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Background and Objectives: Patients with liver failure experience long hospitalizations and acute neurologic complications. Encephalopathy limits the bedside examination, rendering presenting signs of acute brain injury less specific. Seizures are common. Brain MRI is the gold standard for detecting acute brain injury, but intensive medical needs may preclude immediate transfer for imaging. EEG is a bedside test applied in cases of seizure or encephalopathy. We hypothesized that EEG variables can predict MRI signs of acute brain injury in children hospitalized with liver failure., Methods: In this retrospective cohort analysis, records were collected for patients admitted to a MedStar hospital between 2014 and 2022 with ICD-9/10 codes related to liver failure, who underwent brain MRI and EEG testing during the same admission. Exclusion criteria included age older than 24 years and >7 days elapsing between EEG and MRI testing. Clinical data of interest from chart review, reinterpreted MRI scans, reinterpreted EEG tracings, and quantitative EEG variables were compiled into a database. Quantitative EEG variables were processed using MNE-Python., Results: Of 746 records screened, 52 patients met inclusion criteria comprising 63 EEG-MRI pairs. Univariate analysis of all quantitative EEG variables of interest showed depressed theta-alpha variability (TAV) when paired MRI involved abnormal restricted diffusivity in cortical or deep gray matter structures (TAV 0.705, SD 0.310; p < 0.001) compared with MRI with no abnormal restricted diffusivity (TAV 0.895, SD 0.095). Multilinear regression analysis including potential confounders demonstrated independent association of depressed TAV with this MRI finding, with an odds ratio of 4.0317 (95% CI 1.3868-11.7165; AUROC 0.83)., Discussion: Depressed TAV on EEG is associated with increased odds of abnormal restricted diffusivity in gray matter on brain MRI in children and young adults hospitalized with liver failure. This MRI finding is seen in scenarios where changes to medical management are time-sensitive (i.e., acute stroke and PRES) or where prognostic discussion may be influenced by MRI findings (hypoxic-ischemic injury). TAV thus has a potential role as an automated, bedside decision support tool for clinicians deciding on the urgency of brain MRI in critically ill patients., Competing Interests: The authors report no relevant disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp., (© 2024 American Academy of Neurology.)

Background: Some commentators and several professional medical associations have expressed concern that legalizing medical aid in dying ("MAID") will undermine patient trust in the medical profession, particularly among historically disadvantaged patient populations. While this concern remains influential, it has been subject to limited empirical scrutiny. Objectives: This study aims to empirically assess whether MAID legalization undermines patient trust, with considerations of potential trust/demographic correlations in marginalized and minority patient populations. Design: We developed an RCT survey study that assessed patients' trust in the medical professional using the Abbreviated Wake Forest Scale ("AWFS"). Two versions of the survey were used, each distributed at random to half of participants. One survey version included notification that MAID had been legalized in the jurisdiction where patients were receiving care and the other version omitted this information. Setting/Population: We surveyed capacitated, English-speaking adult patients who were receiving care at a not-for-profit, 912-bed academic and research hospital in Washington, D.C. Of those invited to participate, 494 patients (63.2%) completed all AWFS questions, and 70.1% identified as Black or African American and 32.9% as having a physical or mental disability. Conclusions: Most of the participants not notified that MAID was legal in DC were not aware of this fact (92.5%). Patients who were notified that MAID was legal in DC were significantly more likely to report approval of MAID legalization ( p = 0.0410), but showed no significant difference in AWFS score for trust in their physicians. The study did not substantiate concerns that legalizing medical aid in dying undermines patient trust in the medical profession.

A series of nine luminescent iridium(III) complexes with pH-responsive imidazole and benzimidazole ligands have been prepared and characterized. The first series of complexes were of the form [Ir(ppy) 2 (N^N)] + or [Ir(ppy) 2 (C^N)] + (where ppy is 2-phenylpyridine and N^N is 2-(2-pyridyl)imidazole or 2-(2-pyridyl)benzimidazole and C^N represents a pyridyl-triazolylidene-based N-heterocyclic carbene ligand). For these complexes, the benzimidazole group was either unsubstituted or substituted with electron-withdrawing (Cl) or electron-donating (Me) groups. The second series of complexes were of the form [Ir(phbim) 2 (N^N)] + or [Ir(phbim) 2 (C^N)] + (where phbim is 2-phenylbenzimidazole and N^N is either 2,2'-bipyridine or 1,10-phenanthroline and C^N is either a pyridyl-imidazolylidene or pyridyl-triazolylidene N-heterocyclic carbene ligand). UV-visible and photoluminescence pH titration studies showed that changing the protonation state of these complexes results in significant changes in the photoluminescence emission properties. The p K a values of prepared complexes were estimated from the spectroscopic pH titration data and these values show that the nature of the pH-sensitive ligands (either main or ancillary ligands) resulted in a significant capacity to modulate the p K a values for these compounds with values ranging from 5.19-11.22. Theoretical investigations into the nature of the electronic transitions for the different protonation states of compounds were performed and the results were consistent with the experimental results.

This report explores the case of a 49-year-old African American male with a six-month history of multifocal neurological deficits who presented to an outside hospital after a generalized seizure. Patient was transferred to our tertiary medical center after brain imaging showed multiple bilateral supratentorial intraparenchymal hemorrhages (IPH). A brain biopsy confirmed parenchymal and perivascular non-caseating granulomas with vasculitis. The patient was definitively diagnosed with neurosarcoidosis (NS) and his condition improved with high dose corticosteroids and additional immunosuppressive therapies. Intracranial hemorrhage in the setting of NS is extremely rare, with fewer than thirty documented cases; however, this is likely an underestimation of its true prevalence. This case illustrates the difficulty in diagnosis as many other etiologies of IPH must be considered. Additionally, the clinical course and manifestations of NS is often quite variable. The uniqueness of this case lies in the rapid progression from seemingly incidental microhemorrhages to multiple large IPHs over two months. While the cause of this progression is not immediately apparent, a possible cause may be inadequate initial treatment due to delayed diagnosis. Our case demonstrates the importance of early recognition and initiation of immunosuppressive therapy, potentially leading to dramatic clinical improvement, as seen in this patient., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

A family of four Ir(iii) complexes of the form [Ir(ppy)2(L)]Cl (where ppy = 2-phenyl-pyridine and L = a pyridyl-1,2,4-triazole or pyridyl-1,3,4-oxadiazole ligand bearing a boronic acid group) have been prepared as potential luminescent sensors for carbohydrates. A modular eight step procedure was developed to synthesise the complexes, and this was initiated with the preparation of two benzhydrazide and three S-ethylated pyridine-2-thiocarboxamides precursors. Reaction of these precursors produced three new 1,2,4-triazole- and one 1,3,4-oxadiazole-based ligands substituted with boronic acid pinacol ester groups. The boronic acid pinacol esters were then converted to boronic acids in two steps via potassium trifluoroborate intermediates. The boronic acid substituted ligands and their Ir(iii) complexes were fully characterised using a range of techniques including X-ray crystallography in the case of the pyridyl-1,3,4-oxadiazole ligand and two of the Ir(iii) complexes. The capacity of the synthesised Ir(iii) complexes to form boronic acid cyclic esters with the simple sugars glucose and fructose was evaluated using high-resolution mass spectrometry (HRMS) and photoluminescence titration studies. These studies confirm that the Ir(iii) complexes form adducts with both glucose and fructose, with increased levels of boronic acid cyclic esters being formed with fructose at higher pHs. Theoretical calculations were used to gain insight into the nature of the electronic transitions involved in the electronic absorption and emission spectra.

Introduction: The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter., Methods: This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing., Results: Of the 85 eligible patients, 76 (89.4%) were enrolled; 35 (46%) screened positive for food insecurity. Food insecure patients were 1.9 times more likely to be hospitalized than non-food insecure patients (relative risk = 1.90 [1.21-2.99], p<.01). Food insecure patients were younger than non-food insecure patients (50.4 vs 57.5 p<.02), and had significantly higher hemoglobin A1c (HgbA1c) levels (11.2% vs 9.9% p = 0.04). Of the 49 patients prescribed insulin, 17 (34.6%) stated they had used less insulin during the prior week than had been prescribed, and 21 (42.9%) stated they had used less insulin during the prior year than had been prescribed. Food insecure patients were more likely to have used less insulin than prescribed in the prior year (odds ratio = 3.60 [1.09-11.9], p = 0.04)., Conclusion: Our exploratory findings suggest almost half of clinically stable adults presenting to our inner-city ED with hyperglycemia experience food insecurity. More than one-third of those prescribed insulin used less than their prescribed amount in the prior year.