Prevalence of ANCA-associated vasculitis amid natural gas drilling sites in West Virginia.

BACKGROUND: The epidemiology of ANCA-associated vasculitis (AAV) varies by ethnicity and region. Environmental exposure has been implicated in the pathophysiology of MPO-AAV. The aim of this study was to evaluate the epidemiology of AAV and explore a potential relationship with environmental factors in north central West Virginia. METHODS: This is a retrospective cohort study of 212 patients diagnosed with AAV at West Virginia University and its affiliated hospitals from January 1, 1990 to December 31, 2019. We assessed prevalence of AAV over time according to patient's zip codes and counties. Silica exposure through natural gas extraction was considered as a possible environmental factor. RESULTS: The proportion of patients with MPO-ANCA increased after 2010 (37.5% before 2010 vs 61% after 2010, p = 0.008). At the same time, the prevalence of AAV in Monongalia and surrounding counties has increased significantly after 2010 from 64.8 to 141.9 cases per million (p = 0.001). The increase in prevalence of AAV was primarily due to an increase in MPO-AAV (43 vs 101.7 cases per million before and after 2010, respectively, p = 0.028). During this time, the production of natural gas through fracking increased, rising more than tenfold after 2010 (p-value < 0.001). Heat mapping reveals that the increase in cases of AAV occurred in areas of increased fracking activity. CONCLUSIONS: There was an increase in the prevalence of patients who were newly diagnosed with AAV over time in north central West Virginia. Further studies are required to ascertain the potential role of environmental exposure in the pathophysiology of AAV.

Anti-N-methyl-D-aspartate Receptor Encephalitis as a Paraneoplastic Presentation of Mature Ovarian Teratoma.

BACKGROUND Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially fatal form of autoimmune encephalitis that involves autoantibodies directed against the NR1 subunit of the receptor. This leads to dysregulation of neurotransmission and resultant psychotic and neuroanatomical symptoms. Anti-NMDAR encephalitis classically presents in women who have ovarian teratomas, but it also has been associated with a preceding herpes infection, testicular germ cell tumor, small cell lung cancer, and neuroblastoma. CASE REPORT The present case report illustrates the course of severe anti-NMDAR encephalitis in a patient who had poor prognostic factors, including a high anti-NMDAR titer in cerebrospinal fluid and extreme delta brush electroencephalography pattern. In addition, it underscores the importance of a multidisciplinary approach when treating these patients. CONCLUSIONS Despite being the most common form of autoimmune encephalitis, anti-NMDAR encephalitis remains underrecognized in clinical settings because of discrepancies in patient presentations and their resulting hospital courses. These variations make it difficult to devise an appropriate immunotherapy regimen and plan for intensive care management. It has been estimated that 25% of patients with anti-NMDAR encephalitis experience permanent neuropsychiatric debilitation or death even when they receive mainstay treatment. Relapse is estimated to occur in 15% to 24% of patients and is more common in individuals who do not have underlying tumors. Nonetheless, approximately 75% of patients with anti-NMDAR encephalitis recover or have only mild sequelae.

Revisiting the moist heat sterilization myths.

This paper reviews the prevailing myths regarding steam sterilization currently prevalent in the pharmaceutical industry. It updates an earlier article by the same authors on the that subject that was originally published in 1998. The text addresses the current situation with respect to the beliefs debunked in the original effort, as well as several new mistruths that have emerged in the intervening years.

Impact of massage therapy on health outcomes among orphaned infants in Ecuador: results of a randomized clinical trial.

Diarrhea is the second leading cause of death among infants and young children in the developing world. This project investigated whether therapeutic infant massage could reduce diarrheal episodes and decrease overall illness of infants. Infants living in 2 orphanages in Quito, Ecuador, were matched by age and randomly assigned to an experimental or a control condition. The experimental group received an intervention, daily infant massage therapy by orphanage staff or volunteers, which lasted an average of 53 days, and symptoms of illness data were documented daily by volunteers in the orphanages. Results indicated that control group infants had a 50% greater risk of having diarrhea than experimental infants (rate ratio [RR] = 1.54, 95% confidence interval [CI] = 1.18, 2.03, P < 0.001). Control group infants were also 11% more likely than experimental infants to experience illness of any kind (RR = 1.11, 95% CI = 0.96, 1.28, P = 0.17). The implications for the use of therapeutic infant massage, a remarkably inexpensive intervention, are discussed, and the need for further research is highlighted.