Glatiramer Acetate-associated Refractory Immune Thrombocytopenic Purpura

We present a case of glatiramer acetate-associated refractory immune thrombocytopenic purpura (ITP) in a female patient with multiple sclerosis. A search of MEDLINE/PubMed did not find any connection between glatiramer acetate and thrombocytopenia, specifically ITP. The autoimmune reaction was resistant to conservative ITP treatment, and was eventually managed only by splenectomy. To the best of our knowledge, this is the first report of glatiramer acetate-associated ITP. Physicians should be aware of this condition, and consider performing routine blood counts at the beginning of glatiramer acetate treatment

Rhythmic modulation of visual discrimination is linked to individuals' spontaneous motor tempo

The impact of external rhythmic structure on perception has been demonstrated across different modalities and experimental paradigms. However, recent findings emphasize substantial individual differences in rhythm-based perceptual modulation. Here, we examine the link between spontaneous rhythmic preferences, as measured through the motor system, and individual differences in rhythmic modulation of visual discrimination. As a first step, we measure individual rhythmic preferences using the spontaneous tapping task. Then we assess perceptual rhythmic modulation using a visual discrimination task in which targets can appear either in-phase or out-of-phase with a preceding rhythmic stream of visual stimuli. The tempo of the preceding stream was manipulated over different experimental blocks (0.77 Hz, 1.4 Hz, 2 Hz). We find that visual rhythmic stimulation modulates discrimination performance. The modulation is dependent on the tempo of stimulation, with maximal perceptual benefits for the slowest tempo of stimulation (0.77 Hz). Most importantly, the strength of modulation is also linked to individuals' spontaneous motor tempo. Individuals with slower spontaneous tempi show greater rhythmic modulation compared to individuals with faster spontaneous tempi. This finding suggests that different tempi affect the cognitive system with varying levels of efficiency and that self-generated rhythms impact our ability to utilize rhythmic structure in the environment for guiding perception and performance

A Population-based Study of Peripartum Cardiomyopathy in Southern Israel: Are Bedouin Women a New High-risk Group?

Objectives Peripartum cardiomyopathy (PPCM) is a serious complication of pregnancy. Studies investigating the risk factors that worsen outcomes have yielded conflicting results. The goals of this study were to describe the clinical and echocardiographic characteristics of PPCM in a single tertiary center and to determine the prognostic factors associated with persistence of left ventricular (LV) dysfunction in these women. Study Design This retrospective cross-sectional population-based cohort study included all patients with PPCM confirmed by echocardiography who delivered at our center from 2004 to 2014. Two groups were compared to determine long-term maternal outcome: (1) those who recovered normal LV function; and (2) those with residual systolic LV dysfunction. Results There were 148,994 deliveries during the study period. Of these, 89,196 patients were Bedouin and 59,798 were non-Bedouin. Forty-six patients met the PPCM study inclusion criteria. The PPCM prevalence for the total deliveries was 1:3,239. The PPCM prevalence among Bedouin patients was 1:2,787 versus non-Bedouin patients of 1:4,983 (P=0.037). None of the women had pre-existing chronic hypertension, and there was no maternal death. Patients who had severe or moderate LV dysfunction at the clinical presentation of PPCM were less likely to regain normal LV function than those with mild dysfunction (81.2% versus 56.7%, P=0.009). Based on initial echocardiogram, a trend toward residual LV dysfunction was noted in patients with a dilated left ventricle as compared to those with a non-dilated left ventricle (18.8% versus 6.7%, P=0.32). A hypokinetic right ventricle was found in 15.2% of the women who suffered from PPCM. Conclusion In our cohort, Bedouin women may be at increased risk for PPCM, and patients with severe LV dysfunction have a lower chance of recovery from PPCM

Loosely Coupled TCP Acceleration Architecture

We present a novel approach for scalable network acceleration. The architecture uses limited hardware support and preserves protocol processing flexibility, combining the benefits of TCP offload and onload. The architecture is based on decoupling the data movement functions, accelerated by a hardware engine, from complex protocol processing, controlled by an isolated software entity running on a central CPU. These operate in parallel and interact asynchronously. We describe a prototype implementation which achieves multi-gigabit throughpu

Admission of kidney patients to a closed staff nephrology department results in a better short-term survival.

BackgroundThe outcome of patients with chronic kidney disease (CKD) and acute kidney injury (AKI) is often dismal and measures to ameliorate their course are scarce. When admitted to the hospital, kidney patients are often hospitalized in general Medicine wards rather than in a specialized Nephrology department. In the current study, we compared the outcome of two cohorts of kidney patients (CKD and AKI) admitted either to general open-staff (with rotating physicians) Medicine wards or to a closed-staff (non-rotating Nephrologists) Nephrology ward.MethodsIn this population-based retrospective cohort study, we enrolled 352 CKD patients and 382 AKI patients admitted to either Nephrology or General Medicine wards. Short-term (90 days) outcomes were recorded for survival, renal outcomes, cardiovascular outcomes, and dialysis complications. Multivariate analysis was performed using logistic regression and negative binomial regression adjusting to potential sociodemographic confounders as well as to a propensity score based on the association of all medical background variables to the admitted ward, to mitigate the potential admittance bias to each ward.ResultsOne hundred and seventy-one CKD patients (48.6%) were admitted to the Nephrology ward and 181 (51.4%) were admitted to general Medicine wards. For AKI, 180 (47.1%) and 202 (52.9%) were admitted to Nephrology and general Medicine wards, respectively. Baseline age, comorbidities and the degree of renal dysfunction differed between the groups. Using propensity score analysis, a significantly reduced mortality rate was observed for kidney patients admitted to the Nephrology ward vs. general Medicine in short term mortality (but not long-term mortality) among both CKD patients admitted (OR = 0.28, CI = 0.14-0.58, p = 0.001), and AKI patients (or = 0.25, CI = 0.12-0.48, pConclusionsThus, a simple measure of admission to a specialized Nephrology department may improve kidney patient outcome, thereby potentially affecting future health care planning