Volume 98, Issue 7

Lyme disease is a multisystem illness that may affect the central nervous system and subsequently produce mild to severe psychiatric disorders. Physicians who treat patient with Lyme disease need to be aware of its neuropsychiatric symptoms, which may emerge months to years after the initial infection. Prompt diagnosis and effective treatment are needed to avoid the debilitating and possibly irreversible mental illness associated with the neurologic involvement of this spirochetal infection. The author reviews the neuropsychiatric manifestations of Lyme disease and provides diagnostic and therapeutic approaches for the management of the central nervous system disease that may cause them.

Computer-aided clinical cases (CACC) have the potential to complement and/or supplement other types of problem-based learning exercises in modern medical curricula. Deploying a CACC learning experience requires institutional commitment to technology and a belief by administration, faculty, and students that “climbing a steep growth curve” is worth the effort. Several aspects of the institutional environment at the Kirksville College of Osteopathic Medicine (KCOM) led to the development of the CACC exercise described in this article, including the need to design a uniform, supplemental, Internet-based learning experience and assessment exercises for students doing clinical rotations at off-site facilities. The CACC learning experience was enthusiastically accepted by second-year medical students as an integrative and clinically relevant educational experience. The success of this CACC exercise has helped to promote the development of other innovative applications of technology to medical education at KCOM.

We present a case of fentanyl overdose via mucous membrane absorption. A 31-year-old man presented to the emergency department in respiratory arrest. At intubation, a Duragesic transdermal patch (75 μg/h) was recovered from the buccal cavity. A second fentanyl transdermal patch (75 μg/h) was noted on the right lateral aspect of the thigh. Postmortem blood evaluation returned a venous fentanyl level of 17.2 μg/L. The therapeutic range for analgesic use is 1 μg/L to 3 μg/L. Drug screens were positive for benzodiazepines and cocaine. Mass spectrophotometry/gas chromatography was used to determine fentanyl levels and to confirm drug screen results. Case history, findings at intubation, and high fentanyl blood concentration suggest the cause of respiratory arrest and death was fentanyl overdose.