substantial amount of adverse effects and worsening of symptoms and negatively impact one’s quality of life.Method:Two case studies; an adolescent and one adult, diagnosed with BD and the other PTSD. Both endorsed a history of symptoms indicative of TLE. Key assessment findings and screening diagnostics alerted us to the differential diagnosis of TLE. The overlap of the symptom presentation is described.Results:TLE and many psychiatric conditions often present with overlapping symptoms. Patients have the potential to present with absence seizures, unprovoked irritability, oppositionality, aggression, anger, paroxysmal anxiety, somatic symptoms such as headaches, nausea, burning in the abdomen, stereotyped movements or behaviors, hypergraphia bizarre or incongruous affect, symptoms of fear, disturbed sleep, tearfulness, memory problems, déjà vu, fugue states, changes in cognition, inability to concentrate, fatigue, auditory and visual hallucination and bad temper.Our differential diagnosis of TLE was confirmed with electroencephalogram (EEG). By prescribing the appropriate medications to these two individuals, they were able to experience improved moods, become more productive in society, working, attending church, family outings, etc. They were weaned off their antipsychotic medications, of which an abundance of troubling side effects is now a non-issue.Conclusions:A delay in the proper diagnosis of TLE can have a significant negative impact on the adolescent and adult population. A need exists to educate mental health professionals on the overlap of symptoms of TLE and psychiatric disorders. The significant issue at hand is that they may not be receiving adequate or appropriate medications. Considering TLE in the differential diagnosis of presenting mood instability ensures our patients they are getting the basics of psychiatric care; which always emphasizes ruling out medical conditions first.

scholarly journals Lack of Accredited Clinical Training in Movement Disorders in Europe, Egypt, and Tunisia

2020 ◽  
Vol 10 (4) ◽  
pp. 1833-1843
Author(s):  
Gertrúd Tamás ◽  
Margherita Fabbri ◽  
Cristian Falup-Pecurariu ◽  
Tiago Teodoro ◽  
Mónica M. Kurtis ◽  
...  
Keyword(s):  
Internal Medicine ◽  
General Practice ◽  
North Africa ◽  
Movement Disorders ◽  
Clinical Training ◽  
Training Programs ◽  
Subspecialty Training ◽  
Educational Tools ◽  
Printed Books ◽  
Case Presentations

Background: Little information is available on the official postgraduate and subspecialty training programs in movement disorders (MD) in Europe and North Africa. Objective: To survey the accessible MD clinical training in these regions. Methods: We designed a survey on clinical training in MD in different medical fields, at postgraduate and specialized levels. We assessed the characteristics of the participants and the facilities for MD care in their respective countries. We examined whether there are structured, or even accredited postgraduate, or subspecialty MD training programs in neurology, neurosurgery, internal medicine, geriatrics, neuroradiology, neuropediatrics, and general practice. Participants also shared their suggestions and needs. Results: The survey was completed in 31/49 countries. Structured postgraduate MD programs in neurology exist in 20 countries; structured neurology subspecialty training exists in 14 countries and is being developed in two additional countries. Certified neurology subspecialty training was reported to exist in 7 countries. Recommended reading lists, printed books, and other materials are the most popular educational tools, while courses, lectures, webinars, and case presentations are the most popular learning formats. Mandatory activities and skills to be certified were not defined in 15/31 countries. Most participants expressed their need for a mandatory postgraduate MD program and for certified MD sub-specialization programs in neurology. Conclusion: Certified postgraduate and subspecialty training exists only in a minority of European countries and was not found in the surveyed Egypt and Tunisia. MD training should be improved in many countries.

scholarly journals Malignant Peripheral Nerve Sheath Tumors in Africa: A Clinicopathological Study

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Peter M. Nthumba ◽  
Paul Irungu Juma
Keyword(s):  
Peripheral Nerve ◽  
Case Reports ◽  
Soft Tissue Sarcomas ◽  
Late Presentation ◽  
Sub Saharan Africa ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Sub Saharan ◽  
Case Presentations

Introduction. Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive soft tissue sarcomas associated with poor prognosis, that most commonly affect patients aged 20 to 50 years, but have also been reported in children. There is little reported in literature on these tumors in Africa. Materials and Methods. A search of the hospital pathology database between 1992 and 2008 revealed 333 nerve sheath tumors, of which 31 were MPNSTs. Four representative case reports are presented. Discussion. MNPSTs have rarely been reported from sub-Saharan Africa; in this study, they constituted 9.3% of all nerve sheath tumors. The trunk (42%) and limbs (45%) were the most frequently affected anatomical sites. Late presentation of malignant lesions in this environment is exemplified by the four case presentations patients. Conclusions. This report confirms observations from studies on MPNSTs from other environments. Anatomically centrally located MPNSTs may have a higher incidence in sub-Saharan Africa than in the West. Because NF1-associated MPNSTs are difficult to diagnose clinically, and because surgery is the only mode of therapy that offers a complete cure, a lifetime follow-up is important, as this would enable diagnosis of early lesions amenable to surgical extirpation.

Collaboration and Supervision in Advanced Practice Nursing

2014 ◽  
Vol 7 (1) ◽  
pp. 57-62
Author(s):  
Tracy Scott ◽  
Marie Lindsey
Keyword(s):  
Nurse Practitioners ◽  
Clinical Training ◽  
District Of Columbia ◽  
The United States ◽  
Current Data ◽  
Advanced Practice Nursing ◽  
Advanced Practice ◽  
Educational Preparation ◽  
Restrictive Practice ◽  
Collaborative Agreement

Mandated collaborative or supervisory agreements are a restriction to practice for nurse practitioners (NPs) in the United States. According to the Pearson Report (Pearson, 2012), 18 states and the District of Columbia allow NPs to practice without mandated agreements. Progress toward autonomy is being made as many states remove collaborative agreement requirements. These victories are significant but many NPs continue to work in restrictive practice environments. Stiff opposition from the American Medical Association (AMA) is one obstacle to removing these restrictions. Opponents to the removal of mandated agreements cite a concern for patient safety and the educational preparation NPs receive. The evidence regarding safety is not supported by current data and a comparison of the educational requirements for NPs to other providers reveals NPs have a strong background in science and clinical training. This article explores the issues surrounding mandatory practice agreements.

scholarly journals Pantoea agglomerans Infections in Children: Report of Two Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Shraddha Siwakoti ◽  
Rinku Sah ◽  
Rupa Singh Rajbhandari ◽  
Basudha Khanal
Keyword(s):  
Case Reports ◽  
Pediatric Emergency ◽  
Pantoea Agglomerans ◽  
History Of ◽  
Excessive Crying ◽  
Cerebrospinal Fluid Culture ◽  
Case Presentations ◽  
Female Baby ◽  
Postoperative Meningitis

Introduction. Pantoea agglomerans, primarily an environmental and agricultural organism has been reported as both commensal and pathogen of humans. We present two case reports of P. agglomerans infections in children that involved the meninges and bloodstream. Case Presentations. A 6-month-old female baby, diagnosed as congenital hydrocephalus secondary to aqueduct stenosis with ventriculoperitoneal shunt in situ, operated 14 days back was brought to the pediatric emergency with a two-day history of high fever associated with vomiting, irritability, excessive crying, and decreased feeding. Postoperative meningitis was confirmed as cerebrospinal fluid culture revealed P. agglomerans. She responded well with a 14-day intravenous (IV) course of ceftriaxone. Also, we report a case of a 3-year-old male child referred to our center with a provisional diagnosis of UTI with chickenpox for further evaluation. During his 24-hour stay at the local hospital, he had received oral antibiotics and urinary catherization. Urine culture of catheter clamp urine was sterile. P. agglomerans was grown in blood culture. He was treated successfully with IV ceftriaxone and amikacin. Conclusion. P. agglomerans can cause postsurgical meningitis and bloodstream infection in children. The clinical course of infection was mild and timely administration of proper antibiotic resulted in a favorable outcome.

scholarly journals Paradigm Transition from the “Department Model” to the “Comprehensive Dental Care” Teaching Model

2021 ◽  
Author(s):  
Nadia Khalifa ◽  
Amel Ghazi Hamseh ◽  
Abdallah Michail ◽  
Manal M. Awad
Keyword(s):  
Dental Care ◽  
Clinical Training ◽  
Holistic Approach ◽  
Comprehensive Care ◽  
Training Methods ◽  
Patient Centered ◽  
Self Assessment ◽  
Oral Rehabilitation ◽  
Case Presentations ◽  
Consistent Information

Abstract Background This study aimed to assess students’ perceptions of the gains and challenges of the patient-centered comprehensive care methodology of dental clinical training. Methods Self-administered questionnaires were completed by 58 out of 93 students following the end of the academic term 2017–2018. Results Most of the students 43 (74%) understood the philosophy behind a holistic approach to patients’ dental care and employing a multidisciplinary style. Students’ self-assessment showed significant preponderance 41 (71%) (P = 0.026) concerning treatment phases and procedural abilities as well as enhancement of their oral rehabilitation case presentations 50 (86%) (P = 0.0001). Half of the students were not able understand what they needed to work on from their daily continuous clinical assessment grades. The comprehensive dental care (CDC) concept helped them gain more confidence 44 (76%) (P = 0.005) and although students benefited from the interaction with specialists and peers the main advantage was having fixed mentors throughout the year (P = 0.000). Conclusions The results, besides highlighting the benefits, also address some of the shortcomings of the comprehensive care curriculum especially when it comes to grading. Consequently, there is a need for standardized and regular calibration exercises for clinical tutors (general practitioners) and specialists to enable them to impart consistent information to clinical graduates. It is also necessary for students to receive sufficient feedback on their assessment grades to help them understand and improve upon their deficiencies.

scholarly journals Reactivation of BCG vaccination scars after vaccination with mRNA-Covid-vaccines: two case reports

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Libin Mohamed ◽  
Anne Marie Rosendahl Madsen ◽  
Frederik Schaltz-Buchholzer ◽  
Anne Ostenfeld ◽  
Mihai G. Netea ◽  
...  
Keyword(s):  
Viral Infections ◽  
Case Reports ◽  
Vaccine Dose ◽  
Cross Reactivity ◽  
Bacille Calmette Guerin ◽  
Bcg Vaccination ◽  
Care Workers ◽  
Case Presentations ◽  
Inflammatory Syndrome ◽  
Trial Participants

Abstract Background From May 2020 to January 2021, we enrolled 1233 health care workers (HCW) from Danish Hospitals in a randomized trial evaluating whether Bacille Calmette-Guérin (BCG) provides protection against COVID-19. Participants were randomized 1:1 to BCG vs saline and followed for 6 months. From December 2020, Covid-19 vaccines were offered to the HCW. In most cases, BCG vaccination results in a characteristic scar. Reactivation of the BCG scar has been described in children during viral infections and following influenza vaccination, but is mostly associated to Kawasaki’s disease, a disease entity with pathogenesis likely similar to the child Covid-19 complication MIS-C: Multi-System Inflammatory Syndrome. Reactivation of scars after neonatal BCG vaccination has recently been described in four women after Covid-19 mRNA vaccination. Two of our trial participants experienced reactivation of their novel BCG scars after receiving mRNA Covid-19 vaccination 6 to 8 months post-BCG. Case presentations Two female HCW participants that had been randomly allocated to BCG in the BCG-DENMARK-COVID trial, spontaneously reported itching and secretion at the BCG scar site after having received mRNA Covid-19 vaccination (Moderna and Pfizer-BioNTech) 6 to 8 months following inclusion and BCG vaccination. One participant, who had a larger BCG skin reaction, noticed re-appearing symptoms after both the first and the second COVID-vaccine dose, while the other participant only noted symptoms after the second dose. Both had been BCG vaccinated during childhood, and no reactivation was noted in the older scars. No treatment was needed or provided. Conclusions The reactivation of the BCG scar after receiving mRNA vaccine might have been caused by cross-reactivity between BCG and SARS-CoV-2. In both cases, the symptoms were bothersome, but self-limiting and left no sequelae. The risk of reactivation at the scar site is thus not a reason to avoid vaccination with either vaccine.

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