No abstract

Background. Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS) is the acute onset of neuropsychiatric symptoms following group A beta-haemolytic streptococcal infection. The aetiology remains elusive. However, with group A streptococcus being the most common bacterial cause of tonsillitis, surgical intervention in the form of tonsillectomy has often been considered as a potential therapy. Methods. A MEDLINE® search was undertaken using keywords “PANDAS” or “paediatric autoimmune neuropsychiatric disorders associated with streptococcus” combined with “tonsillectomy”. Results. Six case reports and 3 case series met the inclusion criteria. Demesh et al. (case series) reported a dramatic reduction in neuropsychiatric symptom severity in the patient cohort undergoing tonsillectomy. Two case series suggest that there is no association between tonsillectomy and resolution of PANDAS. Conclusion. Due to the lack of uniform data and sporadic reports, tonsillectomy should be carefully adopted for the treatment of this disorder. In particular, tonsillectomies/adenoidectomies to alleviate neuropsychiatric symptoms should be avoided until more definitive evidence is at our disposal. This review highlights the importance of a potential collaborative prospective study.

clinical trials. These DOE should be explored to better design clinical trials. Objectives:To identify effect-modifiers of antipsychotic drugs, in schizophrenia treatment.Methods: Data were retrieved from the CGS observational cohort study, including 1859 schizophrenia inpatients and outpatients aged 15-65 years old through 177 centres in France. Patients were followed-up at 3, 6, 9 and 12 months.Patients who initiated or switched APD were identified and schizophrenia symptoms evolution was measured 3 to 6 months later, using the BPRS-18 scale (∆BPRS).First, potential DOE of APD were identified through a focused literature search, which was reviewed by 3 schizophrenia specialized psychiatrists. Five DOE were short-listed: (1) shorter duration of illness, (2) higher level of negative symptoms, (3) poor adherence, (4) cannabis/drug use and (5) tobacco use.Effect modification was assessed using sub-group analyses, with comparisons of the ∆BPRS in the 2 strata of each DOE. Two-sided Welch t-tests were used with a "non-conservative" type-I error α = 0.2. Multivariate analyses were not performed due to limited sample size.Results: Out of 1859 schizophrenia patients, 116 patients initiated drug B, 272 patients initiated drug D and 204 patients initiated drug K. Other drugs were initiated by too few patients. The mean decreases in BPRS were: -7.2 points (SD = 16.3) in "drug B initiators", -7.5 points (SD = 15.3) in "drug D initiators" -3.9 points (SD = 14.1) in "drug K initiators". The level of symptoms improvement was higher in patients with a "higher level of negative symptoms" for all drugs (p<0.012) and "poorer adherence", for drugs D and K (p<0.013). The level of symptoms improvement was also better in patients who did not smoke, however not significantly. Cannabis use was not an effect-modifier, in all drugs. Conclusions:Overall, "adherence", "tobacco smoking" and "negative symptoms" may be drivers of effectiveness. These factors should be adequately captured and explored in pre-launch clinical trials to avoid an efficacy-effectiveness gap. Background: Beneficial effects of drugs can be divided into efficacy and effectiveness. An understanding of the efficacy-effectiveness gap is important for patients, health care professionals, payers, regulators and the pharmaceutical industry to provide effective treatments. A Systematic Literature Review on the Efficacy-Effectiveness Gap: Comparison of Randomized Controlled Trials and Observational Studies of Glucose-Lowering Drugs

The high prevalence of unplanned pregnancies was related to the effects of contraception, home ownership, and prior unplanned pregnancies.

The ventral visual pathway is directly involved in the perception and recognition of objects. However, the extent to which the neural representation of objects in this region reflects low‐level or high‐level properties remains unresolved. A problem in resolving this issue is that only a small proportion of the objects experienced during natural viewing can be shown during a typical experiment. This can lead to an uneven sampling of objects that biases our understanding of how they are represented. To address this issue, we developed a data‐driven approach to stimulus selection that involved describing a large number objects in terms of their image properties. In the first experiment, clusters of objects were evenly selected from this multi‐dimensional image space. Although the clusters did not have any consistent semantic features, each elicited a distinct pattern of neural response. In the second experiment, we asked whether high‐level, category‐selective patterns of response could be elicited by objects from other categories, but with similar image properties. Object clusters were selected based on the similarity of their image properties to objects from five different categories (bottle, chair, face, house, and shoe). The pattern of response to each metameric object cluster was similar to the pattern elicited by objects from the corresponding category. For example, the pattern for bottles was similar to the pattern for objects with similar image properties to bottles. In both experiments, the patterns of response were consistent across participants providing evidence for common organising principles. This study provides a more ecological approach to understanding the perceptual representations of objects and reveals the importance of image properties.