Mexiletine and False Positive Urine Drug Screen for Amphetamine: A Case Review

Advanced heart failure patients commonly suffer from ventricular arrhythmias which can be managed by antiarrhythmic drugs like mexiletine. These ventricular arrhythmias can be complicated by illicit drug use which alter outcomes and can potentially impact the patient-physician relationship through countertransference. However, mexiletine can lead to false positive urine drug screen testing for amphetamine, and these false-positive urine drug screen test results can affect the decision-making process. Health care providers should be aware of this fact and should either use confirmatory testing or look for confounding compounds in patients who deny using illicit substances and have a positive urine drug screen. Our patient is 64 years old who arrived at the emergency department after experiencing a shock by his intracardiac defibrillator. The patient tested positive for amphetamine on his urine drug screen and was later ruled out by confirmatory quantitative testing.

Abstract 1122‐000051: Isolated Diplacusis Due to Ipsilateral Temporal Lobe Infarction: A Case Report

Introduction : Double hearing or Diplacusis is a synchronous double perception of a sound and can have Binauralis or Monauralis pattern, with inner ear disorders being the main culprit [1] . Other forms of Auditory illusions have been reported as a co‐manifestation of stroke syndromes, but none as an isolated presentation [1][2] . This is a case of a 77‐year‐old male with acute onset isolated Diplacusis in a patient due to a right temporal lobe ischemic infarct. To our knowledge, this is the first case report of an isolated diplacusis due to cortical infarct. Methods : A case presentation with Pubmed search of review articles and case reports. Results : The patient had a past medical history of sensorineural deafness in his left ear. He described any sound heard as the same quality but occurring with an echo heard a fraction of a second later in his right ear. There was no decreased hearing quality or tinnitus reported in his right ear. His drug screen test was negative. His examination was only remarkable for a sensorineural hearing loss pattern on his left ear. His (NIHSS) was zero, and no other cranial nerve abnormalities were detected. His MRI was significant for a punctate restricted diffusion on the right temporal lobe, resembling an ischemic infarct (Figure). Conclusions : Isolated diplacusis can present as acute ischemic stroke in the temporal lobe. Further studies are needed to understand its pathophysiology.

Using a certified electronic health record technology platform to screen, test and refer patients with prediabetes

The objective of this study was to determine if certified electronic health record technology (CEHRT) can be used to identify and refer patients with prediabetes to lifestyle change programs (LCPs) recognized by the National Diabetes Prevention Program (DPP). This pilot utilized a prediabetes registry, patient portal, and clinical decision support to increase referrals. Data from 36 primary care providers showed 4930 patients were eligible for DPP LCP, 293 referrals were generated, compared to 20 referrals in the baseline period, and 116 patients enrolled. Referral to enrollment conversion rates were 41% in the study period and 69% in the post-study 1-year period. CEHRT functionalities can support systematic identification and management of prediabetes. The referral rate increased 7-fold compared to the baseline period, with high referral to enrollment conversion rates. CEHRT coupled with active provider engagement can serve as a tool to identify prediabetes patients and facilitate LCP referrals and enrollment.

Detecting Binocular Diplopia in Orbital Floor Blowout Fractures: Superiority of the Orthoptic Approach

Background and Objectives: In patients with orbital floor blowout fracture (OFBF), accurate diagnosis of ocular motility disorder is important for decisions about conservative or surgical therapy. However, the accuracy of the traditional test for detecting binocular diplopia/ocular motility disorder using a moving pencil or finger (hereinafter, “finger test”) has been generally accepted as correct and has not been subject to scrutiny so far. Hence, its accuracy relative to full orthoptic examination is unknown. Materials and Methods: In this paper, the results of the “finger test” were compared with those derived from a complex examination by orthoptic tests (considered “true” value in patients with OFBF). Results: “Finger test” detected ocular motility disorder in 23% of patients while the full orthoptic examination proved much more efficient, detecting ocular motility disorder in 65% of patients. Lancaster screen test and test with color filters were the most important tests in the battery of the orthoptic tests, capable of identifying 97.7% and 95.3% of patients with ocular motility disorder, respectively. Still, none of the tests were able to correctly detect all patients with ocular motility disorder in itself. Conclusions: As the presence of ocular motility disorder/binocular diplopia is an important indication criterion for the surgical solution of the orbital floor blowout fracture, we conclude that a complex orthoptic evaluation should be always performed in these patients.

Laboratory Monitoring of Mother, Fetus, and Newborn in Hemolytic Disease of Fetus and Newborn

<b><i>Background:</i></b> Laboratory monitoring of mother, fetus, and newborn in hemolytic disease of fetus and newborn (HDFN) aims to guide clinicians and the immunized women to focus on the most serious problems of alloimmunization and thus minimize the consequences of HDFN in general and of anti-D in particular. Here, we present the current approach of laboratory screening and testing for prevention and monitoring of HDFN at the Copenhagen University Hospital in Denmark. <b><i>Summary:</i></b> All pregnant women are typed and screened in the 1st trimester. This serves to identify the RhD-negative pregnant women who at gestational age (GA) of 25 weeks are offered a second screen test and a non-invasive fetal RhD prediction. At GA 29 weeks, and again after delivery, non-immunized RhD-negative women carrying an RhD-positive fetus are offered Rh immunoglobulin. If the 1st trimester screen reveals an alloantibody, antenatal investigation is initiated. This also includes RhD-positive women with alloantibodies. Specificity and titer are determined, the fetal phenotype is predicted by non-invasive genotyping based on cell-free DNA (RhD, K, Rhc, RhC, RhE, ABO), and serial monitoring of titer commences. Based on titers and specificity, monitoring with serial peak systolic velocity measurements in the fetal middle cerebral artery to detect anemia will take place. Intrauterine transfusion is given when fetal anemia is suspected. Monitoring of the newborn by titer and survival of fetal red blood cells by flow cytometry will help predict the length of the recovery of the newborn.

Work schedule and substance abuse in vocational students

Background: Drug abuse is one of the world's most serious and rapidly rising problems, causing a wide variety of health issues with significant morbidity and mortality. This study aimed to explore the association between part-time work and substance abuse among vocational students.Design and methods: We conducted a cross-sectional analytical study that included all part-time working male students from five vocational male schools, and we used a standardized pretested questionnaire after obtaining written informed consent. A One-Step Multi-Drug Screen Test was used to assess the substances that were abused.Results: A total of 316 out of the 400 invited students participated in our study. Of the total screened subjects, 26.6 % were abusing substances. Twenty-five (36.2%) day working adolescents, nine (14.0%) night working adolescents, and forty (36.0%) day and night working adolescents were abusers.Tobacco was the most widely abused drug (68%) in the form of smoking, followed by cannabis (24%), marijuana (16.4%), alcohol (10%), and opioid (6.3%). Night workers had significantly lower rates of smoking, cannabis, Marijuana, alcohol, or opioids abuse, and Logistic regression was performed to ascertain the effects of the work schedule on the likelihood that participants have substance abuse; Night workers were 7.14 times less likely to have substance abuse than day workers, while day and night work did not differ from day work.Conclusions: The prevalence of drug abuse in vocational students is considered high and a serious problem that damages the youth and the community.

Inhibition of NMDA receptors by agmatine is followed by GABA/glutamate balance in benzodiazepine withdrawal syndrome

Background Drug withdrawal syndrome occurs due to abrupt cessation of an addictive substance. Dependence to diazepam can be manifested by withdrawal syndrome which may include symptoms such as irritability, psychosis, sleep disturbance, seizures, mood disturbance, and anxiety. Studies have described the therapeutic role of agmatine in various neurological disorders such as depressive mood, learning deficits, anxiety, memory impairment, and psychosis. Various studies have also validated agmatine as a putant neuromodulator and revealed its mechanism of action with other neurotransmitters. The study was designed to reveal the potentials of agmatine in benzodiazepine withdrawal syndrome by maintaining GABA/glutamate balance. The study aimed to determine the underlying mechanism of action of agmatine at synaptic level using behavioral and biochemical evaluations. Results Agmatine significantly enhanced locomotion in open filed test and decreased anxiety as observed in elevated plus maze test (p < 0.01). Agmatine also reduced withdrawal symptoms scores along with compulsive behaviors in marble burying test and improved muscular strength by decreasing latency to fall in inverted screen test (p < 0.01). Moreover, agmatine established GABA/glutamate balance by increasing GABA levels and decreased glutamate concentration significantly (p < 0.01). Conclusion The present study reveals the possible mechanism of action of agmatine on NMDA receptor at GABA interneurons and glutamate post synaptic neuron that may lead to GABA/glutamate balance during withdrawal syndrome.

Determinants of Sputum Ordering for Tuberculosis Diagnosis in People Living with HIV in the Greater Accra Region, Ghana

BackgroundTuberculosis (TB) remains a significant public health concern, and a leading cause of ill-health and death globally. More so, People living with HIV have been shown to carry an increased risk of developing TB with an estimated one-third of deaths in this population. The World Health Organization recommends systematic and routine screening of PLHIV for TB on every clinic visit and further testing using sputum for those with a positive TB screen test. Not all PLHIV with a positive TB screen test in Ghana are further tested for TB using sputum and the factors for this are not well understood. This study assessed factors associated with sputum ordering for TB diagnosis in PLHIV who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.MethodsMixed method study performed at three purposively selected hospitals providing HIV care and treatment services in the Greater Accra region. The study involved a cross sectional review of patients’ charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Quantitative data was analyzed using STATA version 15. Chi square test was used for bivariate analysis. Logistic regression was used for multivariate analysis. P≤ 0.05 was considered statistically significant. Inductive thematic analysis was used to determine emerging themes from the interviews. The major themes were represented with representative quotations.ResultsFour hundred (400) patient charts were reviewed of which 67.7% were female with median age of 39 (IQR 31-49). TB screening was recorded in 78% (95% CI 73.6, 82.0) of the patients of whom ninety-two (92) patients had a positive TB screen test. Only 53 (57.6%) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, patient general appearance described as abnormal (OR=3.05, p=0.036), having more than one TB symptom (OR=3.42, p=0.028) and presence of an alternative presumptive diagnosis (OR=0.34, p=0.023) were associated with having a sputum test ordered. High patient numbers, inability to produce sputum, unwillingness of the not so sick patients to provide sputum and the costs associated with chest X-ray were perceived as the challenges to further testing for TB.ConclusionTB screening in PLHIV is still lower than recommended and almost half of PLHIV with a positive TB screen test did not have a sputum test documented. Sputum testing was likely to be done in patients with an abnormal general appearance and more than one TB symptom and unlikely in those with an alternative presumptive diagnosis. High workload, costs of TB tests, lack of training for health workers and inability to produce sputum by patients were the barriers to sputum testing highlighted by the health workers.

The effect of corrective exercises on functional movement screen test and motor skills

The aim of this study is to examine the effect of 8-week corrective exercises applied to 12-15 age group basketball players on Functional Movement Screen Test (FMS) and motor skill (MS) score. 65 volunteer children between the ages of 12-15 participated in the study. The children were the control group (CG) (N = 25) who did not do any exercise, the basketball group that only trained basketball (BG) (N = 20), and the corrective exercise group (CEG) (N = 20) that did corrective exercises in addition to basketball training. It is divided into 3 groups. Basketball training was applied to children on BG 3 days a week. In addition to basketball training, an 8-week corrective exercise protocol was applied to the children in CEG. Functional movement patterns of children were determined with FMS test and MSs with Deutscher Motor Test (DMT). Kruskal-Wallis H Test was used to determine the differences children's pre-tests and post-tests after corrective exercises. As a result of the statistical analysis, a statistically significant difference was found between the pre-test and post-tests of FMS total scores and DMT scores in CEG (p<0.05). As a result, it has been shown that corrective exercises contribute to FMS total scores and the MS development of children. It is thought that the placement of corrective exercises in the training contents can increase the MSs of children. ​Extended English summary is in the end of Full Text PDF (TURKISH) file. Özet Bu çalışmasının amacı, 12-15 yaş grubu basketbolculara uygulanan 8 haftalık düzeltici egzersizlerin fonksiyonel hareket tarama testi (FHT) ve motor beceri (MB) puanı üzerine etkisinin incelenmesidir. Çalışmaya 12-15 yaş arası 65 gönüllü çocuk katılmıştır. Çocuklar herhangi bir egzersiz yapmayan kontrol grubu (KG) (N=25), sadece basketbol antrenmanı yapan basketbol grubu (BG) (N=20) ve basketbol antrenmanına ilaveten düzeltici egzersiz yapan düzeltici egzersiz grubu (DEG) (N=20) olmak üzere 3 gruba ayrılmıştır. BG’da bulunan çocuklara haftada 3 gün sadece basketbol antrenmanı, DEG’da bulunan çocuklara basketbol antrenmanlarına ilaveten 8 haftalık düzeltici egzersiz protokolü uygulanmıştır. Çocukların fonksiyonel hareket kalıpları FHT testi ile MB’leri Deutscher Motor Testi (DMT) ile belirlenmiştir. Çocukların FHT skorları ve DMT skorlarının ön testleri ile düzeltici egzersizler sonrası son testleri arasındaki farkı belirlemede Wilcoxon İşaretli Sıralar Testi kullanılmıştır. İstatiksel analizler sonucunda, DEG’da FHT toplam skorları ve DMT skorları ön test ile son testleri arasında istatiksel olarak anlamlı bir farklılık bulunmuştur (p<0,05). Sonuç olarak düzeltici egzersizlerin FHT toplam skorlarına ve çocukların MB gelişimine katkı sağladığı gösterilmiştir. Düzeltici egzersizlerin antrenman içeriklerine yerleştirilmesinin çocukların MB’lerini artırabileceği düşünülmektedir.

Histopathology is required to identify and characterize myopathies in high-throughput phenotype screening of genetically engineered mice

The development of mouse models that replicate the genetic and pathological features of human disease is important in preclinical research because these types of models enable the completion of meaningful pharmacokinetic, safety, and efficacy studies. Numerous relevant mouse models of human disease have been discovered in high-throughput screening programs, but there are important specific phenotypes revealed by histopathology that are not reliably detected by any other physiological or behavioral screening tests. As part of comprehensive phenotypic analyses of over 4000 knockout (KO) mice, histopathology identified 12 lines of KO mice with lesions indicative of an autosomal recessive myopathy. This report includes a brief summary of histological and other findings in these 12 lines. Notably, the inverted screen test detected muscle weakness in only 4 of these 12 lines ( Scyl1, Plpp7, Chkb, and Asnsd1), all 4 of which have been previously recognized and published. In contrast, 6 of 8 KO lines showing negative or inconclusive findings on the inverted screen test ( Plppr2, Pnpla7, Tenm1, Srpk3, Sidt2, Yif1b, Mrs2, and Pnpla2) had not been previously identified as having myopathies. These findings support the need to include histopathology in phenotype screening protocols in order to identify novel genetic myopathies that are not clinically evident or not detected by the inverted screen test.