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Aversive and rewarding experiences can exert a strong influence on subsequent behavior. While decisions are often supported by the value of single past episodes, most research has focused on the role of well-learned value associations. Recent studies have begun to investigate the influence of reward-associated episodes, but it is unclear whether these results generalize to negative experiences, such as pain. To investigate whether and how the value of previous aversive experiences modulates behavior and brain activity, in our experiments female and male human participants experienced episodes of high or low pain in conjunction with incidental, trial-unique neutral pictures. In an incentive-compatible surprise test phase, we found that participants avoided pain-paired objects. In a separate fMRI experiment, at test, participants exhibited significant pain value memory. Neurally, when participants were re-exposed to pain-paired objects, we found no evidence for reactivation of pain-related patterns in pain-responsive regions, such as the anterior insula. Critically, however, we found significant reactivation of pain-related patterns of activity in the hippocampus, such that activity significantly discriminated high versus low pain episodes. Further, stronger reactivation in the anterior hippocampus was related to improved pain value memory performance. Our results demonstrate that single incidental aversive experiences can build memories that affect decision-making and that this influence may be supported by the hippocampus. SIGNIFICANCE STATEMENT Aversive and rewarding experiences can exert a strong influence on our subsequent behavior. While decisions are often supported by single past negative or positive episodes, most research has focused on the role of well-learned value associations. In experiments using aversive heat pain in conjunction with incidental objects, we found that participants9 choices were biased by the level of pain associated with the objects. Further, when participants saw the objects again, pain-related neural patterns in the hippocampus were re-expressed, and this was related to pain value memory performance. These results suggest a mechanism by which even single negative experiences can guide our later decisions.

Background/purpose: MS and LB, the primary bacteria groups responsible for dental caries, and high levels of these bacteria in the mother promote transmission from mother to infant. The aim of this study was prevention of maternal MS and LB transmission on infants by using different preventive strategies and inhibition of early childhood caries proggession. Materials and methods: This study was conducted with 50 mother-child pairs who were randomly allocated into either a study group or a control group (n = 25 each). Mothers in the study group were enrolled in a detailed preventive program that included elimination of dental caries with restorative and antibacterial procedures, whereas those in the control group received only a single episode of oral-health education. Results: After 18 months, significant MS and LB inhibition was observed in the study group (p < 0.0001). In addition, caries prevalence in the infants in the study and control groups was 0% and 20% respectively, and the difference between the two groups was statistically significant (p = 0.020). Conclusion: These results indicate that primary preventive intervention and oral-health instruction can significantly inhibit the MS and LB levels of mothers and prevent caries in their children during the early years of life. © 2020 Association for Dental Sciences of the Republic of China 2013/02 This study was financially supported by the Scientific Research Project of Kirikkale University , Turkey (project number: 2013/02 ).

Objectives We investigated the efficacy, safety and acceptance of rectally administered metronidazole for the treatment of giardiasis in children. Patients and Methods This study (ClinicalTrials.gov Identifier: NCT02942485) was an open-labeled randomized comparison of a 3-day-course of rectal metronidazole and single-dose oral tinidazole in children with giardiasis. Clinical cure was defined as the resolution of symptoms by day 10 post-treatment. Microbiological eradication was assessed with stool enzyme immunoassay for G.duodenalis antigen on day 7-10 post-treatment. Results The study was terminated due to the extremely slow enrollment. We describe the outcome for six patients treated with rectal metronidazole and one patient treated with oral tinidazole. All symptomatic patients (4/4) were clinically cured with rectal metronidazole. Microbiological eradication was successful after the first treatment course in all tested patients (6/6), of whom five were treated with rectal metronidazole and one with oral tinidazole. Side effects were reported in one patient and were restricted to a single episode of loose stool after the third dose of rectal metronidazole. The majority of caregivers (4/6) considered the administration of rectal metronidazole relatively easy. Conclusions We provide a proof of principle for the efficacy of rectally administered metronidazole in the treatment of giardiasis.

Background and ObjectiveThere are no current guidelines to manage female retention patients. We aimed to see if a standardized approach could be used to manage these patients. MethodsBetween October 2014 and September 2016, all female patients with urinary retention admitted under a urology consultant were reviewed. ResultsA total of 46 females had a single episode of urinary retention whilst 19 females had recurrent episodes. The commonest cause for a single episode of retention was attributed to anesthesia (general/spinal) (n=9), constipation (n=9) and medication use (n=4). Most of these women (95%) voided on the first attempt fol-lowing catheter removal. In the absence of any neurological symptoms, pelvic ultrasound was the only investigation that revealed any underlying pathology in female retention patients. A pelvic mass was identi-fied in 3 (4.5%) patients. ConclusionFemales with an isolated episode of retention, with an obvious precipitating cause identified during full history and examination, could proceed directly to a nurse-led trial of catheter removal without the need for any further urology review. Others should undergo a pelvic ultrasound and review by a urologist. In our opinion, females with recurrent unexplained episodes of urinary retention should be referred for a trial of sacral neuromodulation if considered appropriate.

The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.

Aim: The aim of the study was to establish the utility of ultrasound scan in detecting renal tract abnormalities following a single episode of epididymitis. Methods: A single-centre retrospective review of all boys diagnosed with epididymitis between October 2012 and 2017 including review of follow up imaging and clinical course was completed. Primary outcome was new diagnosis of renal tract abnormality by ultrasound. Main results: Eighty-four boys with a first diagnosis of epididymitis were identified. Sixty-four cases (76%) were diagnosed at scrotal exploration, the remaining twenty clinically. Median age was 7.30 years (range 0.08–15.83 years), and five had a positive urine culture at presentation. Forty-eight boys (57%) had a follow-up ultrasound scan (at median 4.57 weeks [range 1–31 weeks]). Only two renal tract abnormalities were identified by ultrasound scan, both in boys aged < 6 months, and neither was clinically relevant. Recurrent epididymitis occurred in 4 cases at median 26 days after initial presentation, of whom 3 had been followed up by ultrasound after initial presentation, all of which were normal. Further investigation revealed posterior urethral valves in 1 boy (age 6.5 months at initial presentation). Conclusion: Following a single episode of epididymitis, ultrasound was not helpful at detecting clinically relevant renal tract abnormalities, and furthermore did not identify the only patient with a clinically relevant abnormality. Based on these data, we propose follow-up imaging only in boys ≤ 6 months of age with a positive urine culture or a recurrent episode with consideration given to micturating cystogram even if ultrasound normal. Level of evidence: IV.

We developed a method, ArchaicSeeker 2.0, to identify introgressed hominin sequences and model multiple-wave admixture. The new method enabled us to discern two waves of introgression from both Denisovan-like and Neanderthal-like hominins in present-day Eurasian populations and an ancient Siberian individual. We estimated that an early Denisovan-like introgression occurred in Eurasia around 118.8–94.0 thousand years ago (kya). In contrast, we detected only one single episode of Denisovan-like admixture in indigenous peoples eastern to the Wallace-Line. Modeling ancient admixtures suggested an early dispersal of modern humans throughout Asia before the Toba volcanic super-eruption 74 kya, predating the initial peopling of Asia as proposed by the traditional Out-of-Africa model. Survived archaic sequences are involved in various phenotypes including immune and body mass (e.g., ZNF169), cardiovascular and lung function (e.g., HHAT), UV response and carbohydrate metabolism (e.g., HYAL1/HYAL2/HYAL3), while “archaic deserts” are enriched with genes associated with skin development and keratinization., Existing methods to identify the presence of DNA from other hominin species can be limited in the ability to accurately estimate introgression waves, or can only be applied to specific populations. Here, the authors have developed a generalizable method to identify introgression in multi-wave situations.

Early-life seizures (ELS) are associated with autism spectrum disorder (ASD); however, due to a lack of effective treatments for ELS, it is not clear whether ELS plays a causal role, potentiates the ASD phenotype, or is the result of a common pathophysiology. Deficits in communications are a core feature of ASD. To isolate the impact of ELS on communication, we probed the behavioral consequences of a single episode of kainic acid-induced early-life seizures (KA-ELS) in male and female Sprague-Dawley (CD) rats. Deficits in auditory communication were observed in adult male rats as assessed by behavioral response to ultrasonic vocalization (USV) playback. Ultrasonic vocalizations are classified into two major categories - 50-kHz (positive) calls and 22-kHz (aversive) calls. Behavioral response was assessed via rat preference for different USV playback in a radial arm maze. Response to 22-kHz calls was not impacted by ELS while response to 50-kHz calls was impacted. All rats demonstrated positional preference for the arms adjacent to where 50-kHz calls were playing compared to background noise; however, male ELS rats demonstrated a greater positional preference for the arms adjacent to where 50-kHz calls were playing compared to male control rats. These studies demonstrate that responses to socially relevant auditory cues are chronically altered in adult male rats following a single episode of ELS. We speculate that these changes contribute to previously reported social deficits associated with ELS. ispartof: EPILEPSY & BEHAVIOR vol:127 ispartof: location:United States status: published

BACKGROUND To evaluate periodontal disease progression (PDP) and potentially detectable effects of a single episode of scaling and root planing (se-SRP) in subjects lacking professional dental care and oral hygiene practices for >40 years. METHODS In 2013, se-SRP was offered to all available subjects from the original cohort of 480 males initially established in 1970. From a total of 75 attending the previous examination in 2010 (baseline), 27 consented to receive the intervention while 18 declined and served as controls. Clinical data were recorded again in 2014 (follow-up) similarly to the previous surveys (1970 to 2010). RESULTS Subjects' mean age in 2010 was 62.5 (± 3.6, test) and 61.9 (± 3.8, control) years. At follow-up, both groups presented with elevated tooth loss of 1.2 (from 15.5 ± 9.0, test) and 1.5 (from 17.9 ± 6.6, control) resulting in 1,392 (test) and 1,061 (control) sites available for further analysis. In both groups, clinical attachment level (CAL) loss and probing depths (PD) deteriorated. PD increase of 0.22 mm (± 1.70) in the test group was significantly higher compared with the control group (0.08 mm ± 1.30) (P

Background Syphilis rates have continued to rise in the United States. Florida and Louisiana consistently report high numbers of cases. In a previous study, reinfections accounted for 30.4% of new infections among men in 2018. In this analysis, we evaluated rates of reported reinfections in women. Methods We evaluated all syphilis records, all stages (primary, secondary, early latent, and late latent) in females aged 15–70 years from the Florida and Louisiana Departments of Health surveillance databases during 2000–2018. Demographics of cases and repeaters (individuals reported with 2 or more cases of syphilis) were examined. Percentages of syphilis cases from repeaters by year were calculated as were percentages from HIV+ females. Results From 2000–2018, 124,827 syphilis cases were reported from 107,405 individuals: 33,594(31%) were female accounting for 35,279(28%) of all cases. Of 33,594 females, 32,050(95%) reported a single episode of syphilis and 1,544(5%) were repeaters. Most women with a single case report were African American 18,429(57.5%) and 1,510(4.7%) of single cases were HIV+. Women with a single episode of syphilis were likely in the age range of 20–39 (primary child-bearing years) 20,037(63%). Repeaters were primarily African American 914(59.2%) and 218(14.1%) were HIV+. Women reported with two or more episodes of syphilis also were likely to be of child-bearing age 20–39: 1,065(69%). Repeaters had 1,685 cases reported; range 2 to 5. Mean time to second infection was 3.5 years (median=2.3 years). From 2010–2018, repeaters accounted for a slowly increasing percentage of all syphilis reported: 2010 (5.1%), 2013 (5.9%), 2016 (6.8%), and reached (10.3%) in 2018. Within females living with HIV, cases from repeaters also increased: 2010 (13%), 2014 (16%), 2016 (21%), and 2018 (25%). Conclusion Most syphilis diagnosed in Florida and Louisiana was among persons infected for the first time and among men. However, syphilis infection and reinfections are increasing in women.

Hypoglycemia is associated with adrenergic and various neurological symptoms including hemiparesis. Though not common, movement disorders such as chorea and ballism have been reported in hypoglycemia. This case was of an elderly lady, a known diabetic, who developed two episodes of hemiparesis and single episode of jerky head movement with preserved sensorium lasting for few seconds, associated with hypoglycemia on different occasions, 1 week after increasing the dosage of oral hypoglycemic agent with complete recovery each time with correction of sugar levels. Magnetic resonance imaging showed transient bilateral diffusion restriction in posterior limb of internal capsule.

Background Salmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection. Case presentation The patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics. Conclusions This case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.

Recent advances in biosensor technology herald a major shift in the way alcohol use will be tracked in humans. Wearable biosensors can passively and continuously monitor wearers' alcohol consumption in real time. An important application of these biosensors is to improve the way medication for alcohol use disorder (AUD) is tested in clinical research. Both laboratory-based screening paradigms and clinical trials have methodological problems that impact their efficiency and predictive validity. Medication screening using laboratory-based methods is a resource-intensive assessment of a single episode of behavior in a non-representative setting. Clinical trials rely on participant self-report to document medication-induced changes in drinking behavior. This review describes how mobile biosensors can be leveraged to improve AUD medication development research. We first review the current state of alcohol biosensor technology with a focus on strengths and limitations of the devices. We describe how multiple biosensors can be combined to create a far more detailed record of drinking compared to single biosensor platforms. We then discuss each phase of the medication development pipeline in turn (i.e., phases 1-4) and describe how mobile biosensors can be incorporated in standard medication testing paradigms to improve efficiency and predictive validity. We conclude with discussion of challenges associated with using currently available biosensors for medication testing and recommendations for researchers wishing to incorporate alcohol biosensors into their own research.

Background Electronic health record (EHR) data are available for research in all UK nations and cross-nation comparative studies are becoming more common. All UK inpatient EHRs are based around episodes, but episode-based analysis may not sufficiently capture the patient journey. There is no UK-wide method for aggregating episodes into standardised person-based spells. This study identifies two data quality issues affecting the creation of person-based spells, and tests four methods to create these spells, for implementation across all UK nations. Methods Welsh inpatient EHRs from 2013 to 2017 were analysed. Phase one described two data quality issues; transfers of care and episode sequencing. Phase two compared four methods for creating person spells. Measures were mean length of stay (LOS, expressed in days) and number of episodes per person spell for each method. Results 3.5% of total admissions were transfers-in and 3.1% of total discharges were transfers-out. 68.7% of total transfers-in and 48.7% of psychiatric transfers-in had an identifiable preceding transfer-out, and 78.2% of total transfers-out and 59.0% of psychiatric transfers-out had an identifiable subsequent transfer-in. 0.2% of total episodes and 4.0% of psychiatric episodes overlapped with at least one other episode of any specialty. Method one (no evidence of transfer required; overlapping episodes grouped together) resulted in the longest mean LOS (4.0 days for all specialties; 48.5 days for psychiatric specialties) and the fewest single episode person spells (82.4% of all specialties; 69.7% for psychiatric specialties). Method three (evidence of transfer required; overlapping episodes separated) resulted in the shortest mean LOS (3.7 days for all specialties; 45.8 days for psychiatric specialties) and the most single episode person spells; (86.9% for all specialties; 86.3% for psychiatric specialties). Conclusions Transfers-in appear better recorded than transfers-out. Transfer coding is incomplete, particularly for psychiatric specialties. The proportion of episodes that overlap is small but psychiatric episodes are disproportionately affected. The most successful method for grouping episodes into person spells aggregated overlapping episodes and required no evidence of transfer from admission source/method or discharge destination codes. The least successful method treated overlapping episodes as distinct and required transfer coding. The impact of all four methods was greater for psychiatric specialties.

Introduction The aim of this study is to compare the outcomes of surgical management after primary anterior shoulder dislocation to the outcomes of patients who have surgical stabilization after recurrent anterior shoulder instability. Methods A Medline (PubMed) search was performed in November of 2016 using the following key terms: shoulder, labrum, Bankart, instability, repair, outcome, recurrent. In May 2017 a Cochrane search was performed using similar key terms to ensure we included all studies. Only level I and II studies were included. Results There were three studies that compared primary repair to delayed repair. In all three studies, the rate of recurrence was higher in group R than group S. When pooled, there was not a statistically significant difference between these groups, but there was a slightly higher odds of recurrence in group R (pooled OR 2.08, CI 0.69–6.26, p = 0.19). No significant differences were appreciated in functional outcomes or complications in these two groups. Conclusion Further level I and level II studies to compare surgical treatment after first time and recurrent instability are needed. This study failed to find a statistically significant difference in recurrence rates in patients who had stabilization acutely after a single episode compared to patients with recurrent instability events, although results suggest there may be a small benefit in primary stabilization.

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.

Background Despite fast progress in neuroscientific approaches, the neurobiological continuum links psychotic spectrum, and affective disorder is obscure. White matter WM abnormalities found utilizing Diffusion Tensor Imaging (DTI) showing impaired communication in both disorders have been consistently demonstrated; however, direct comparisons of findings between them are scarce. This study aims to study WM abnormalities in single episode bipolar I disorder, and single episode brief psychotic disorder related to healthy control with the association of executive function. Methods A cross-sectional case-control study was used to assess 60 subjects divided into 20 patients with single episode bipolar I disorder, 20 individuals with single episode brief psychotic disorder (both groups of patients were in remission), and 20 healthy controls. The present study examined the superior longitudinal fasciculus (SLF), and cingulum bundle fractional anisotropy (FA) determined from DTI images symmetrically and connected these results with cognitive functions as assessed by the trail making test (TMT) and Wisconsin card sorting test (WCST). Results DTI data indicated that the psychotic group had a significant decrease in FA of the right SLF (p-value less than 0.001), left SLF (p-value less than 0.001), and left cingulum (p-value less than 0.001) than the bipolar I group. In terms of executive functioning, the psychotic group performed significantly worse than the bipolar I group on the TMT part B (p-value less than 0.001), the WCST (number of classifications fulfilled) (p-value less than 0.001), and perseverative errors (p-value less than 0.001). Conclusion Even after clinical remission, individuals with single episode brief psychotic disorder had more pronounced white matter impairments and executive function deficiencies than individuals with single episode bipolar I disorder.

This chapter asks what the comic televisual representation of apartheid in the late 1960s tells us about its perception in Britain, and what it reveals about race relations in the country. To achieve this, this chapter focuses on a single episode from the situation comedy Till Death Us Do Part broadcast on the BBC on 12 January 1968. The chapter illuminates how the comic mode helped to circulate an anti-apartheid message to a large audience, and, inadvertently, to subvert the explicit intent to protest apartheid. It demonstrates how the protest against a racist system of governance in South Africa highlights racism in Britain.

IntroductionHospital administrative data is a valuable source to measure myocardial infarction (MI) rates. However, admission counts are susceptible to over-inflation if the patient is transferred multiple times during a single episode of care, and variables denoting transfers may not be reliable. To obtain an accurate number of events, hospital transfers need to be correctly identified. Objectives and ApproachWe assessed multivariable logistic regression and various machine-learning models to predict transfers in hospital administrative data. Using Western Australian linked hospital data, we identified records from 2000-2016 with a principal discharge diagnosis of MI. Our standard method to compare against was a 24-hour look-back to identify a transfer using just admission and separation dates from the current and previous records for the same patient. Multivariable logistic regression and decision trees with various boosting algorithms were used to predict if a single record was a transfer, using variables recorded in the admission (e.g. age, sex, type of hospital, admitted from, emergency/elective admission). The performance of each model was calculated using metrics including area under the curve (AUC). ResultsRecords in the training, validation and testing samples had similar characteristics: mean age=68.9 years, 66% were male and 58% admitted to tertiary hospitals. Gradient Boosting Decision Tree (AUC=0.887, 95%CI: 0.886-0.887) outperformed multivariable logistic regression (AUC=0.875; 95% CI: 0.869-0.881) and random forest models (AUC=0.859; 95% CI: 0.853-0.865). Conclusion / ImplicationsMultivariable logistic regression and machine-learning models are able to identify transfers in a single record from existing variables. They can be used in unlinked hospital administrative data where records belonging to the same patient cannot be identified.

This study was designed to investigate the acute effects of nonnicotinized e-cigarette (e-cig) aerosol inhalation in nonsmokers both in terms of blood-based markers of inflammation and oxidative stress and evaluate their association with hemodynamic-metabolic MRI parameters quantifying peripheral vascular reactivity, cerebrovascular reactivity, and aortic stiffness. Thirty-one healthy nonsmokers were subjected to two blood draws and two identical MRI protocols, each one before and after a standardized e-cig vaping session. After vaping, the serum levels of C-reactive protein, soluble intercellular adhesion molecule, and the danger signal machinery high-mobility group box 1 (HMGB1) and its downstream effector and the NLR family pyrin domain containing 3 (NLRP3) inflammasome (as monitored by its adaptor protein ASC) increased significantly relative to the respective baseline (prevaping) values. Moreover, nitric oxide metabolites and reactive oxygen species production decreased and increased, respectively. These observations were paralleled by impaired peripheral vascular reactivity (with reduced flow-mediated dilation and attenuated hyperemic response after a cuff-occlusion test) and metabolic alterations expressed by decreased venous oxygen saturation, postvaping. The current results suggest propagation of inflammation signaling via activation of the danger signaling axis (HMGB1-NLRP3). The findings indicate that a single episode of vaping has adverse impacts on vascular inflammation and function. NEW & NOTWORTHY Endothelial cell signaling and blood biomarkers were found to correlate with functional vascular changes in a single episode e-cigarettes inhalation in healthy adults. This is indicative of the potential of e-cigarettes (even when inhaled acutely) to lead of vascular dysfunction.

There is limited information on the impact of CMV DNAemia episodes developing prior to engraftment (pre-CMV DNAemia) on clinical outcomes following allogeneic hematopoietic stem cell transplantation (allo-HSCT). This issue was addressed in the current retrospective multicenter study including 878 patients. All participant centers used preemptive antiviral therapy strategies for prevention of CMV disease. CMV DNA load in blood was monitored by real-time PCR assays. A total of 144 patients (cumulative incidence 16.5%, 95% CI, 14%-19%) had an episode of pre-CMV DNAemia at a median of 10 days after allo-HSCT. Patients who developed pre-CMV DNAemia had a significantly higher (P = < 0.001) probability of recurrent episodes (50%) than those who experienced post-CMV DNAemia (32.9%); Nevertheless, the incidence of CMV disease was comparable (P = 0.52). Cumulative incidences of overall mortality (OM) and non-relapse mortality (NRM) at 1-year after allo-HSCT were 32% (95% CI, 29-35%) and 23% (95% CI 20-26%), respectively. The risk of OM and NRM in adjusted models appeared comparable in patients developing a single episode of CMV DNAemia, regardless of whether it occurred before or after engraftment, in patients with pre- and post-engraftment CMV DNAemia episodes or in those without CMV DNAemia.

Major depressive disorder (MDD) is a highly prevalent psychiatric disorder, and recurrent depression is associated with severe and chronic impairment. Identifying markers of risk is imperative to improve our ability to predict which individuals are likely to experience a recurrence. According to cognitive theories, biases in attention for affectively-salient information may serve as one mechanism of risk. Existing research has combined participants with a single episode (sMDD) and those with recurrent MDD (rMDD); therefore, little is known about whether these biases track the severity of disease course. The current study examined attentional biases to facial displays of emotion among 115 women with a history of rMDD, sMDD, or no history of psychopathology using a passive viewing eye-tracking task. Women with rMDD exhibited significantly lower sustained attention to happy faces compared to both healthy controls and sMDD women. These results extend previous research on the presence of attentional avoidance of positive stimuli in individuals with a history of MDD and provide preliminary evidence that this bias is strongest among individuals with a history of rMDD.

This paper demonstrates ways in which vision is integrated with other modalities of perception in a manner relevant to a temporally unfolding activity. It will do so by analyzing a single episode extracted from an abdominal palpation conducted on a pregnant woman by a midwife in Japan. The episode forms a “natural experiment” through which one can demonstrate that the integrated visual and tactile perception of an object is organized differently according to the status of the ongoing activity in which it is embedded. Data are in Japanese with English translations.

Chronic wounds represent a large and growing disease burden. Infection and biofilm formation are two of the leading impediments of wound healing, suggesting an important role for the microbiome of these wounds. Debridement is a common and effective treatment for chronic wounds. We analyzed the bacterial content of the wound surface from 20 outpatients with chronic wounds before and immediately after debridement, as well as healthy skin. Given the large variation observed among different wounds, we introduce a Bayesian statistical method that models patient-to-patient variability and identify several genera that were significantly enriched in wounds vs. healthy skin. We found no difference between the microbiome of the original wound surface and that exposed by a single episode of sharp debridement, suggesting that this debridement did not directly alter the wound microbiome. However, we found that aerobes and especially facultative anaerobes were significantly associated with wounds that did not heal within 6 months. The facultative anaerobic genus Enterobacter was significantly associated with lack of healing. The results suggest that an abundance of facultative anaerobes is a negative prognostic factor in the chronic wound microbiome, possibly due to the increased robustness of such communities to different metabolic environments.

We present an uncommon case of a patient presenting at the emergency department for severe vomiting, persisting for at least 12 hours, without nausea or abdominal pain. She initially referred vomiting food eaten several hours earlier and eventually a single episode of haematemesis with emission of a small amount of red blood and clots. She also reported the occurrence of acute dysphagia for solid food. The patient underwent oesophagogastroduodenoscopy (OGD), which showed that the lumen was almost completely narrowed by a submucosal bluish bulging from midoesophagus (19 cm from the incisors) to the cardia (located at 35 cm from the incisors). She therefore underwent chest CT showing a 15 cm long intramural oesophageal haematoma. Although the combination of vomiting and haematemesis is usually associated with Mallory-Weiss syndrome, in which a prompt OGD has a key role in the patient management, when these symptoms are associated with acute dysphagia, a possible intramural haematoma might be suspected. In this case, chest CT should take precedence, because it allows a quick and complete diagnostic appraisal. However, in this setting, although OGD can directly show typical findings (bluish swelling mucosa with or without a superficial tears), it might increase the risk of oesophageal haematoma rupture and intraluminal bleeding.

Highlights • Very rare case report, isolated congenital upper lip midline sinus. • Surgical excision is curative, no recurrence. • Upper lip midline sinus can be associated with syndromes or conditions., Introduction Congenital pits of the lip are uncommon and may be associated with conditions such as Van der Woude syndrome. Isolated lip pits are extremely rare developmental defects. Presentation of case A 7 year old Caucasian girl presented to plastic surgery clinic in Jordan University academic hospital complaining of an upper lip pit that has been present since birth. It was associated with a single episode of whitish discharge. On examination, an isolated upper lip midline sinus was found. She is otherwise fit and healthy. Surgical excision was curative with good cosmetic outcome. Discussion The prevalence of lower lip sinuses has been estimated to be about 0.00001% of the white population. Upper lip sinuses are even more uncommon. To date, there have been several case reports of upper lip sinuses and fistulas. A total of 55 cases was found upon reviewing the English literature. No similar cases were reported in Jordan. Different presentations are mentioned in this review. Several embryologic theories are presented. Conclusion Upper lip sinus formations are rare developmental events, and the pathogenesis of these lesions still needs further evaluation. Simple surgical excision is the treatment of choice.

Women of advanced age present a major challenge for fertility treatments. This study was designed to assess whether poor ovarian response (POR) according to the Bologna criteria is a significant predictor for live birth in women over 40. The outcomes of subsequent IVF cycles were also studied. The results of 1870 fresh IVF cycles in 1212 women were retrospectively analysed. The live birth per cycle was 3.3 times higher (11.61% versus 3.54%, P < 0.001) in good responders with more than three oocytes collected compared with women with less. Ovarian response defined by oocytes collected, but not by the number of follicles, was independently associated with live birth (odds ratio, 2.0; 95% confidence interval, 1.18 to 3.54; P = 0.009). The occurrence of POR in subsequent IVF cycles was only 55%. No differences in live births were found in persistent POR compared with women with at least one good response. A single episode of POR in a first IVF cycle in older women has a limited predictive value for the outcomes of subsequent cycles. POR in women aged 40-43 years, defined by the number of oocytes retrieved, is a predictor for live birth in IVF.

Post-traumatic stress disorder (PTSD) is a stress-related psychiatric/mental condition. Tangeretin (TAN), a major polymethoxylated flavone of citrus plants, exhibits anti-inflammatory and neuroprotective activities. However, whether TAN leads to cognitive improvement in PTSD patients remains unclear. In the present study, we explored whether TAN improved cognitive impairment induced in rats by single prolonged stress (SPS episode mimicking PTSD induction) and determined whether TAN reversed reductions in dopamine (DA) and serotonin (5-HT) levels. Rats were intraperitoneally injected with TAN for 14 consecutive days after the SPS, which had induced cognitive deficits evident in the object recognition task and the Morris water maze test; the impairments were improved by TAN (100 mg/kg). TAN rescued the neurochemical abnormalities and the SPS-induced decreases in DA and 5-HT levels in the hippocampus and amygdala. These effects may be attributable in part to induction of hippocampal genes encoding tyrosine hydroxylase and tryptophan hydroxylase-1. Our results support the idea that rats with PTSD exhibit changes in DAergic and serotonergic transmission and in memory impairment. Thus, TAN mediated reversal of memory-related behavioral dysfunction associated with traumatic stress may be a useful therapeutic intervention in PTSD patients.

Purpose To present ophthalmic imaging findings in the case of a 40-year-old male with sustained visual loss after a single episode of acute central serous retinopathy (CSR). Observations A male subject presented with visual acuity decline to 20/50 OS and was diagnosed with acute CSR. The initial pigment epithelial detachment and subretinal fluid resolved within 6 weeks, but visual acuity remained impaired. Using directional optical coherence tomography (D-OCT) and confocal and split-detector adaptive optics scanning light ophthalmoscopy (AOSLO), we imaged pathologic alterations in the photoreceptor mosaic of the affected eye. A foveal region of intermittent missing cones, a temporal parafoveal region of confluent missing cones, and a nasal parafoveal region of misdirected cones were observed. Conclusions and Importance Pathologic alterations in photoreceptor microanatomy underlie residual visual acuity deficits in this case of acute CSR. Observations of missing cones correlated well across all imaging modalities in the fovea and the temporal parafoveal region of missing cones. However, in the nasal parafovea where cones were present but misdirected, D-OCT and AOSLO may be able to identify and image photoreceptors with greater fidelity as compared to non-directional SDOCT (spectral domain OCT). D-OCT may thus have a clinical role in rapidly assessing photoreceptor mosaic integrity in pathology.

Key Clinical Message Adult-onset Still's disease (AOSD) due to visceral leishmaniasis (VL) has not been previously reported. This case report analyzes a single episode of AOSD probably due to a visceral leishmaniasis successfully treated with pentamidine isethionate and prednisone.

Metal-on-metal (MoM) total hip arthroplasty (THA) is associated with increased incidence of failure from metallosis, adverse tissue reactions, and the formation of pseudotumors. This case highlights a 53-year-old female with an enlarging painful thigh mass 12 years status post MoM THA. Radiographs and advanced imaging revealed an atypical mass with cortical bone destruction and spiculation, concerning for periprosthetic malignancy. Open frozen section biopsy was performed before undergoing revision THA in a single episode of care. This case illustrates that massive pseudotumors can be locally aggressive causing significant femoral bone destruction and may mimic malignancy. It is important that orthopaedic surgeons, radiologists and pathologists understand the relative infrequency of periprosthetic malignancy in MoM THA to mitigate patient concerns, misdiagnosis, and allow for an evidence based discussion when treating massive pseudotumors.

Introduction : Myocardial injury after percutaneous coronary intervention (PCI) occurs in approximately 30% of procedures, and is related to worse prognosis. Effects of remote ischemic preconditioning (RIPC) on reperfusion injury have been investigated before, yielding conflicting results. Aim : To assess the impact of a single episode of RIPC on myocardial injury after elective PCI. Material and methods : One hundred and four patients undergoing elective PCI, with normal baseline cardiac troponin-I (cTn-I) values, were randomized to two groups. Two patients were excluded due to data loss, and 102 patients were analyzed. Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group, by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm. Postprocedural 16th hour cTn-I, cTn-I (difference between the 16th h and baseline cTn-I values) and the prevalence of type 4a myocardial infarction were compared between the two groups. Results : Median cTn-I values after the procedure were compared. 16th hour cTn-I was insignificantly lower in the preconditioning arm (0.026 µg/l vs. 0.045 µg/l, p = 0.186). The incidence of cTn-I elevation 5-fold above the upper reference limit (URL) (> 0.115 µg/l) was lower in the preconditioning group, but it was also not significant (21.6% vs. 11.8%, p = 0.184). Conclusions : A single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect.

Introduction: Acute otitis media is a disease with high global prevalence, that can lead to several acute complications and auditory sequelae. Data regarding the auditory evaluation in the acute phase of acute otitis media are scarce. Objective: To evaluate the main audiometric changes (air and bone conduction thresholds) in the initial phase of an acute otitis media episode. Methods: A case-control study was performed. Patients diagnosed with acute otitis media with less than 7 days of evolution in relation to the complaint onset were selected, and healthy volunteers were selected as controls. The acute otitis media and control groups were submitted to pure tone and vocal audiometry. Results: The acute otitis media group included a total of 27 patients (30 ears). Hearing loss was present in 90.0% of the ears with acute otitis media, with conductive loss in 14 (46.67%) and mixed loss in 13 (43.33%). Both the air and bone conduction thresholds obtained with the tonal audiometry in the acute otitis media group were significantly worse than the controls at all tested frequencies (p< 0.05). In patients with acute otitis media, we observed that the thresholds for frequency >1 kHz (bone conduction) and 3 kHz (air conduction) were significantly worse in patients with tinnitus compared to patients without tinnitus. Conclusion: During the first 7 days of evolution after the onset of an isolated episode of acute otitis media, we observed significant increases in bone and air thresholds at all frequencies, especially >2 kHz, compared to healthy ears. Resumo Introdução: A otite média aguda é uma doença de elevada incidência global, que pode levar a diversas complicações agudas e sequelas auditivas. Dados referentes à avaliação auditiva na fase aguda da otite média aguda são escassos. Objetivo: Avaliar as principais alterações audiométricas (limiares em via aérea e óssea) na fase inicial de um episódio de otite média aguda. Método: Realizou-se estudo de caso-controle. Selecionamos pacientes com diagnóstico de otite média aguda, com menos de sete dias de evolução em relação ao início das queixas, e voluntários saudáveis foram selecionados como controles. Os grupos otite média aguda e controle foram submetidos a audiometria tonal, vocal e audiometria. Resultados: O grupo otite média aguda incluiu 27 pacientes (30 orelhas). Observou-se presença de perda auditiva em 90% das orelhas com otite média aguda, condutiva em 14 (46,67%) e mista em 13 (43,33%). Tanto os limiares auditivos por via aérea quanto os limiares por via óssea obtidos com audiometria tonal do grupo otite média aguda eram significativamente piores em relação aos controles, em todas as frequências testadas (p < 0,05). Em pacientes com otite média aguda, observamos que os limiares das frequências acima de 1 kHz (via óssea) e 3 kHz (via aérea) eram significantemente piores entre pacientes com zumbido em comparação a pacientes sem zumbido. Conclusão: Nos primeiros sete dias de evolução do quadro inicial de um episódio isolado de otite média aguda, observamos aumentos significativos dos limiares ósseos e aéreos em todas as frequências, principalmente nas acima de 2 kHz, em comparação a orelhas sadias.

Priapism is urological emergency that consists of a prolonged erection for more than four hours, independently of sexual stimulation. Due to its low incidence, the pidemiology is not fully known. The aim of the present study was to investigate the clinical and sociodemographic profile of patients with priapism treated at a university hospital. A retrospective, cross-sectional study was conducted involving the records of patients with priapism treated at an emergency urological service between January 2011 and August 2018. The variables analyzed were age, ethnicity, marital status, previous adverse health conditions, the use of recreational drugs and the number of visits to the hospital by each patient. Forty-two patients with priapism were studied, totaling 178 hospital visits. The analysis of the charts revealed age ranging from 15 to 85 years, with the majority of cases (72%) occurring between 20 and 50 years of age. Regarding ethnicity and marital status, 64% were self-declared white, 22% were self-declared black, 43% were married and 33% were single. Approximately 52% of the patients (n = 22) had a previous adverse health condition. Among these individuals, eight (36%) had a blood disease, the most frequent of which was sickle cell anemia (n = 5; 62.5%). Eleven (26%) patients reported using recreational drugs and 74% made no use of drugs. Analyzing the number of hospital visits per patient, 57% were treated for a single episode and 43% (n = 18) returned more than once to the urological emergency service with the same condition. Based on the present findings obtained from a university hospital, sickle cell anemia was the most frequent condition among the patients. No significant association was found between the use of recreational drugs and the occurrence of priapism. The most affected age group was 20 to 40 years, with a predominance of white, married men.Read Complete Article at ijSciences: V82019021979 AND DOI: http://dx.doi.org/10.18483/ijSci.1979

Given increasing health care costs and clinical equipoise on numerous topics, value calculations are critical. Cost-minimization analysis evaluates throughout a single episode of care. For anterior cruciate ligament reconstruction, this is a reasonable approach given that cost-effectiveness data have been published. Using Healthcare Cost and Utilization Project data, general anesthesia, anesthesia time, greater age, and medical comorbidities were correlated with higher costs. Among the surprising results were increased costs with male gender and Hispanic race. Interestingly, the location of the surgery, surgery center versus hospital, or meniscal repair did not significantly impact costs. This information can be used by physicians for cost comparison and factors that determine costs.

Aim To review current alcohol hangover research in animals and humans and evaluate key evidence for contributing biological factors. Method Narrative review with alcohol hangover defined as the state the day after a single episode of heavy drinking, when the alcohol concentration in the blood approaches zero. Results Many of the human studies of hangover are not well controlled, with subjects consuming different concentrations of alcohol over variable time periods and evaluation not blinded. Also, studies have measured different symptoms and use varying methods of measurement. Animal studies show variations with respect to the route of administration (intragastric or intraperitoneal), the behavioural tests utilised and discrepancy in the timepoint used for hangover onset. Human studies have the advantage over animal models of being able to assess subjective hangover severity and its correlation with specific behaviours and/or biochemical markers. However, animal models provide valuable insight into the neural mechanisms of hangover. Despite such limitations, several hangover models have identified pathological changes which correlate with the hangover state. We review studies examining the contribution of alcohol's metabolites, neurotransmitter changes with particular reference to glutamate, neuroinflammation and ingested congeners to hangover severity. Conclusion Alcohol metabolites, neurotransmitter alterations, inflammatory factors and mitochondrial dysfunction are the most likely factors in hangover pathology. Future research should aim to investigate the relationship between these factors and their causal role.

Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT (n = 14) or EMDR (n = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity.

We present the case of a patient with a first single episode of a dual drug-induced aseptic mening (DIAM) due to amoxicillin and ibuprofen and a short review of updated literature. A 76-year-old man was admitted to our hospital with slowness and confusion following a dental and gingival inflammation treated with oral amoxicillin 500 mg bid and ibuprofen 600 mg tid for 1 week. His mental state and higher functions abruptly worsened after therapy increase leading to hospitalization. Both the drugs were stopped and the patient improved rapidly within 2–3 days and was released asymptomatic after a week. On the basis of this temporal relationship with a comprehensive negative neuroimaging and laboratory testing for viral, bacterial, and mycobacterial micro-organisms, a DIAM by amoxicillin and ibuprofen was diagnosed. We support the hypothesis that this dual therapy was causative because of the progressive onset of central nervous system symptoms starting at a low amoxicillin dose with a high ibuprofen intake and that this sort of chemical meningoencephalitis was mostly due to the pharmacokinetic of amoxicillin after its dose increase. To our knowledge, this is the first documented publication of a severe first episode of DIAM with predominant higher function involvement caused by these two drugs commonly used together, amoxicillin and ibuprofen.

Bone or cartilage, or both, are frequently injured related to either a single episode of trauma or repetitive overuse. The resulting structural damage is varied, governed by the complex macroscopic and microscopic composition of these tissues. Furthermore, the biomechanical properties of both cartilage and bone are not uniform, influenced by the precise age and activity level of the person and the specific anatomic location within the skeleton. Of the various histologic components that are found in cartilage and bone, the collagen fibers and bundles are most influential in transmitting the forces that are applied to them, explaining in large part the location and direction of the resulting internal stresses that develop within these tissues. Therefore, thorough knowledge of the anatomy, physiology, and biomechanics of normal bone and cartilage serves as a prerequisite to a full understanding of both the manner in which these tissues adapt to physiologic stresses and the patterns of tissue failure that develop under abnormal conditions. Such knowledge forms the basis for more accurate assessment of the diverse imaging features that are encountered following acute traumatic and stress-related injuries to the skeleton. (©) RSNA, 2016.

AIM: The early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range. METHODS: Data were collected on all patients aged 36-65 years who were referred to an inner London EI service from 2011-2014 using the MiData 2 tool at entry and at 1-year follow up. RESULTS: People aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1-year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission. CONCLUSIONS: These findings indicate that admitting over 35-year-olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.

Considerando sua experiência entre os indígenas dos sertões de Goiás e a proposta de criação de uma associação de proteção aos povos indígenas que Leolinda de Figueiredo Daltro (c. 18591935) divulgou intensamente e em vários espaços sociais após seu retorno ao Rio de Janeiro, podem-se fazer algumas proposições. Afínal, o que ela sabia ou havia lido sobre o modo de vida dos indígenas antes de sua experiência entre eles? O que ela sabia da política indigenista adotada pela República? Ou da região do Brasil central e para a qual ela se dirigiu? Estas são as questões que abordaremos ao longo do texto. Para melhor explorarmos este retorno à capital federal, acreditamos que seja importante também verifícar como Leolinda se envolveu com a "causa indígena"? Ou como uma proposta laica de educação indígena conseguiu movimentar intensamente a opinião pública? Sendo assim, pode-se presumir que o episódio singular vivido por Leolinda - e registrado em seu livro Da catechese dos indios no Brasil - nos aponta para diversos indícios sobre sua missão -nas cidades e nos sertões - e a pluralidade da rede da sociedade regional e nacional em que se envolveu e foi envolvida. Teniendo en cuenta su experiencia entre los indios de las tierras de los sectores de Goiás y la propuesta de creación de una asociación de protección de los pueblos indígenas la cual Leolinda de Figueiredo Daltro (1859 - 1935) divulgó intensamente y en diversos espacios sociales, después de su regreso al Río de Enero, se pueden hacer algunas proposiciones. Al fínal, lo que ella sabía o había leído sobre el modo de vida indígena antes de su experiencia entre ellos. ¿Lo que ella sabía de la política indígena adoptada por la República? O lo que conocía sobre la región central de Brasil y por la cual se dirigió. Estos son los temas que discutiremos a lo largo del texto. Para mejor profundizar ese regreso a la capital federal, creemos que también es importante comprobar cómo Leolinda se involucró con la "causa indígena". O de qué manera una propuesta secular de educación indígena logró mover la opinión pública. Por lo tanto, se puede suponer que el episodio singular experimentado por Leolinda - y registrado en su libro Da catechese dos indios no Brasil - nos señala varias pistas sobre su misión - en las ciudades y en los sectores - y la pluralidad de red de la sociedad regional y nacional en el que estaba involucrada y comprometida. Leolinda de Figueiredo Daltro's report of her experience among the Indians in the hinterlands of Goiás (Central-Western Brazil) and the proposal to create an association for protecting the indigenous people, which she disseminated widely in diverse social spaces after her return to Rio de Janeiro,raises some interesting issues. What did she know or had read about the indigenous way of life before her experience with them? What did she know about the policies adopted by the Republic in relation to the indigenous population? Or what did she know about the area in Central Brazil which she traversed? These are the questions that will be addressed throughout the text in order to explore more deeply the reactions on her return to the Federal Capital. We believe it is also important to understand how Leolinda got involved in the "indigenous cause" and how a proposal for indigenous secular education managed to evoke such a strong public response. This single episode experienced by Leolinda - as recorded in her book Da catechese dos indios no Brasil - offers several clues about her mission - in the city and in the hinterlands - and the numerous facets of the regional and national society networks that got her involved and committed.

The alcohol hangover is defined as the combination of negative mental and physical symptoms, which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero. Here, we present the book “The alcohol hangover: causes, consequences, and treatment”, written to celebrate the 10th anniversary of the Alcohol Hangover Research Group (AHRG), summarizing recent advances in the field of alcohol hangover research.

Rhabdomyolysis is defined as breakdown of skeletal muscle fibers with subsequent release of its cellular components into the circulation. It is associated with variety of causes and status epilepticus is one of it. The excessive muscular activity associated with seizure is possible explanation for it. It is clinically evident by the new onset severe generalized bodyache, weakness and myalgia associated with dark coloured urine. Acute kidney injury is one of the most serious complications associted with rhabdomyolysis. Single episode of generalized seizure is not a frequent cause for rhabdomyolysis. Acute kidney injury due to rhabdomyolysis, following a single episode of seizure is a rare entity. Here we report a case of rhabdomyolysis with acute kidney injury following a single episode of generalized seizure. High index of suspicion is required to timely diagnose and treat such patients. Timely intervention with hemodialysis along with other supportive care can completely revert this potentially serious complication to normal.

Patient and public involvement (PPI) refers to research carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them.1 PPI can include patients, carers, service users and the public, referred to here as ‘lay advisors’ (can also be called PPI experts, public advisors, stakeholders, experts by experience). PPI entails contributing in varying degrees to the design, development, conduct, data analysis and dissemination of research.2 Involvement can be consultative (single episode), collaborative (ongoing) or user controlled (actively controlled, directed, and managed by service users).3 PPI is now commonly required in research funding proposals. There are national UK standards for conducting PPI,4 and considerable guidance on how to identify and engage with lay advisors (eg, tailoring PPI to the needs of the study and the willingness of representatives),5 and how to evaluate the impact of PPI.6 7 Most guidance addresses PPI in the context of intervention studies and/or long-term conditions (including long-term stigmatised conditions)8 where lay advisors are sought through regular clinic attendance, patient support groups or charities. In contrast, there is little guidance or precedence on conducting PPI for episodic infection involving singular attendance (eg, chlamydia), for studies which seek to describe population characteristics or risk factors, or for study populations defined by stigmatised behaviours.9 Much sexual health research fits within one of these scenarios, making PPI in this field challenging.9–11 The aim of this paper, therefore, is to share experiences of conducting PPI in sexual health research. Successes and failures from four studies are discussed (see table 1 for an overview of each study). Lessons learnt are presented in relation to three stages of PPI activities: (1) determining who to include as lay advisors; (2) identifying where to access lay advisors; and (3) engaging with those …

PIM (postictal mania) or PIP (postictal psychosis) usually comes on after a single episode or a seizure cluster of generalized tonic-clonic or complex partial secondarily generalized seizures. Patients maintain a lucid interval of clear consciousness which precedes a psychotic episode. The symptoms may include insomnia, hallucinations, delusions, elated expansive mood, euphoria, and distractibility. We present a case of a 62-year-old male with PIP or mania preceding an episode of seizure. In the light of this case report, we illustrate the importance of being vigilant about the psychotic symptoms in a patient with epilepsy in order to minimize the morbidity.

We present the case of a 40-year-old female who presented to the General Surgery clinic due to a single episode of abdominal pain which required a visit to the Emergency Department. The patient had undergone surgery during childhood due to the suspicion of a hepatic hydatid cyst. However, an intraoperative cholangiography identified a small, non-complicated biliary cyst. Therefore, a hepatic resection was not performed. The patient did not undergo follow-up of the lesion.