Atrial lead malfunction presenting as new onset pacemaker-mediated tachycardia

This report describes the de novo occurrence of pacemaker-mediated tachycardia (PMT) in a patient with a dual-chamber implantable cardioverter-defibrillator and stable retrograde ventriculoatrial conduction time. The same rate-adaptive post-ventricular atrial refractory period (PVARP) duration had previously prevented PMT. Oversensing of atrial false signals from a defective lead shortened the PVARP with consequent sensing of retrograde conduction.     

IMI Impact of Myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.     

Are countries using global fund support to implement HIV drug resistance surveillance? A review of funded HIV grants

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is the largest funder of human immunodeficiency virus (HIV) prevention and treatment programs worldwide. Since 2002, the Global Fund has encouraged grant recipients to implement drug resistance surveillance (DRS) as part of treatment programs. We reviewed documentation of 147 grants funded in 2004-2008 (funding rounds 4-8) to assess grantees' use of funds to support HIV DRS. Overall, 94 grants (64%) described HIV DRS as part of the national treatment program. However, only 32 grants (22%) specifically documented DRS as a grant-funded activity. This review provides baseline information suggesting limited use by countries of Global Fund financing to support HIV DRS. Additional assessment is required to evaluate barriers to using Global Fund grants to support DRS.     

Corrélats neuraux de l’attirance sexuelle pédophile

The high frequency of sexual offenses against children and the severity of psychiatric disturbances that they contribute to generate warrant studying the mechanisms of pedophilic attraction to children, in order to improve therapeutic and preventive approaches. Emerging research based on functional neuroimaging techniques suggests that some brain regions are more activated in pedophilic patients than in healthy controls in response to non-pornographic images representing children. These regions include the cerebellum, the right orbital gyrus, the right inferior frontal gyrus, the left fusiform gyrus, the left anterior cingulate gyrus, the right and left insulae. By contrast, in response to these images, the activation of the right middle temporal gyrus is higher in controls. To help interpret these results, we present a neurophenomenological model of sexual arousal. This model comprises four coordinated components, i.e., cognitive, emotional, motivational, and physiological (autonomic and endocrinological). The cognitive component comprises a process of appraisal through which a stimulus is categorized as a sexual incentive and quantitatively evaluated as such. The emotional component includes the specific hedonic quality of sexual arousal, i.e., the pleasure associated with rising arousal and with the perception of specific bodily changes, such as penile tumescence. The motivational component comprises the processes that direct behavior to a sexual goal, including the perceived urge to express overt sexual behavior. The autonomic and endocrinological components include various responses (i.e., cardiovascular, respiratory, genital) leading the subject to a state of physiological readiness for sexual behavior. These four components are conceived as closely interrelated and coordinated. Finally, inhibitory processes comprise: 1) processes that are active between periods of sexual arousal and that prevent its emergence; we have suggested that this type of inhibitory control is exerted by regions of the temporal lobes where activity decreases in response to visual sexual stimuli; 2) cognitive processes that may – at least in patients with decreased sexual desire – devalue the sexual relevance of visual sexual stimuli; we have proposed that this type of control is mediated by the medial orbitofrontal cortex; and 3) processes that control the overt behavioral expression of sexual arousal, once it has begun to develop; we have proposed that the head of the right caudate nucleus participates in this function. It is likely that advances in functional neuroimaging studies of pedophilia will lead to relevant results regarding judicial issues and cases. These studies should be better organized through setting up a platform dedicated to clinical and research work in this area.     

Knowledge of TIA among general practitioners and emergency department physicians. A questionnaire survey in a French semi-rural area

Background and objective

Management of transient ischemic attacks (TIAs) is of vital importance in an attempt to prevent stroke. However, suboptimal management still raise concern among general practitioners (GPs) and emergency department (ED) physicians—the first medical contact of most TIA patients. This may relate to their poorly updated knowledge about TIA. The study was designed to assess knowledge of TIA among these non-neurologists.

Methods

The study was a post-mailed questionnaire survey among GPs and ED physicians. The questionnaire related to selective clinical aspects on TIA.

Results

There were a total of 85 respondents for analysis, mostly GPs (n = 64; 75.3%), out of 177 mailed physicians. Response rate was 52.7%. Many of these respondents were unaware of the newly proposed TIA definition (59%), unfamiliar with TIA mimics and predictors of post-TIA early stroke recurrence and therefore with the rationales underlying the need of emergency management of TIA. More than one third (39%) were unaware of the relevant national guidelines. Guidelines-aware respondents performed better in most part of the mailed questionnaire.

Conclusion

Our results show that poorly updated knowledge about TIA among non-neurologists represents a potential contributing factor to the persisting sub-optimal management of the disorder. Although further studies are needed to confirm this, improved continuous medical education of this group of health care professionals appears warranted.     

COVID-19 manifestations in people with Parkinson’s disease: a USA cohort

Journal of Neurology - With the explosion of COVID-19 globally, it was unclear if people with Parkinson’s disease (PD) were at increased risk for severe manifestations or negative outcomes....