A ketogenic diet suppresses seizures in mice through adenosine A₁ receptors

A ketogenic diet (KD) is a high-fat, low-carbohydrate metabolic regimen; its effectiveness in the treatment of refractory epilepsy suggests that the mechanisms underlying its anticonvulsive effects differ from those targeted by conventional antiepileptic drugs. Recently, KD and analogous metabolic strategies have shown therapeutic promise in other neurologic disorders, such as reducing brain injury, pain, and inflammation. Here, we have shown that KD can reduce seizures in mice by increasing activation of adenosine A1 receptors (A1Rs). When transgenic mice with spontaneous seizures caused by deficiency in adenosine metabolism or signaling were fed KD, seizures were nearly abolished if mice had intact A1Rs, were reduced if mice expressed reduced A1Rs, and were unaltered if mice lacked A1Rs. Seizures were restored by injecting either glucose (metabolic reversal) or an A1R antagonist (pharmacologic reversal). Western blot analysis demonstrated that the KD reduced adenosine kinase, the major adenosine-metabolizing enzyme. Importantly, hippocampal tissue resected from patients with medically intractable epilepsy demonstrated increased adenosine kinase. We therefore conclude that adenosine deficiency may be relevant to human epilepsy and that KD can reduce seizures by increasing A1R-mediated inhibition.     

Global partnerships in nursing – A qualitative study in lessons for success

Global nursing partnerships can develop cultural competence and standardisation across international nurse education programmes. Issues of context, cultural awareness and modes of engagement can influence the success of international collaboration. The ‘Supporting Internationalisation of Traineeships in the Healthcare Sector’ project, funded from 2017, brought together nine international partners from Finland, Poland, Spain and the UK to develop a pan-European quality audit process for clinical learning environments. As part of the evaluation, eight project partners were interviewed about the project and their criteria for a successful global partnership. The interviews allowed insight into previously hidden aspects of implementation. The importance of a scoping period for nursing global partnerships was highlighted that built on cultural diversity to explore common understandings. Attention to the use of prior expertise in internationalisation, or project objectives, could accelerate a global partnership to achieve a greater potential in its outcomes and cultural sensitivity. Framed in a clear structure, it is possible for global partnerships to embed ownership, autonomy and individual voice in partner organisations. The research concludes that only by growing international champions through funded and well constituted projects, that a genuine impact on the global health and educational needs in nursing can be met.     

Yoga in school sport – A non-randomized controlled pilot study in Germany

ObjectivesDistress is an increasing public health problem for adolescents and young adults. We aimed to evaluate potential effects of a 10-week 90-minute once-a-week yoga course.MethodsA non-randomized controlled study with a school sport control group was implemented in two German secondary schools. Primary outcome was stress on the Perceived Stress Scale from baseline to week 10. Secondary outcomes included depression/anxiety, attention, quality of life, mood, visual analogue scales (for pain, headache, neck tension, exhaustion, sleep), and yoga-efficacy. Parameters were assessed at pre-baseline (before holidays), baseline (after 3-week holidays, before interventions started), week 10, and at a 6-months follow-up. An intention-to-treat analysis using ANCOVA was performed.Results92 participants (67 % female; 19.6 ± 2.2 years) were included into the study. No significant differences were observed between the groups with regard to PSS, at either 10 weeks (Δ=-1.4; 95 % CI: -3.6;0.8; p = 0.22) or 6 months (Δ = 2; 95 % CI: -0.2;4.2, p = 0.08). Only VAS headache in favour of yoga and HADS-D in favour of school sport showed significant group differences at the 6-months follow-up. Significant intra-group mean changes for the primary outcome and several secondary outcomes were found in the yoga group.ConclusionsYoung adults in German secondary school settings might benefit from yoga, as the found effects were more prominent in the yoga group. However, the effects might be attributed to non-specific effects due to the chosen study design. Further studies are needed, which include high-quality study designs including randomization, longer-term follow-ups and larger sample sizes.     

Group A β-hemolytic streptococcal pharyngitis in children

Group A β-hemolytic streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis in children. Because clinical findings can be nonspecific, even experienced physicians cannot reliably diagnose GABHS pharyngitis solely on the basis of clinical presentation. Suspected cases should be confirmed by a throat culture or a rapid antigen detection test before antibiotic therapy is initiated. Microbiologic testing is generally not necessary in patients with pharyngitis whose clinical and epidemiologic findings are not suggestive of GABHS. Clinical score systems have been developed to help physicians decide which patients should undergo diagnostic testing and to reduce the unnecessary use of antibiotics. Antibiotic therapy should be initiated as soon as the diagnosis is confirmed. Penicillin V remains the drug of choice. Alternative therapy, eg, with cephalosporin or macrolide, is often sought because of penicillin allergy, noncompliance, and treatment failure.     

Genitourinary Complaints in Young Adults: A Sheep in Wolf’s Clothing

With adolescents and young adults constituting a large percentage of sexually transmitted infection cases in the United States, providers serving this population are often required to manage suspected and confirmed cases. Unique presentations may prove challenging when considering empiric treatment, possible diagnostic culprits, and management of patients at risk for loss to follow-up. Additionally, concerns regarding the appropriateness of human immunodeficiency virus pre-exposure or postexposure prophylaxis can confound care strategies. This case describes an atypical encounter involving a college student. It highlights the importance of prompt and effective care of genitourinary complaints in college health settings.