Munchausen Syndrome.

Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. They solicit attention from physicians, going doctor-to-doctor, having repeated diagnostic tests, procedures, hospitalizations, and evidence little improvement. Adherence to treatment plans is generally suboptimal and the patients frequently leave the hospital against medical advice. A compassionate, multidisciplinary approach to treatment is advised. It often includes conjoint clinical communication between the primary care physician and a psychiatrist. Open, supportive discussion with the patient about his or her condition is important. Long-term psychotherapy and follow-up are recommended.

Sports-Injury Encephalopathy.

Sports-related encephalopathies are a growing concern among athletes who have experienced head trauma. Anxiety is heightened for the public and especially among parents of children playing contact sports. The most common neuropsychological conditions are concussions and traumatic encephalopathies. Concussions result from brain traumas that can be asymptomatic, but more serious concussions can include loss of consciousness, neurological abnormalities, and/or posttraumatic amnesias. Repetitive concussions lead to persistent brain pathology, known as chronic traumatic encephalopathies. This gradually progressive neurodegenerative disease frequently presents with cognitive and neurological deficits, which can result in significant parkinsonian features and dementia. Imaging studies may be noncontributory; however, diffusion tensor imaging, magnetic resonance spectroscopy, and functional magnetic resonance imaging can detect changes indicative of these encephalopathies. Progressive neuronal degeneration with tau proteins are documented on pathological examination. Prevention, early diagnosis, and proper treatment are the recommended approach to these conditions.

The naloxone option.

This quick guide provides you with naloxone dosing information and steps you'll want to take once the crisis has passed.

Guns and Suicide: Are They Related?

Shooting oneself with a firearm is the leading method of suicide, accounting for over half of all such deaths. About two-thirds of the annual 33,000 gun-related fatalities in the United States are suicide-nearly 60 every day. Although most suicidal impulses are intense, they usually last for a short time, which makes prompt intervention imperative. Approximately 90% of those who attempt suicide and survive do not later die by suicide. However, attempts with a gun are usually fatal. A clear connection between firearms in the home and an increased risk of suicide exists. People who have access to these weapons are more likely to commit suicide than those who live in a home without a gun; thus, limiting access to guns decreases the opportunity for self-harm. Physicians should recommend that firearm access be removed from individuals with depression, suicidal ideations, drug abuse, impulsivity, or a mental or neurologic illness.

Indwelling Pleural Catheters for Nonmalignant Effusions: Evidence-Based Answers to Clinical Concerns.

Pleural effusions occur in 1.5 million patients yearly and are a common cause of dyspnea. For nonmalignant effusions, initial treatment is directed at the underlying cause, but when effusions become refractory to medical therapy, palliative options are limited. Tunneled pleural catheters (TPCs) are commonly used for palliation of malignant effusions, but many clinicians are reluctant to recommend these devices for palliation of nonmalignant effusions, citing concerns of infection, renal failure, electrolyte disturbances and protein-loss malnutrition. Based on the published experience to date, TPCs relieve dyspnea and can result in spontaneous pleurodesis in patients with nonmalignant effusions. The infection rate compares favorably to that for malignant effusions with possible increased risk in patients with hepatic hydrothorax and posttransplant patients. Renal failure, electrolyte disturbance and protein-loss malnutrition have not been observed. TPCs are a reasonable option in select patients to palliate nonmalignant effusions refractory to maximal medical therapy.

Stent thrombosis with bioabsorbable polymer drug-eluting stents: insights from the Food and Drug Administration database.

BACKGROUND: SYNERGY, a bioabsorbable polymer-based, everolimus-eluting stent (BP-DES), recently received regulatory approval in the USA for use in percutaneous coronary interventions. Yet, information on the safety of BP-DES in routine clinical practice is limited. Our aim was to compare the safety of the recently approved BP-DES with current durable polymer drug-eluting stents (DP-DES) by analyzing adverse events, namely, stent thrombosis (ST), reported to the Manufacturer and User Facility Device Experience (MAUDE) database. MATERIALS AND METHODS: The MAUDE database requires nationwide mandatory notification for adverse events on devices approved for clinical use. This database was searched for adverse events reported between 1 October 2015 and 25 December 2016, encountered after the placement of either BP-DES or DP-DES. Only those adverse events were included where the exposure period to the stents was comparable after the index procedure. Of all the adverse events reported, the event of interest was ST. RESULTS: A total of 951 adverse events were reported. ST occurred in 48/951 of all events, 31/309 and 17/642 when BP-DES or DP-DES were used, respectively (P=0.00001). Of the 31 ST events with BP-DES, 68% (21/31) occurred within less than or equal to 24 h of the index procedure and 52% (16/31) occurred within less than or equal to 2 h. CONCLUSION: Our results raise the possibility of an increased risk of ST, particularly early ST (within 24 h), with the recently approved BP-DES. However, because of the inherent limitations of reporting within the MAUDE database, these data merely highlight a potential need for additional surveillance and randomized trials to assess further the safety of the bioabsorbable platform.