Autoimmune glial fibrillar acidic protein (GFAP) astrocytopathy typically presents as acute or subacute meningoencephalitis with or without myelitis. We describe a case of autoimmune GFAP astrocytopathy that mimicked tuberculous meningitis. A man in his 70s was referred to our hospital with lethargy persistent for 2 months, appetite loss for 1 month and fever with headache for 10 days. The cerebrospinal fluid test revealed lymphocytic pleocytosis with elevated adenosine deaminase (ADA). Laboratory investigations ruled out microbial and neoplastic causes. Empirical therapy for tuberculous meningitis combined with corticosteroid improved the patient’s condition. Culture forMycobacterium tuberculosisfailed to show microbial growth despite 1 month of incubation. The cerebrospinal fluid was examined for GFAP antibody and returned positive result. Antituberculous agents were discontinued, and corticosteroid was administered until patient’s symptoms resolved completely. Thus, clinicians should consider autoimmune GFAP astrocytopathy as one of the differential diagnoses of lymphocytic meningitis with elevated ADA.

No abstract

defective devices, then at the very least, hospitals should ensure that their care teams understand the concerns about existing pulse oximeter outputs and that additional confirmatory measures should be considered for darker-skinned patients. This is especially true when pulse oximeter readings guide decisions about therapies and scarce resource allocation, such as during the COVID-19 pandemic, when pulse oximetry estimates of oxygenation helped determine hospital admission decisions.However, at least 1 manufacturer of pulse oximeter devices now claims to have overcome this defect, with support in the peer-reviewed literature. 3 Research is proceeding in related areas, such as cerebral pulse oximetry. 4 As lawyers, we leave it to clinicians and hospitals to carefully evaluate these manufacturer claims and adopt the appropriate devices. If newer-generation pulse oximeters are in fact an improvement, there may be a point in the future in which entities become liable for choosing to use the older-generation devices rather than switching.Our points regarding entity liability when selecting or continuing to use certain medical devices can be situated more broadly in tort and consumer protection law. Historically, some industries have lagged in the adoption of reasonable safety precautions, and the law can be a helpful press against complacency. 5 Legal accountability is especially important when the injured persons are "discrete and insular minorities" who may face challenges raising such claims in political or economic forums. 6 When medical devices do not work as well or work differently for darker-skinned patients, it is important for clinicians to understand and correct the issues to ensure these patients receive the same quantity and quality of care as other patients, and move to adopt any device improvements that address this bias.

There are two possible ways to conceptualize the term “insomnia”: insomnia disorder and insomnia symptoms, which are often poorly reported. The purpose of this study was to examine the proportion of randomized controlled trials (RCTs) and systematic reviews (SRs) that mention insomnia in their abstracts and cannot distinguish between insomnia disorder and insomnia symptoms from the abstract. We included RCT and SR articles that included the word “insomnia” in the methods or results sections of their structured abstracts, published after 2010. We searched PubMed using English language restrictions on 10 March 2022. From 1580 PubMed articles, we obtained 100 random samples each for eligible RCTs and SRs. The unclear insomnia concept accounted for 88% of the RCT abstracts and 94% of the SR abstracts. Among the RCT and SR abstracts with unclearness, the concept of insomnia was unclear in 27% of RCTs and 57% of SRs after investigating the full text. The concept of insomnia has been unclear in many RCTs and SRs abstracts. The authors of RCTs and SRs are recommended to state “insomnia disorder” or “insomnia symptoms” in the methods and results sections of their abstracts.

No abstract