Anti-glomerular basement membrane disease (anti-GBMD) is a rare small-vessel vasculitis presenting as rapidly progressive glomerulonephritis and/or diffuse alveolar hemorrhage. A third of patients with anti-GBMD have antineutrophil cytoplasmic antibodies and are known as double-positive patients. There are a limited number of pediatric double-positive cases published in the literature. In this case report, we summarize the presentation, treatment, and outcome of a patient with anti-GBMD with both anti-myeloperoxidase and anti-GBM antibodies, highlighting the safe use of rituximab. We also describe atypical complications in our case, including significant weight loss of unclear etiology and development of recurrent episodes of acute pericalcific arthritis.

BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department (ED) utilization for mental health purposes. We aimed to study the race specific association between the dependent coverage provision of the Affordable Care Act (ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses. METHODS:We utilized a Quasi-Experimental analysis of ED use in California from 2009–2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-in-differences approach comparing those targeted by the ACA dependent provision (19–25 years) and those who were not (27 to 31 years), evaluating changes in ED visit rates per 1000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and gender. RESULTS:The ACA dependent provision was associated with 0.05 per 1000 people fewer psychiatric ED visits among the treatment group (19–25 years) compared to the control group (27–31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance. CONCLUSION:The ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacific Islander racial groups.

In-vivo neuroimaging of small animal models of epilepsy offers the ability to serially examine the progressive structural and functional changes that occur during the development of chronic epilepsy (i.e. epileptogenesis). Such approaches allow the correlation of imaging findings to the etiology, development, progression, treatment and prognosis of epilepsy in animal models, associations that are poorly understood clinically. MRI and PET imaging of the kindling and kainic acid models of TLE have begun to piece together the relationship of structural and functional changes in the brain during epileptogenesis and their relationship to seizure and histological outcomes.