Did the “Woman in the Attic” in Jane Eyre Have Huntington Disease?

Background: References to neurologic disorders are frequently found in fictional literature and may precede description in the medical literature. Aim: Our aim was to compare Charlotte Brontë’s depiction of Bertha Mason in Jane Eyre to the tenets set forth in George Huntington’s original essay “On chorea” with the hypothesis that Mason was displaying features of Huntington disease. Results: Charlotte Brontë’s 1847 Victorian novel Jane Eyre features the character Bertha Mason, who is portrayed with a progressive psychiatric illness, violent movements, and possible cognitive decline. Similar to Huntington’s tenets, Mason has a disorder with a strong family history suggestive of autosomal dominant inheritance with onset in adulthood, and culminating in suicide. Conclusion: Brontë’s character had features of Huntington disease as originally described by Huntington. Brontë’s keen characterization may have increased awareness of treatment of neuropsychiatric patients in the Victorian era

Orthostatic Tremor and Orthostatic Myoclonus: Weight-bearing Hyperkinetic Disorders: A Systematic Review, New Insights, and Unresolved Questions

Background: Orthostatic tremor (OT) and orthostatic myoclonus (OM) are weight-bearing hyperkinetic movement disorders most commonly affecting older people that induce “shaky legs” upon standing. OT is divided into “classical” and “slow” forms based on tremor frequency. In this paper, the first joint review of OT and OM, we review the literature and compare and contrast their demographic, clinical, electrophysiological, neuroimaging, pathophysiological, and treatment characteristics. Methods: A PubMed search up to July 2016 using the phrases “orthostatic tremor,” “orthostatic myoclonus,” “shaky legs,” and “shaky legs syndrome” was performed. Results: OT and OM should be suspected in older patients reporting unsteadiness with prolonged standing and/or who exhibit cautious, wide-based gaits. Surface electromyography (SEMG) is necessary to verify the diagnoses. Functional neuroimaging and electrophysiology suggest the generator of classical OT lies within the cerebellothalamocortical network. For OM, and possibly slow OT, the frontal, subcortical cerebrum is the most likely origin. Clonazepam is the most useful medication for classical OT, and levetiracetam for OM, although results are often disappointing. Deep brain stimulation appears promising for classical OT. Rolling walkers reliably improve gait affected by these disorders, as both OT and OM attenuate when weight is transferred from the legs to the arms. Discussion: Orthostatic hyperkinesias are likely underdiagnosed, as SEMG is often unavailable in clinical practice, and thus may be more frequent than currently recognized. The shared weight-bearing induction of OT and OM may indicate a common pathophysiology. Further research, including use of animal models, is necessary to better define the prevalence and pathophysiology of OT and OM, in order to improve their treatment, and provide additional insights into basic balance and gait mechanisms

Hijama (wet cupping) for female infertility treatment: a pilot study

Background: To assess the effectiveness of wet cupping (Hijama) as a treatment of female factor infertility. The primary outcome measured was pregnancy rates after Hijama. The secondary outcome measured was the effect on the reproductive hormonal profile before and after Hijama.Methods: A pilot clinical study was conducted for the use of Hijama as treatment for female infertility at King Abdulaziz University Hospital from September 2013 to May 2015. Inclusion criteria included: patients with female factor infertility between 20-50 years of age. Exclusion criteria were women who were menopausal, male factor infertility and pregnancy. Informed consent was obtained from all patients. Upon inclusion in the study, an interview with the participant was done. Blood tests were done at the initial visit which included a complete blood count and hormonal profile (FSH, LH, Estradiol, Progesterone, TSH) if not done already. Patients had repeated Hijama each month if pregnancy did not occur.Results: Out of 59 women, 31 (52.5%) had primary infertility and 28 (47.5%) had secondary infertility. The duration of infertility ranged from 1 to 22 years. In 40 women (67.8%), the partner had a normal semen analysis and 19 (32.2%) had oligospermia. 12 women had an abnormal hystosalpngiogram (20.3%) with two women with complete bilateral tubal blockage. 36 women (61%) had a normal hormonal profile (FSH, LH, TSH, Prolactin). 12 patients (20.3%) became pregnant after hijama; 7 patients had only one or two sessions of Hijama and one patient had 7 sessions. Factors that were found to affect pregnancy rate included: patient with no dysmenorrhea (p 0.034), secondary infertility diagnosis (p 0.005) and history of OCP use (P 0.04). There were significant changes of the hormonal profile before and after Hijama.Conclusions: Hijama might be beneficial in infertile women to achieve a pregnancy. Further studies are needed to confirm the findings from this study

Slow Orthostatic Tremor: Review of the Current Evidence

Background: Orthostatic tremor (OT) is defined as tremor in the legs and trunk evoked during standing. While the classical description is tremor of ≥13 Hz, slower frequencies are recognized. There is disagreement as to whether the latter represents a slow variant of classical OT, or different tremor disorder(s) given frequent coexistent neurological disease. Methods: A systematic literature search of PubMed was performed in February 2019 for “slow orthostatic tremor” and related terms which generated 573 abstracts, of which 61 were included. Results: Between 1970 and 2019, there were 70 cases of electrophysiologically confirmed slow OT. Two-thirds were female, of mean age 60 years (range 26–86), and mean disease duration 6 years (range 0–32). One-third of cases were isolated, and two-thirds had a coexistent disorder(s), including parkinsonism (30%), ataxia (12%), and dystonia (10%). Postural arm tremor was present in 34%. Median tremor frequency was 6–7 Hz (range 3–12). Tremor bursts ranged from 50 to 150 ms duration, and were alternating or synchronous in antagonistic and/or analogous muscles. Low and high coherences were reported. Five cases (7%) had coexistent classical OT. Clonazepam was the most effective medication across all frequencies, and levodopa was effective for 4–7 Hz OT with coexistent parkinsonism. Two cases resolved with the treatment of Graves’ disease. Electrophysiology and imaging predominantly support a central tremor generator. Discussion: While multiple lines of evidence separate slow OT from classical OT, clinical and electrophysiological overlap may occur. Primary and secondary causes are identified, similar to classical OT. Further exploration to clarify these slow OT subtypes, clinically and neurophysiologically, is proposed

Airborne Bacterial Pollution in Clinical Environment, Sana'a - Yemen

Abstract: This work aims to know the extent of air pollution and common bacterial species in delivery rooms in some hospitals in Sana'a city. Six randomly airborne samples from delivery rooms of three hospitals (Algmhory, Althwrah and Alsabeen hospitals). Out of 65 airborne bacteria were isolated from delivery rooms, 89.2% of them showed Gram positive bacterial isolates and 10.8% Gram negative bacteria. Bacteria isolates were identified as Staphylococcus aureus, Staphylococcus epidemidis, Micrococcus sp., Bacillus sp., Pseudomonas aeruginosa, Corynebacterium sp., Klebsiella sp., Lactobacillus sp. and Proteus mirabilis. The highest percentage of bacterial isolates was recorded in Alsabeen hospital as 66.2%. Staphylococcus was the most dominant organism isolated from the delivery rooms in all examined hospitals (37 isolates, 56.9%), while the lowest percentages were: Lactobacillus (two isolates, 3.1%), Klebsiella and Proteus (one isolate, 1.5%) for each

Efficacy and safety of N-acetyl-l-leucine in Niemann–Pick disease type C

Objective: To investigate the safety and efficacy of N-acetyl-L-leucine (NALL) on symptoms, functioning, and quality of life in pediatric (≥ 6 years) and adult Niemann-Pick disease type C (NPC) patients. Methods: In this multi-national, open-label, rater-blinded Phase II study, patients were assessed during a baseline period, a 6-week treatment period (orally administered NALL 4 g/day in patients ≥ 13 years, weight-tiered doses for patients 6-12 years), and a 6-week post-treatment washout period. The primary Clinical Impression of Change in Severity (CI-CS) endpoint (based on a 7-point Likert scale) was assessed by blinded, centralized raters who compared randomized video pairs of each patient performing a pre-defined primary anchor test (8-Meter Walk Test or 9-Hole Peg Test) during each study periods. Secondary outcomes included cerebellar functional rating scales, clinical global impression, and quality of life assessments. Results: 33 subjects aged 7-64 years with a confirmed diagnosis of NPC were enrolled. 32 patients were included in the primary modified intention-to-treat analysis. NALL met the CI-CS primary endpoint (mean difference 0.86, SD = 2.52, 90% CI 0.25, 1.75, p = 0.029), as well as secondary endpoints. No treatment-related serious adverse events occurred. Conclusions: NALL demonstrated a statistically significant and clinical meaningfully improvement in symptoms, functioning, and quality of life in 6 weeks, the clinical effect of which was lost after the 6-week washout period. NALL was safe and well-tolerated, informing a favorable benefit-risk profile for the treatment of NPC. CLINICALTRIALS. Gov identifier: NCT03759639

Hijama (wet cupping) for female infertility treatment: a pilot study

Background: To assess the effectiveness of wet cupping (Hijama) as a treatment of female factor infertility. The primary outcome measured was pregnancy rates after Hijama. The secondary outcome measured was the effect on the reproductive hormonal profile before and after Hijama.Methods: A pilot clinical study was conducted for the use of Hijama as treatment for female infertility at King Abdulaziz University Hospital from September 2013 to May 2015. Inclusion criteria included: patients with female factor infertility between 20-50 years of age. Exclusion criteria were women who were menopausal, male factor infertility and pregnancy. Informed consent was obtained from all patients. Upon inclusion in the study, an interview with the participant was done. Blood tests were done at the initial visit which included a complete blood count and hormonal profile (FSH, LH, Estradiol, Progesterone, TSH) if not done already. Patients had repeated Hijama each month if pregnancy did not occur.Results: Out of 59 women, 31 (52.5%) had primary infertility and 28 (47.5%) had secondary infertility. The duration of infertility ranged from 1 to 22 years. In 40 women (67.8%), the partner had a normal semen analysis and 19 (32.2%) had oligospermia. 12 women had an abnormal hystosalpngiogram (20.3%) with two women with complete bilateral tubal blockage. 36 women (61%) had a normal hormonal profile (FSH, LH, TSH, Prolactin). 12 patients (20.3%) became pregnant after hijama; 7 patients had only one or two sessions of Hijama and one patient had 7 sessions. Factors that were found to affect pregnancy rate included: patient with no dysmenorrhea (p 0.034), secondary infertility diagnosis (p 0.005) and history of OCP use (P 0.04). There were significant changes of the hormonal profile before and after Hijama.Conclusions: Hijama might be beneficial in infertile women to achieve a pregnancy. Further studies are needed to confirm the findings from this study

Synthesis and Biological Evaluation of Some New Pyridines, Isoxazoles and Isoxazolopyridazines Bearing 1,2,3-Triazole Moiety

Some new isoxazole derivatives 3a-d were synthesized via the reaction of 3-(dimethylamino)-1-(5-methyl-1-(3-nitrophenyl)-1H-1,2,3-triazol-4-yl)prop-2-en-1-one (1) with different hydroximoyl chlorides derivatives 2a-d. From these new isoxazoles 3a-d a new series of isoxazolopyridazines 4a-d was derived using hydrazine hydrate. In addition, enaminone 1 was reacted with ethyl acetoacetate to afford the corresponding ester derivative 6, the latter was submitted to react with different chemical reagents to obtain a variety of bioactive substituted pyridine derivatives. The azido derivative 14, was used as the key molecule for the synthesis of new urea and aryl carbamate derivatives upon its reaction with different amines and phenol through Curtius rearrangement. The chemical structures of all new compounds were investigated from their spectral and microanalytical data. The synthesized compounds were tested for their pharmacological potency as, anti-hepatic cancer and anti-microbial agents. Most of the tested compounds showed good anti-hepatic cancer results comparing with the standard drug doxorubicin especially when their toxic effects on the normal cell lines were studied. Referring to the anti-microbial test most of the compounds showed strong effects

Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence.

Patients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors.We queried the data from the International Multicenter National Parkinson Foundation Quality Improvement study. Multivariate logistic regression with backward selection was performed to identify factors associated with hospital encounter prior to baseline visit. Kaplan-Meier estimates were obtained and Cox regression performed on time to hospital encounter after the baseline visit.Of the 7,507 PD patients (mean age 66.5±9.9 years and disease duration 8.9±6.4 years at baseline visit), 1919 (25.6%) had a history of a hospital encounter prior to their baseline visit. Significant factors associated with a history of a hospital encounter prior to baseline included race (white race: OR 0.49), utilization of physical therapy (OR 1.47), history of deep brain stimulation (OR 1.87), number of comorbidities (OR 1.30), caregiver strain (OR 1.17 per standard deviation), and the standardized Timed Up and Go Test (OR 1.21). Patients with a history of hospitalization prior to the baseline were more likely to have a re-hospitalization (HR1.67, P<0.0001) compared to those without a prior hospitalization. In addition, the time to hospital encounter from baseline was significantly associated with age and number of medications. In patients with a history of hospitalization prior to the baseline visit, time to a second hospital encounter was significantly associated with caregiver strain and number of comorbidities.Hospitalization and re-hospitalization were common in this cohort of people with PD. Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates