fective clinical management of STDs represent an important combined strategy necessary to improve reproductive and sexual health and to improve HIV prevention efforts. This is especially relevant to women, adolescents, and infants, because untreated infections frequently result in severe, long-term complications, including facilitation of HIV infection, tubal infertility, adverse pregnancy outcomes, and cancer. For >20 years, the publication of national guidelines by the Centers for Disease Control and Prevention

Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.

Sexually transmitted diseases treatment guidelines, 2015.

Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction

The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies1 and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format)3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).

By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs),4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy,5 and GRADE for observational studies that inform both therapy and prognosis questions.6

GRADE evidence profile tables7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low,8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias).9

These evidence profile tables were then used to create a …

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Part 4: Advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the ‘Utstein style’

Fifty-nine subjects over age 60 had a computerized tomography (CT) scan and completed four neuropsychological tests. Measurements of ventricular size and sulcal enlargement were compared to test performance. Performance of the elderly subjects was also compared to that of subjects aged 16 to 40 years. Subjects over 60 years of age had significantly more brain atrophy and more impaired test performance than younger subjects. Subjects aged 80 to 99 had more atrophy and impaired performance than those 60 to 79 years. Our results suggest that, with aging, the brain atrophies and loses its abilities as measured by neuropsychological testing. However, CT evidence of atrophy only weakly predicts impaired mental function independently of age.

Cortical atrophy, ventricular enlargement and intellectual impairment in the aged

Sudden unexplained death syndrome (SUDS) accounts for about 10% of deaths in patients with epilepsy. It is associated with subtherapeutic postmortem serum antiepileptic drug (AED) levels but no anatomic cause of death on autopsy. The mechanisms of death are not known. We investigated 44 cases of SUDS for details of seizure history, treatment, medical and psychological history, events at the time of death, and postmortem findings. Cases of status epilepticus, drowning or other identifiable causes of death were excluded. Two groups emerged: five children with uncontrolled seizures receiving multiple AEDs and good compliance with medications, and 39 adults with less frequent seizures, often receiving monotherapy, but noncompliant with medications. Four children (80%) but only one adult (3%) had fully therapeutic postmortem AED levels. Sixty-three percent of adults recently had experienced an unusually stressful life event. Investigation of the circumstances at the time of death suggested two possible modes of death: (a) a seizure with an immediately fatal arrhythmia, or, (b) a seizure, recovery, then delayed secondary respiratory arrest or arrhythmia. Even though the mechanisms of death are unknown, the risk of SUDS may be reduced by encouraging patients to be compliant with medications, especially in times of unusual life stress.

The sudden unexplained death syndrome in epilepsy: demographic, clinical, and postmortem features.

Intravenous (IV) phenytoin sodium in small volumes of normal saline was administered in a municipal hospital emergency department for treatment of convulsions in 200 patients. A total of 72 complications developed in 51 patients. Twenty-nine complications were burning pain at the IV site, and 36 were related to excessive total dose of phenytoin and resultant drug intoxication. Seven other patients had cardiovascular complications, including hypotension and arrhythmias. These seven complications were related to high concentrations of drug administered at a rapid rate. Both the IV and cardiovascular complications promptly resolved when the IV rate was slowed or temporarily stopped. No patient died, and none was hospitalized because of a complication. The authors propose specific guidelines for the safe administration of IV phenytoin. ( JAMA 1983;249:762-765)

https://jamanetwork.com/journals/JAMA/articlepdf/383280/jama_249_6_032.pdf

Complications of intravenous phenytoin for acute treatment of seizures. Recommendations for usage

Neurocysticercosis has become more prominent in the United States in recent years because of an increase in immigration from endemic regions and because of improved ease of diagnosis with computed tomography (CT). Neurocysticercosis should be suspected in any patient from a high-risk region who has symptoms or signs of a central nervous system disorder, especially seizures, headaches, or signs of increased intracranial pressure. The best diagnostic test is CT of the head, which usually shows a combination of multiple punctate calcifications; hydrocephalus; and parenchymal, subarachnoid, or intraventricular cysts with and without contrast enhancement. Cysticercosis is confirmed serologically by measurement of cysticercosis antibody titers in serum or cerebrospinal fluid and histologically by biopsy of a lesion. Treatment with praziquantel and dexamethasone is usually sufficient, but ventricular shunting or surgical removal of intraventricular or spinal cysts may be necessary. Whenever a case is identified, other household members should be examined for symptoms and signs of neurocysticercosis and screened for active Taenia solium infection.

Neurocysticercosis in the United States: 35 cases and a review.

Cocaine is a commonly abused drug. We report three patients who had generalized seizures immediately following intravenous injection of cocaine. Previous experimental and clinical literature have documented a relationship between cocaine and convulsions. The rising incidence of cocaine use may be associated with a rising incidence of cocaine-associated seizures.

Michael P. Earnest

Papers

Cortical atrophy, ventricular enlargement and intellectual impairment in the aged

The sudden unexplained death syndrome in epilepsy: demographic, clinical, and postmortem features.

Complications of intravenous phenytoin for acute treatment of seizures. Recommendations for usage

Neurocysticercosis in the United States: 35 cases and a review.

Generalized seizures and cocaine abuse.