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Survey of Ophthalmology May 2024A 51-year-old man presented with decreased vision, fever, confusion, headaches, agitation, nausea, vomiting and diarrhea. Magnetic resonance imaging of the brain...
A 51-year-old man presented with decreased vision, fever, confusion, headaches, agitation, nausea, vomiting and diarrhea. Magnetic resonance imaging of the brain demonstrated bilateral T2 hyperintense lesions in the region of the mesial temporal lobe and optic radiations. There was a predominantly polymorphonuclear leukocyte pleocytosis in the cerebrospinal fluid (CSF) with hyperproteinorachia. A meningoencephalitis was diagnosed. Intravenous fluorescein angiography (IVFA) demonstrated a multifocal chorioretinitis that was in a linear pattern in the left eye. CSF enzyme-linked immunosorbent assay was positive for West Nile virus (WNV) IgM. We review the clinical manifestations of WNV disease and highlight the value of IVFA in determining the diagnosis.
PubMed: 38750826
DOI: 10.1016/j.survophthal.2024.05.003 -
Indian Journal of Medical Ethics 2023Custodial death is generally linked in the public mind with police brutality and torture, not with indirect brutality through negligence and callous treatment in jail...
Custodial death is generally linked in the public mind with police brutality and torture, not with indirect brutality through negligence and callous treatment in jail custody. Yet it is not known how many of the thousands of prisoners who die in our jails every year die due to neglect by the jail authorities. The official Prison Statistics India (PSI) in its most recent report states that 1,879 men and women died due to "natural causes" in prisons across India in 2021. Natural causes are defined in the report as "illness" and "ageing". According to the report, 185 more prisoners died of "unnatural" causes, and 52 of "causes not yet known". [1: p 179]. "Unnatural deaths" include "deaths due to negligence or excesses by jail personnel"a. The vagueness of this classification in the PSI data had been noted by Justice Lokur in a landmark Supreme Court judgment, in 2013, when he said: "The distinction made by the NCRB [National Crime Records Bureau] between natural and unnatural deaths is unclear. For example, if a prisoner dies due to a lack of proper medical attention or timely medical attention, would that be classified as a natural death or an unnatural death?" [2].
Topics: Male; Humans; Female; Prisons; Prisoners; Aging; Police; India
PubMed: 37718540
DOI: 10.20529/IJME.2023.040 -
Frontiers in Medicine 2023Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and... (Review)
Review
Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and mechanisms on accelerated ovarian aging, mental health (emotional disruptions, depression, and suicide), sexuality (reduced libido), cardiovascular (brain stroke, myocardial infarction, hypertension, and thrombosis), and oncological (breast, cervical, and endometrial cancers). Other "collateral damage" includes negative effects on communication, scientific mistrust, poor physician-patient relationships, increased patient burden, economic drain on the healthcare system, and environmental pollution. Hormone-sensitive tumors present a dilemma owing to their potential dual effects: preventing some cancers vs. higher risk for others remains controversial, with denial or dismissal as non-relevant adverse effects, information avoidance, and modification of scientific criteria. This lack of clinical assessment poses challenges to women's health and their right to autonomy. Overcoming these challenges requires an anthropological integration of sexuality, as the focus on genital bodily union alone fails to encompass the intimate relational expression of individuals, complete sexual satisfaction, and the intertwined feelings of trust, safety, tenderness, and endorsement of women's femininity.
PubMed: 37457571
DOI: 10.3389/fmed.2023.1167504 -
ELife Jan 2024After hitting rock bottom a few months into a prestigious fellowship, a postdoc recounts how they found their way to ADHD medication, therapy, and better mental health.
After hitting rock bottom a few months into a prestigious fellowship, a postdoc recounts how they found their way to ADHD medication, therapy, and better mental health.
Topics: Humans; Health Personnel; Mental Health; Research Personnel
PubMed: 38265066
DOI: 10.7554/eLife.96286 -
AEM Education and Training Feb 2024This reflective poem explores the profound human impact of receiving a serious medical diagnosis. The speaker grapples with the emotional upheaval of this sudden...
This reflective poem explores the profound human impact of receiving a serious medical diagnosis. The speaker grapples with the emotional upheaval of this sudden severing from one's presumed healthy future. There are attempts to cling to denial or bargain for a different outcome. But the truth of the diagnosis persists, sending ripples of change throughout the patient's life. Dreams slip away and plans evaporate in the crucible of illness. After a struggle, the mind makes peace and courageously leans into the difficulties ahead. The poem celebrates the human capacity to accept vulnerability, find gifts within trials, and walk the remaining road with wisdom. It reflects on how a diagnosis can heighten awareness that life is fleeting and precious. The accompanying digital artwork was generated using OpenAI's DALL·E 3 and modified using Adobe Firefly. It is a stark, black canvas, which can be seen as a metaphor for the profound and contemplative journey described patients go through. It symbolizes the inner darkness and uncertainty faced when confronting life-altering diagnoses, echoing the feelings of isolation, the search for meaning, and the gradual acceptance of a new reality as one navigates through the trials of illness.
PubMed: 38510736
DOI: 10.1002/aet2.10941 -
American Journal of Psychoanalysis Mar 2024This paper presents and discusses two sets of theories concerning trauma. The first involves a contemporary social theory of "cultural trauma" and the second refers to...
This paper presents and discusses two sets of theories concerning trauma. The first involves a contemporary social theory of "cultural trauma" and the second refers to psychoanalytic theories on psychic trauma. We argue that these two groups of theories have some relevant elements in common, despite social theorists' critique of psychoanalytic understanding on the matter. In our view, the most important meeting points between these groups of theories concern (a) the possibility to think that trauma is not welded to events but has a formation process, one of attribution of meaning, (b) that this process has a temporality of its own, and (c) that the environment (the objects, actors, and agents that compose it) has a fundamental and determinant role in trauma formation. Further, we suggest that trauma is still an open concept in psychoanalysis.
Topics: Humans; Psychoanalytic Theory; Psychoanalysis; Psychoanalytic Therapy
PubMed: 38454112
DOI: 10.1057/s11231-024-09442-0 -
Cureus Nov 2023Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune condition characterized by recurrent episodes of optic neuritis (ON) and transverse myelitis. This case...
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune condition characterized by recurrent episodes of optic neuritis (ON) and transverse myelitis. This case report aims to highlight the importance of considering atypical presentations of NMOSD when confronted with MRI-detected Wernicke's encephalopathy. The primary target in NMOSD is the aquaporin-4 (AQP4) protein, predominantly located on astrocyte surfaces. Antibodies binding to AQP4 can lead to astrocyte dysfunction and damage, contributing to NMOSD's distinctive pathology. The associated immune response and inflammation can cause secondary harm to various components of the central nervous system, including oligodendrocytes and neuronal axons. This inflammatory process results in perivascular demyelination and axonal injury, further aggravating neurological deficits in NMOSD. In this case, we present a 39-year-old female with no prior medical or surgical history who sought medical attention due to a three-week history of progressive eyelid heaviness and somnolence. NMOSD is an autoimmune condition primarily targeting the AQP4 protein, resulting in recurrent ON and transverse myelitis. The patient was initially misdiagnosed with myasthenia gravis due to somnolence and ptosis. Due to concerns about myasthenia gravis due to diffuse fatigue and bilateral ptosis, the patient was initially treated with intravenous immunoglobulin (IVIG) and admitted to the neurology service. On the first day of her hospitalization, MRI with and without contrast revealed extensive, non-enhancing T2-weighted-fluid-attenuated inversion recovery (T2-FLAIR) hyperintensities surrounding the third ventricle and affecting the periaqueductal grey, medial thalami, and mammillary bodies. There was also an interval increase in T2-FLAIR hyperintensity within the right medial temporal lobe, extending more posteriorly and inferiorly, abutting the temporal horn. Subsequent CSF encephalitis panel results showed positive West Nile virus (WNV) IgG but negative WNV IgM, and AQP4 antibodies were positive. Given the high specificity of AQP4 antibodies, the patient was diagnosed with neuromyelitis optica (NMO) encephalitis. This case underscores the importance of considering atypical presentations of NMO when confronted with MRI-detected Wernicke's encephalopathy. Since our patient primarily displayed somnolence and eye-related symptoms, neither NMO nor Wernicke's encephalopathy were initially considered in the differential diagnosis. Furthermore, despite MRI findings suggestive of Wernicke's encephalopathy, it was considered less likely due to the absence of thiamine deficiency and consistent denials by family members regarding alcohol use, gastrointestinal issues, or inadequate oral intake. This case underscores the importance of considering NMOSD in patients with atypical symptoms, even when initial presentations suggest other conditions. Timely diagnosis is crucial to prevent mismanagement and improve patient outcomes. Clinicians should maintain a high level of suspicion for NMOSD, especially when MRI findings do not align with the initial diagnosis, as early recognition and treatment can significantly impact patient care and prognosis.
PubMed: 38046734
DOI: 10.7759/cureus.48168