Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS): Experience at a Tertiary Referral Center

Background: Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is an autoimmune disorder presenting with obsessive compulsive disorder and/or tics. Like Sydenham’s chorea, its presumed pathogenesis consists of autoantibodies cross-reacting with neurons in response to a group A beta-hemolytic streptococcal infection (GASI). There are currently no diagnostic laboratory findings and management ranges from antibiotic prophylaxis to intravenous immunoglobulin to plasmapheresis. The diagnosis remains controversial, resulting in inconsistent referrals and significant patient anxiety. Methods: A retrospective study was performed on all patients referred to the Pediatric Infectious Disease Division with a pre-referral diagnosis of PANDAS. Patients were analyzed by demographics, medical history, co-morbidities, symptoms, prior treatment, laboratory tests, management strategies, and treatment outcomes. Results: From 2003 to 2013, there were 21 patients with a pre-referral diagnosis of PANDAS. Only five met the diagnostic criteria. No patient at referral had an objective scale to monitor symptoms. Eight referrals had a major psychiatric disorder, and none fulfilled diagnostic criteria (p<0.01). Discussion: The majority of the patients referred with a pre-diagnosis of PANDAS do not fulfill diagnostic criteria nor do they have objective criteria for symptom monitoring. Major psychiatric disorders do not seem to be associated with PANDAS, and better physician education may prevent misdiagnoses. Multidisciplinary management is recommended

Meals for the dead:investigating Romano-British accessory vessels in burials using organic residue analysis

Accessory vessels, including platters, dishes, beakers, flagons, jars, and amphorae, are a common feature of Romano-British burials, raising questions as to their provenance; for example, were such vessels recycled from the domestic sphere or made specially for funerary purposes? Furthermore, uncertainty surrounds their purpose: did they contain foods for the deceased, possibly for their final journey to the underworld? Interestingly, organic residue analysis of vessels from Baginton, a site adjacent to The Lunt fort, Coventry, an early (mid to late first century) Roman military cremation cemetery did not yield evidence for food offerings and may have reflected the use of seconds or damaged vessels in burials, perhaps to provide a symbolic meal. In contrast, here we provide, for the first time, direct chemical and isotopic evidence for ‘meals for the dead’, comprising mainly dairy products, often mixed with leafy plants, extracted from somewhat unusual accessory vessels found in a small, enclosed inhumation cemetery, perhaps associated with a family group, which dates to the late (third to late fourth century, or early fifth century A.D) in urban Canterbury. Thus, we can confirm that accessory vessels found in later Romano-British burials were, in this instance, used in the laying out of funerary meals, presumably to nourish the soul on the journey to the underworld. These preliminary insights on vessel use and burial practices across the span of the Roman occupation of Britain thus provide a strong hint at the diversity of Roman burial practices

Utility of Galactomannan and (1-3)-Beta-D-Glucan Assays in the Diagnosis of Invasive Aspergillosis

Medical Schoolhttp://deepblue.lib.umich.edu/bitstream/2027.42/171692/1/Caitlin_Helm_1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171692/2/Caitlin_Helm_2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171692/3/Caitlin_Helm_3.pd

Management of Acute Osteomyelitis: A Ten-Year Experience

Osteomyelitis is an infection of the bone; proper management requires prolonged antibiotic treatment. Controversy exists as to when a patient should transition from intravenous to oral antibiotics. However, due to the high bioavailability of some oral antibiotics, optimal time to transition from high to low bioavailability antibiotics is a more valid consideration. Additionally, there are questions surrounding the efficacy of certain antibiotics, specifically trimethoprim-sulfamethoxazole (TMP-SMX), in treating osteomyelitis. After obtaining Institutional Review Board approval from both universities, a retrospective chart review was conducted, utilizing an author-created severity scale, on all patients seen by Pediatric Infectious Diseases at the Universities of Michigan and Toledo with an acute osteomyelitis diagnosis from 2002-2012. There were 133 patients, 106 treated successfully. Success was defined in this study specifically as treatment of &lt;14 weeks without recurrence within 30 days of stopping antibiotics or permanent site disability. Seventeen patients were treated with TMP-SMX at comparable cure rates. Patients with pre-existing bone defects (noted in radiological reports), initial erythrocyte sedimentation rate (ESR) ≥70, hematogenous osteomyelitis with soft tissue extension, and skull osteomyelitis were associated with increased failure rate. Switch to low bioavailability antibiotics occurred, on average, at 3.5 weeks; however, switching before then was not associated with decreased cure rate. As prevalence of methicillin-resistant Staphylococcus aureus (MRSA), especially clindamycin- resistant MRSA, increases, TMP-SMX appears to be an acceptable antibiotic. There does not appear to be a minimum length of high bioavailability treatment required for cure. Prior bone defect, extensive infection, ESR≥70, or skull osteomyelitis may be indications for more aggressive management

A longitudinal study of cannabis use and risk for cognitive and functional decline among older adults with HIV

Cannabis use is rapidly increasing among older adults in the United States, in part to treat symptoms of common health conditions (e.g., chronic pain, sleep problems). Longitudinal studies of cannabis use and cognitive decline in aging populations living with chronic disease are lacking. We examined different levels of cannabis use and cognitive and everyday function over time among 297 older adults with HIV (ages 50-84 at baseline). Participants were classified based on average cannabis use: frequent (&gt; weekly) (n = 23), occasional (≤ weekly) (n = 83), and non-cannabis users (n=191) and were followed longitudinally for up to 10 years (average years of follow-up = 3.9). Multi-level models examined the effects of average and recent cannabis use on global cognition, global cognitive decline, and functional independence. Occasional cannabis users showed better global cognitive performance overall compared to non-cannabis users. Rates of cognitive decline and functional problems did not vary by average cannabis use. Recent cannabis use was linked to worse cognition at study visits when participants had THC+ urine toxicology-this short-term decrement in cognition was driven by worse memory and did not extend to reports of functional declines. Occasional (≤ weekly) cannabis use was associated with better global cognition over time in older adults with HIV, a group vulnerable to chronic inflammation and cognitive impairment. Recent THC exposure may have a temporary adverse impact on memory. To inform safe and efficacious medical cannabis use, the effects of specific cannabinoid doses on cognition and biological mechanisms must be investigated in older adults