Respecting the Patient’s Choice: A Case of Possible Drug-Induced Parkinsonism

This report describes a case of likely drug-induced Parkinsonism (DIP) identified by the pharmacist. A 54-year-old female patient was referred by a physician to the pharmacist in a rural, integrated care team for a comprehensive medication review (CMR) to address the patient’s concerns of possible Parkinson’s disease (PD). While PD may occur over the progression of age, medications that affect dopamine transport can also cause DIP, a secondary form of Parkinson’s disease. Although PD and DIP may be clinically indistinguishable, differentiation may be possible by reviewing a patient’s medication history for any potential causative drugs correlating to the timeline of the onset of symptoms. In this case, the pharmacist reviewed the medication profile and identified medications that could be responsible for causing DIP, specifically bupropion. The pharmacist suggested discontinuing bupropion and identifying another option for treating depression. The patient appreciated the suggestion and education, but ultimately preferred continuing her bupropion therapy instead of discontinuing therapy or changing to an alternative agent. At a follow-up meeting with the pharmacist, not only was the patient still experiencing tremors despite taking carbidopa/levodopa, but additional medications known to be potential inducers of tremors were added to her regimen. Although the pharmacist repeatedly discussed DIP with the patient and believed stopping bupropion would determine whether her Parkinsonism was PD or DIP, ultimately the patient continued taking bupropion because of concerns related to depression severity and the impact on her well-being. The patient’s wishes were respected.

Indigenous Media and Social Media Convergence: Adaptation of Storytelling on Twitter, SoundCloud and YouTube

Storytelling is ordinarily trivialised as an antiquated oramedia genre, and of less significance in Zimbabwean mainstream media and communication studies, hence it is understudied. Recent studies largely take a literary gaze on storytelling, and do not theorise it from an indigenous media viewpoint or appreciate its convergence with social media. Drawing on concepts of media convergence and the digital public sphere, this netnographic study examines the adaptation of storytelling on Twitter, SoundCloud and YouTube, focusing on patterns of production, delivery, participation, language forms, reception and audiences. The article shows inventive re-embodiment and adaptation of storytelling on online spaces, that is, the endurance and remaking of indigenous media in the context of new media and communication technologies. The manifestation of the folktale narrative style on social media exhibits the rise of a secondary form of orality recreated, reproduced and applied in the digital form and on social media. While digital and social media are perceived as threatening the continued existence of indigenous media, this article attests social media as breathing spaces for indigenous media.

LINGUISTIC CORRELATION OF PRIMARY TEXT AND ITS VERBAL REPRODUCTION IN THE INTERROGATION PROTOCOL

Problem statement. The article deals with the problem of modern linguo-expert activity related to the use of interrogation protocols as a material carrier of negative-evaluative information about a person. The variability of expert views regarding the possibility of analyzing someone else’s speech in the interrogation protocol more and more often entails the lack of expert assessment of the materi-als of the preliminary investigation in criminal cases. The purpose of the study is to establish the nature of the relationship and the degree of approxi-mation of the primary and secondary texts, where the primary text is recorded on the phonogram, the secondary one is reproduced in the interrogation protocol from the words of the interrogated. The research methodology consists of theoretical approaches to the comparative analysis of the prototypical utterance and its secondary form. The material of the research is video and audio recordings of speech events of insult, as well as interrogation protocols, the descriptive part of which contains information about the recorded conflict speech. Research results. The study showed the maximum degree of formal-semantic affinity of the texts serving as the basis and their verbal reproductions, reflected in the interrogation protocols. The inter-rogation protocol also reproduces important paralinguistic characteristics of the voice of the person to whom the invective evaluative statements belong. Conclusions. The results obtained in the course of the study can be used in developing guidelines for experts involved in the analysis of speech material extracted from the interrogation protocol, as well as other indirect sources of information about expert objects. The proposed system of under-standing broadens understanding of secondary texts as objects of research within the framework of forensic linguistic expertise.

Burning mouth syndrome (BMS) – clinical symptoms

The scientific news and the importance for medical practice of approaching this oro-dental disease is supported not only by the patient’s persistent long-term suffering, but also by the concern to know how to identify the possible etiopathogenesis, especially in the secondary form, which once identified and sanctioned therapeutically is successful for both the attending physician and the patient.

Cutis verticis gyrata: three cases illustrating three different etiologies

Cutis Vertcis gyrata is an uncommon neurocutaneous syndrome characterized by excessive growth of the skin of the scalp or the face, forming folds of similar aspect to cerebral cortex gyri. Three categories have been individualized: the primary form, essential or non-essential, and the secondary form.

Category of Sacredness in the Discourse of the English Sermon (Theolinguistic Approach)

The present paper deals with the investigation of the category of sacredness of the English religious preaching discourse, considered from the standpoint of theolinguistics. It has been proved that being a secondary form of sacred texts the text of the sermon demonstrates frequent use of sacral vocabulary of different groups: narrow conceptual and terminological vocabulary, which has religious sense and meanings, borrowings from sacred texts (the so-called biblicalisms), and vocabulary of everyday communication, which in the context of preaching becomes religious, and is included in the semantic field of religion on this basis. Different perception of the nature and ways to realize the sermon in the Anglican and Neo-Protestant churches is manifested in the peculiarities of the attitude towards the sacrality of the Word. The process of desacralization of the sermon, recorded in the Neo-Protestant sermons, occurs due to the contrasting use of sacred vocabulary in a stylistically reduced context, on the one hand, and the use of profane vocabulary to nominate sacred phenomena, on the other.

A cohort study of membranous nephropathy, primary or secondary

Background Although IgG4 deposit against phospholipase A2 receptor (anti-PLA2R) is predominantly presented in the renal biopsy of patients with primary membranous nephropathy (MN), its diagnostic value of this immune complex has not been fully established. Methods In this cohort study, 108 biopsy-proven MN patients with proteinuria were evaluated during two years follow up and were divided into primary and secondary groups. Renal biopsy specimens were pathologically assessed for IgG4 and PLA2R depositions by immunohistochemistry (IHC). Therefore, the relationships between staining severity, MN type and total proteinuria in all patients were determined. Results Of 108 patients, 73.1% had primary MN and 26.9% were diagnosed as secondary form. IHC staining in patients with primary MN was positive for PLA2R in 76 (96.2%) and IgG4 in 68 (86.1%). Cases with positive PLA2R expression had a significantly higher rate among patients with mild to moderate stages (P = 0.03). No significant relationship was found between intensity of PLA2R and IgG4 deposits with proteinuria and serum creatinine. Based on our data, double positivity/negativity of PLA2R and IgG4 expression adds prominent information to the clinical data and were found to be useful and robust biomarkers for detection of primary MN patients with high sensitivity and specificity (97.1 and 96.3% respectively, PPV = 98.5% and NPV = 92.9%). Conclusions Simultaneously expression of PLA2R and IgG4 in renal biopsy specimens of patients with MN could possibly be used as a potential diagnostic method to distinguish primary from secondary MN and also pathological severity of the disease.

Clinical characteristics of IgG4-related retroperitoneal fibrosis versus idiopathic retroperitoneal fibrosis

Retroperitoneal fibrosis (RPF) is an uncommon condition characterized by inflammation and fibrosis in the retroperitoneal space. More than two-thirds of RPF are idiopathic, with the remaining stemed from a variety of secondary causes. It was suggested that IgG4-related RPF is a secondary form of RPF. We undertook this study to compare detailed demographic, clinical and laboratory characteristics of IgG4-related RPF and IRPF in a large Chinese cohort. We retrospectively reviewed the medical records of 132 RPF patients diagnosed at Peking University People’s Hospital between March 2010 and March 2018. Among the 132 patients, the mean age at disease onset was 54.8 years. IgG4-related RPF group showed greater male predominance compared to IRPF group. IgG4-related RPF patients showed a longer interval between symptom onset and diagnosis, and allergic diseases were more common in this group. Sixty-four patients (48.4%) had lower back pain, which was more common in IRPF group than that in IgG4-related RPF patients. In terms of organ involvement, although 42 of 47 patients (89.3%) with IgG4-related RPF had other organ involvement, there were no patients in the IRPF group with other organ involvement. In addition, the serum IgG4 level, elevated eosinophils counts and IgE level were significantly higher in IgG4-related RPF patients. We described the demographic, clinical and laboratory differences between IgG4-related RPF and IRPF patients, indicating their potential differences in pathogenesis, which was of great importance to diagnose and manage the two phenotypes.

Psychological-physiological characteristics of vaginismus

While vaginismus can occur in some women during the first sexual intercourse, and sometimes in women who have not had any problems during previous sexual intercourse, this diagnosis can occur over time, depending on a traumatic event or problem they are experiencing. Vaginismus is divided into primary and secondary according to the time of its formation. The following are the reasons for the formation of the secondary form: Problems between couples A traumatic birth experience Abortion Exposure to sexual assault Rough gynecological examination, etc. One of the points to note is that the diagnosis of vaginismus may include additional symptoms. These are: Apareunia, Dyspareunia and Vulvar Vestibulitis Syndrome (VVS, Vulvar Vestibulitis). Although the symptoms we have listed are very similar to vaginismus, they are completely different from each other. Key words: vaginismus, trauma, Attachment, types of vaginismus, couple relationships, Dyspareunia, Vulvar vestibulitis, Aparoni

Ethnic Ties Between Buryats and Yakuts: Malǰirag˱ ~ Manǰirag˱ || Malˊdaγar (Malǰaγar) || Malljaγar

In this paper they are analyzed the ethnonyms known among the Buryats in the form of Manǰiraγ [Manǯirag˱], Malǰiraγ [Malǯirag˱] etc. (those are Manžirak, Manžirak in Russian spelling, “Manzir” in Russian documents of the 17th century), and among the Yakuts to be attested as Maldˊaγar. The Buryat forms reflected the original *Manǰi Uraγ or *Malǰi Uraγ, where attested in both cases the first element characterized by the development of complex -nǰ- > -lǰ-. The secondary form may be found also in mentioned Yakut Maldˊaγar that to be metathesised version of *Maldˊǝraχ < *Malǰiraγ, due to development of Mong. -raγ > Yak. *-raχ > -γar. So, it is possible to view here another Mongolic borrowing in the register of Yakut ethnonyms. The etymology of the original ethnonym was also analysed in the paper. The word is not based on roots such nor as Manču ~ Manǰu, that is the ethnic name of Manchu people, nor the from Buddhist lexicon word Bandi ‘novice, pupil of a lama’ (> Kalm. Manži), because of problems in chronology for possibility of any of such versions. So, it is of the possible the most optimal version seems to prefer the word analysed to be compared with known in Written Mongolian manǰi ‘an elk’. It may be to argue that the development -nǰ- > -lǰ- attested had made place already in the form of the word have not yet been a part of the ethnonym contracted. Among Tofalars it is known the tribal name Maldˊär < *Malǰi är ‘Malǰi people, people of Malǰi’,. It seems that among both Yakuts and Tofalars it is circulated the secondary form of the Mongolic name. The penetration of the word here had started before 17th century. And one can say also that not only the development -nǰ- > -lǰ- had its place to that time that supported by known among Yakuts personal name attested in Russian spelling as Malegar, i.e., *Maläγar [*Maljäγar], but it was also the Middle Mongolic /ǰ/ > Buryat */dz/ reflected in Russian spelling “Manzirskiy” found in documents of the 17th century.