Vascular Contributions to the Neurobiological Effects of Prenatal Alcohol Exposure.

Fetal alcohol spectrum disorders (FASD) are often characterized as a cluster of brain-based disabilities. Though cardiovascular effects of prenatal alcohol exposure (PAE) have been documented, the vascular deficits due to PAE are less understood, but may contribute substantially to the severity of neurobehavioral presentation and health outcomes in persons with FASD. Methods: We conducted a systematic review of research articles curated in PubMed to assess the strength of the research on vascular effects of PAE. 40 pertinent papers were selected, covering studies in both human populations and animal models. Results: Studies in human populations identified cardiac defects, and defects in vasculature, including increased tortuosity, defects in basement membranes, capillary basal hyperplasia, endarteritis, and disorganized and diminished cerebral vasculature due to PAE. Preclinical studies showed that PAE rapidly and persistently results in vasodilation of large afferent cerebral arteries, but to vasoconstriction of smaller cerebral arteries and microvasculature. Moreover, PAE continues to affect cerebral blood flow into middle-age. Human and animal studies also indicate that ocular vascular parameters may have diagnostic and predictive value. A number of intervening mechanisms were identified, including increased autophagy, inflammation and deficits in mitochondria. Studies in animals identified persistent changes in blood flow and vascular density associated with endocannabinoid, prostacyclin and nitric oxide signaling, as well as calcium mobilization. Conclusion: Although the brain has been a particular focus of studies on PAE, the cardiovascular system is equally affected. Studies in human populations, though constrained by small sample sizes, did link pathology in major blood vessels and tissue vasculature, including brain vasculature, to PAE. Animal studies highlighted molecular mechanisms that may be useful therapeutic targets. Collectively, these studies suggest that vascular pathology is a possible contributing factor to neurobehavioral and health problems across a lifespan in persons with a diagnosis of FASD. Furthermore, ocular vasculature may serve as a biomarker for neurovascular health in FASD.

Acute Flaccid Paralysis in an 11-Year-Old.

ABSTRACT: Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and subsequent release of intracellular components into the systemic circulation. We report a case of rhabdomyolysis causing acute paralysis from underlying and unrecognized hypothyroidism in an 11-year-old girl. To date, publications of rhabdomyolysis secondary to hypothyroidism have been limited, especially in the pediatric population. Early intervention with intravenous fluids and levothyroxine led to resolution of our patient's symptoms and is overall important in preventing the serious sequela of rhabdomyolysis including renal failure, cardiac dysrhythmias, compartment syndrome, and disseminated intravascular coagulation.

UnBeelievable: A Case of Pediatric Myocarditis After Insect Envenomation.

ABSTRACT: There are numerous case studies describing myocarditis and cardiac events in adults after insect envenomation. To our knowledge, there are no similar cases documented in children. We report a unique case of a 14-year-old adolescent boy who developed acute myocarditis after a bee sting. The pathophysiology involving envenomation and myocarditis remains poorly understood.

Factors Associated With a Higher Risk of Undiagnosed Prediabetes in a Community-Dwelling Medicare Population.

OBJECTIVE: To identify characteristics in an ambulatory Medicare population that are significantly more likely to be associated with a high risk of undiagnosed prediabetes.
DESIGN: Cross-sectional study.
SETTING: Fourteen health clinics targeting Medicare beneficiaries were held throughout northern and central California during the fall of 2017.
PATIENTS, PARTICIPANTS: Noninstitutionalized Medicare beneficiaries receiving medication therapy management services without self-reported diabetes.
INTERVENTIONS: Beneficiaries were screened for their risk of type 2 diabetes mellitus (T2DM) through the use of the American Diabetes Association (ADA) risk assessment (score of ≥ 5 indicates increased risk of developing type 2 diabetes) by pharmacy students. For this study, patients with a score of ≥ 5 were considered to be at high risk for undiagnosed prediabetes.
MAIN OUTCOME MEASURE(S): Characteristics significantly more likely to be identified in patients at high risk for undiagnosed prediabetes.
RESULTS: A total of 683 Medicare beneficiaries without self-reported diabetes completed the ADA risk assessment, with 457 (66.9%) receiving a score of 5 or more. In those, the presence of hyperlipidemia, hypertension, obesity, coronary heart disease, and use of aspirin were all characteristics researchers identified as significantly more likely to be found in this group. In contrast, those of Asian race or who took dietary supplements were significantly less likely to score 5 or higher in the questionnaire.
CONCLUSION: Identification of older adults at higher risk for undiagnosed prediabetes through the use of appropriate screening tools allows for targeted preventive interventions, potentially lowering risk of developing T2DM for selected patients.

Trimethoprim/Sulfamethoxazole-Induced Bradycardia, Renal Failure, AV-Node Blockers, Shock and Hyperkalemia Syndrome.

BRASH (bradycardia, renal failure, atrioventricular-node blockers, shock, and hyperkalemia) syndrome is a recently coined term for a condition that describes the severe bradycardia and shock associated with hyperkalemia in patients on atrioventricular (AV)-node blocking agents. The proposed pathophysiology involves a precipitating event that exacerbates renal dysfunction with resulting AV-node blocker and potassium accumulation that act synergistically to precipitate bradycardia and hypotension. This syndrome may be refractory to the usual management of bradycardia. This case describes BRASH syndrome precipitated by trimethoprim/sulfamethoxazole.

The Malingering Intussusception.

While intussusception is rarely seen in adults, it is typically obstructive in nature when it does occur. Even less commonly seen is transient intussusception, which occurs without a radiological lead point or any evidence of bowel obstruction. Such findings consist of a "target pattern" seen on computed tomography (CT) but are incidental and do not require any surgical intervention. We report the case of a 31-year-old female who presented to the emergency department with abdominal pain, vomiting, and diarrhea. CT imaging revealed transient intussusception, a benign finding that is not well established in emergency medicine literature.

Dead Legs: A Case of Bilateral Leg Paralysis.

Aortoiliac occlusive disease (AOD) is a rare presentation of thrombosis of the abdominal aorta. Also known as Leriche syndrome, its classic description entails claudication of the buttocks, thighs, and calves, absent femoral pulses, and impotence. AOD risk factors include smoking, hypertension, hyperlipidemia, diabetes, chronic renal insufficiency, and hypercoagulopathy. Ischemic complications of gastrointestinal malperfusion, renal infarction, and paralysis secondary to spinal cord ischemia are also noted. This case describes AOD complicated by a Stanford Type B aortic dissection leading to multi-system organ failure. A brief review of the literature further elucidates the key risk factors in identifying and treating Leriche syndrome.

Time perception and time perspective differences between adolescents and adults.

The present experiment aimed to investigate the differences in time perception and time perspective between subjects representing two developmental stages, namely adolescence and middle adulthood. Twenty Chinese adolescents aged 15-25 and twenty Chinese adults aged 35-55 participated in the study. A time discrimination task and a time reproduction task were implemented to measure the accuracy of their time perception. The Zimbardo Time Perspective Inventory (Short-Form) was adopted to assess their time orientation. It was found that adolescents performed better than adults in both the time discrimination task and the time reproduction task. Adolescents were able to differentiate different time intervals with greater accuracy and reproduce the target duration more precisely. For the time reproduction task, it was also found that adults tended to overestimate the duration of the target stimuli while adolescents were more likely to underestimate it. As regards time perspective, adults were more future-oriented than adolescents, whereas adolescents were more present-oriented than adults. No significant relationship was found between time perspective and time perception.