Toxic cannabis psychosis is a valid entity

One hundred black men admitted to hospital with acute psychiatric symptoms were investigated for the presence of urinary cannabis metabolltes in order to delineate the psychiatric role played by 'dagga', the potent South African cannabinol, in the study population and to determine the diagnostic value of the entity 'toxic psychosis (dagga)'. Cannabinoids were present in 29% of patients, and 31% were discharged with a diagnosis of toxic psychosis (dagga). Clinical and demographic material was gathered for all patients and no consistent differences were found between dagga-posItlve and dagga-negative patients or toxic dagga psychotic patients and 'functional' psychotics other than a history of recent dagga use and the dagga screening test result. The latter measure was found to be both more sensitive and more specific than the history of dagga use alone. The findings support the routine use of a simple screening test for dagga in the sample population studied. The study demonstrated the heterogeneous nature of the toxic dagga psychosis syndrome by documenting a variety of different clinical presentations, which included schizophrenia (42%), paranoia (26%), maniform psychosis (16%) and organic psychosis (16%)

Bounce Conditions in f(R) Cosmologies

We investigate the conditions for a bounce to occur in Friedmann-Robertson-Walker cosmologies for the class of fourth order gravity theories. The general bounce criterion is determined and constraints on the parameters of three specific models are given in order to obtain bounces solutions. It is found that unlike the case of General Relativity, a bounce appears to be possible in open and flat cosmologies.Comment: 11 pages LaTe

Tuberculous meningitis in children: reducing the burden of death and disability

Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. There remains an urgent need for strengthened surveillance, improved rapid diagnostics technology, optimised anti-tuberculosis drug therapy, investigation of new host-directed therapy, and further research on long-term functional and neurodevelopmental outcomes to allow targeted intervention. This review focuses on the neglected field of paediatric tuberculous meningitis and bridges current clinical gaps with research questions to improve outcomes from this crippling disease

Cutting Ties with Pro-Ana: A Narrative Inquiry Concerning the Experiences of Pro-Ana Disengagement from Six Former Site Users.

Websites advocating the benefits of eating disorders (“Pro-Ana”) tend to reinforce and maintain restrictive eating and purging behaviors. Yet remarkably, no study has explored individual accounts of disengagement from these sites and the associated meanings. Using narrative inquiry, this study sought to address this gap. From the interviews of six women, two overarching storylines emerged. The first closely tied disengagement to recovery with varying positions of personal agency claimed: this ranged from enforced and unwelcomed breaks that ignited change, to a personal choice that became viable through the development of alternative social and personal identities. A strong counternarrative to “disengagement as recovery” also emerged. Here, disengagement from Pro-Ana was storied alongside a need to retain an ED lifestyle. With “recovery” being just one reason for withdrawal from Pro-Ana sites, clinicians must remain curious about the meanings individuals ascribe to this act, without assuming it represents a step toward recovery.Peer reviewedFinal Accepted Versio

A Solution to the Graceful Exit Problem in Pre-Big Bang Cosmology

We examine the string cosmology equations with a dilaton potential in the context of the Pre-Big Bang Scenario with the desired scale factor duality, and give a generic algorithm for obtaining solutions with appropriate evolutionary properties. This enables us to find pre-big bang type solutions with suitable dilaton behaviour that are regular at $t=0$, thereby solving the graceful exit problem. However to avoid fine tuning of initial data, an `exotic' equation of state is needed that relates the fluid properties to the dilaton field. We discuss why such an equation of state should be required for reliable dilaton behaviour at late times.Comment: 16 pages LaTeX, 5 figures. To appear in Physical Review

Tuberculous meningitis in children: a forgotten public health emergency

Tuberculous meningitis (TBM) remains a major cause of morbidity and mortality in children with tuberculosis (TB), yet there are currently no estimates of the global burden of paediatric TBM. Due to frequent non-specific clinical presentation and limited and inadequate diagnostic tests, children with TBM are often diagnosed late or die undiagnosed. Even when diagnosed and treated, 20% of children with TBM die. Of survivors, the majority have substantial neurological disability with significant negative impact on children and their families. Surveillance data on this devastating form of TB can help to quantify the contribution of TBM to the overall burden, morbidity and mortality of TB in children and the epidemiology of TB more broadly. Paediatric TBM usually occurs shortly after primary infection with Mycobacterium tuberculosis and reflects ongoing TB transmission to children. In this article we explain the public health importance of paediatric TBM, discuss the epidemiology within the context of overall TB control and health system functioning and the limitations of current surveillance strategies. We provide a clear rationale for the benefit of improved surveillance of paediatric TBM using a TB care cascade framework to support monitoring and evaluation of paediatric TB, and TB control more broadly. Considering the public health implications of a diagnosis of TBM in children, we provide recommendations to strengthen paediatric TBM surveillance and outline how improved surveillance can help us identify opportunities for prevention, earlier diagnosis and improved care to minimize the impact of TBM on children globally

Bounce behaviour in Kantowski-Sachs and Bianchi Cosmologies

Many cosmological scenarios envisage either a bounce of the universe at early times, or collapse of matter locally to form a black hole which re-expands into a new expanding universe region. Energy conditions preclude this happening for ordinary matter in general relativistic universes, but scalar or dilatonic fields can violate some of these conditions, and so could possibly provide bounce behaviour. In this paper we show that such bounces cannot occur in Kantowski-Sachs models without violating the {\it reality condition} $\dot{\phi}^2\geq 0$. This also holds true for other isotropic spatially homogenous Bianchi models, with the exception of closed Friedmann-Robertson-Walker and Bianchi IX models; bounce behaviour violates the {\em weak energy condition} $\rho\geq 0$ and $\rho+p\geq 0$. We turn to the Randall-Sundrum type braneworld scenario for a possible resolution of this problem.Comment: Matches published versio

Recent developments in Tuberculous meningitis pathogenesis and diagnostics [version 2; peer review: 1 approved]

The pathogenesis of Tuberculous meningitis (TBM) is poorly understood, but contemporary molecular biology technologies have allowed for recent improvements in our understanding of TBM. For instance, neutrophils appear to play a significant role in the immunopathogenesis of TBM, and either a paucity or an excess of inflammation can be detrimental in TBM. Further, severity of HIV-associated immunosuppression is an important determinant of inflammatory response; patients with the advanced immunosuppression (CD4+ T-cell count of 150 cells/μL. Host genetics may also influence outcomes with LT4AH genotype predicting inflammatory phenotype, steroid responsiveness and survival in Vietnamese adults with TBM. Whist in Indonesia, CSF tryptophan level was a predictor of survival, suggesting tryptophan metabolism may be important in TBM pathogenesis. These varying responses mean that we must consider whether a “one-size-fits-all” approach to anti-bacillary or immunomodulatory treatment in TBM is truly the best way forward. Of course, to allow for proper treatment, early and rapid diagnosis of TBM must occur. Diagnosis has always been a challenge but the field of TB diagnosis is evolving, with sensitivities of at least 70% now possible in less than two hours with GeneXpert MTB/Rif Ultra. In addition, advanced molecular techniques such as CRISPR-MTB and metagenomic next generation sequencing may hold promise for TBM diagnosis. Host-based biomarkers and signatures are being further evaluated in childhood and adult TBM as adjunctive biomarkers as even with improved molecular assays, cases are still missed. A better grasp of host and pathogen behaviour may lead to improved diagnostics, targeted immunotherapy, and possibly biomarker-based, patient-specific treatment regimens

Is cannabis use a contributory cause of psychosis?

Objective: To assess whether cannabis use in adolescence and young adulthood is a contributory cause of schizophreniform psychosis in that it may precipitate psychosis in vulnerable individuals. Method: We reviewed longitudinal studies of adolescents and young adults that examined the relations between self-reported cannabis use and the risk of diagnosis with a psychosis or of reporting psychotic symptoms. We also reviewed studies that controlled for potential confounders, such as other forms of drug use and personal characteristics that predict an increased risk of psychosis. We assessed evidence for the biological plausibility of a contributory causal relation. Results: Evidence from 6 longitudinal studies in 5 countries shows that regular cannabis use predicts an increased risk of a schizophrenia diagnosis or of reporting symptoms of psychosis. These relations persisted after controlling for confounding variables, such as personal characteristics and other drug use. The relation did not seem to be a result of cannabis use to self-medicate symptoms of psychosis. A contributory causal relation is biologically plausible because psychotic disorders involve disturbances in the dopamine neurotransmitter systems with which the cannabinoid system interacts, as demonstrated by animal studies and one human provocation study. Conclusion: It is most plausible that cannabis use precipitates schizophrenia in individuals who are vulnerable because of a personal or family history of schizophrenia