Benign neonatal sleep myoclonus: an under-recognized, non-epileptic condition

During a 3-y period 13 newborns were referred for investigation of jerks. The events were epileptic in six children. The diagnosis of benign neonatal sleep myoclonus was made in the remaining seven children. CONCLUSION: Benign neonatal sleep myoclonus is an important neonatal entity that can be mistaken for epilepsy.     

Telephone-administered psychotherapy for depression

BACKGROUND: Several studies have shown that telephone-administered cognitive-behavioral therapy (T-CBT) is superior to forms of no treatment controls. No study has examined if the skills-training component to T-CBT provides any benefit beyond that provided by nonspecific factors. OBJECTIVE: To test the efficacy of a 16-week T-CBT against a strong control for attention and nonspecific therapy effects. DESIGN: Randomized controlled trial including 12-month follow-up. SETTING: Telephone administration of psychotherapy with patients in their homes. PARTICIPANTS: Participants had depression and functional impairments due to multiple sclerosis. INTERVENTIONS: A 16-week T-CBT program was compared with 16 weeks of telephone-administered supportive emotion-focused therapy. MAIN OUTCOME MEASURES: Hamilton Depression Rating Scale score, Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder, Beck Depression Inventory score, and Positive Affect scale score of the Positive and Negative Affect Scale. RESULTS: Of the 127 participants randomized, 7 (5.5%) dropped out of treatment. There were significant improvement during treatment on all outcome measures (P<.01 for all) and an increase in Positive Affect Scale score. Improvements over 16 weeks of treatment were significantly greater for T-CBT, compared with telephone-administered supportive emotion-focused therapy, for major depressive disorder frequency (P = .02), Hamilton Depression Rating Scale score (P = .02), and Positive Affect Scale score (P = .008), but not for the Beck Depression Inventory score (P = .29). Treatment gains were maintained during 12-month follow-up; however, differences across treatments were no longer evident (P > .16 for all). CONCLUSIONS: Patients showed significant improvements in depression and positive affect during the 16 weeks of telephone-administered treatment. The specific cognitive-behavioral components of T-CBT produced improvements above and beyond the nonspecific effects of telephone-administered supportive emotion-focused therapy on evaluator-rated measures of depression and self-reported positive affect. Attrition was low.     

Staphylococcal enterotoxins condition cells of the innate immune system for Toll-like receptor 4 stimulation

In this report we examined overlap between superantigen (SAg) and Toll-like receptor 4 (TLR4) stimulation of the innate immune system. Before in vivo stimulation we found that mouse splenic DCs expressed unexpectedly low levels of surface TLR4 compared to macrophages. In response to LPS, TLR4 gene expression in fractionated spleen cells was downregulated. By comparison, surface TLR4 staining with the Sa15-21 mAb showed little downregulation, and the anti-TLR4 MTS510 mAb showed decreased staining, suggesting that LPS was bound to TLR4 at the time points examined. Interestingly, SAg stimulation induced decreased TLR4 staining as measured by the MTS510 mAb, even though the TLR4 gene was not downregulated. Nevertheless, LPS potently induced DCs to produce TNF and IL-12, but SAg did not, even though they efficiently activated DCs. Notwithstanding, in vivo stimulation with staphylococcal enterotoxin SAg conditioned the innate immune system to hyper-respond to various pathogen-associated molecular patterns (PAMPs). Specifically, pre-priming with SAg enhanced LPS-mediated DC synthesis of TNF and IL-12. Thus, SAgs may exert their pathogenesis on the host by conditioning DCs, in a T cell activation dependent manner to potentiate responses to PAMPs.     

The gastrointestinal tract and glucose tolerance

PURPOSE OF REVIEW: The development of incretin hormones and incretin analogues for the therapy of diabetes highlights the importance of the gastrointestinal tract in the maintenance of glucose tolerance. RECENT FINDINGS: The review focuses on recent information on the role of incretins and their breakdown products on insulin secretion, gastric emptying, and satiety. The importance of gastric emptying and its absorptive potential as well as of dietary composition on gastric emptying and glucose tolerance is highlighted. The concept of a portal glucose sensor in humans has been the subject of some controversy but has been recently revisited. SUMMARY: The gastrointestinal tract plays an important part in glucose tolerance. In this review we have examined how factors altering gastric emptying, insulin secretion in response to meal ingestion, and gastric emptying contribute to the maintenance and deterioration of glucose tolerance.     

Cryptococcal meningitis in two apparently immunocompetent Maltese patients

Two cases of cryptococcal meningitis occurring in immunocompetent men are described. The first case involves a farmer in whom cryptococcal meningitis was rapidly diagnosed using direct microscopy, latex antigen tests and culture of cerebrospinal fluid (CSF). In the second case, initial mycological tests on CSF (direct microscopy and culture) were repetitively negative and latex antigen tests gave unconvincing results. The patient was started on triple antituberculosis therapy, on which he improved immediately; therapy was continued for 1 year with the patient remaining well. However, within 1 week of stopping therapy, he had to be readmitted with neurological signs and symptoms. Culture of CSF this time yielded Cryptococcus neoformans and the antigen test was consistently positive. These are the first reported cases of cryptococcal meningitis in immunocompetent patients in Malta.     

A randomized trial of 2 different 4-drug antiretroviral regimens versus a 3-drug regimen,in advanced human immunodeficiency virus disease

To compare long-term virologic benefits of antiretroviral regimens in persons with advanced human immunodeficiency virus (HIV) disease, a randomized, open-label study was conducted of 517 subjects with no or limited previous experience with antiretroviral therapy. Subjects received lamivudine plus zidovudine and indinavir (indinavir group), efavirenz plus indinavir (efavirenz + indinavir group), or nelfinavir plus indinavir (nelfinavir + indinavir group) and were monitored for 2.1 years. Virologic failure was lower in the efavirenz + indinavir group (P=.04) and higher in the nelfinavir + indinavir group (P=.006), compared with that in the indinavir group. No difference in grade 3 or 4 adverse event rates in the efavirenz + indinavir group (P=.97) and a trend toward an increased rate in the nelfinavir + indinavir group (P=.07), compared with the indinavir group, were noted. A 4-drug regimen containing efavirenz plus indinavir resulted in a superior virologic response, whereas one containing nelfinavir plus indinavir resulted in an inferior response and a greater likelihood of toxicity.