De novo epileptic confusional status in a patient with cobalamin deficiency

A 80-year-old man with cobalamin deficiency and no history of epilepsy developed a partial complex epileptic confusional status (ECS) unresponsive to acute i.v. diazepam. Brain CT scan and MRI investigation ruled out a focal cerebral lesion. Therapy with high doses (10,000 micrograms i.m. daily) of cobalamin alone was started, and the patient fully recovered in the following 72-hour. Control EEGs repeatedly performed days and weeks later showed progressive disappearance of the frontal interictal spiking, while the patient was on monotherapy with cobalamin (5,000 micrograms i.m. weekly). A month later the patient unfortunately discontinued replacement therapy and 13 weeks later he developed a fatal convulsive epileptic status. To our knowledge the association of ECS and cobalamin deficiency has not been previously reported.     

Effects of age and schooling on the acquisition of elementary quantitative skills.

The influence of school- and age-related variables was examined separately on 2 tasks involving elementary quantitative skills: conservation of number and mental addition. Performance on these tasks was compared by using a cutoff design with 3 groups of kindergarten and Grade 1 children who differed in age but not amount of schooling (grade), in schooling but not age, or in both age and schooling. The effects of age and schooling were distinct. On conservation of number, performance improved as a function of age but not schooling. On mental arithmetic, accuracy improved with schooling rather than age but children's use of various solution procedures (e.g., retrieval, counting) was not influenced by schooling. Thus, in the domain of elementary mathematical skills, the influence of schooling can be very specific, and age-related variables other than schooling play an important role in the development of elementary mathematical skills. Results illustrate the utility of the cutoff design for investigating instructional and developmental influences on cognitive development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of geriatrics to family medicine: a position paper by the Group on Geriatric Education of the Society of Teachers of Family Medicine

The role of geriatrics and geriatricians in family medicine remains unsettled. Despite a rapidly aging population, a tremendous shortage now exists of faculty with interest and expertise in geriatrics. Relatively few family practice residents choose to enter geriatric fellowship programs, and federal funding for such programs has been reduced. Despite accreditation requirements, residency programs are not always able to provide the range of geriatric experiences needed to properly prepare graduates to provide care for the broad range of older patients. Medical students' exposure to geriatrics remains limited. The Group on Geriatric Education of the Society of Teachers of Family Medicine believes that family medicine faculty must recognize and be committed to the notion that geriatrics is integral to family medicine. Both undergraduate and residency training programs should emphasize experience with geriatric patients in multiple settings. In particular, the nursing home should not be the main focus of geriatric training. The small number of certified geriatric faculty will be able to provide leadership, but a broad range of faculty must become involved in teaching geriatrics. Faculty development activities and continuing education programs to foster the necessary expertise will be essential to the accomplishment of this task.